Coumadin: A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References

COUMADIN A M EDICAL D ICTIONARY , B IBLIOGRAPHY , AND A NNOTATED R ESEARCH G UIDE TO I NTERNET R E FERENCES

J AMES N. P ARKER , M.D. AND P HILIP M. P ARKER , P H .D., E DITORS

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ICON Health Publications ICON Group International, Inc. 4370 La Jolla Village Drive, 4th Floor San Diego, CA 92122 USA Copyright 2003 by ICON Group International, Inc. Copyright 2003 by ICON Group International, Inc. All rights reserved. This book is protected by copyright. No part of it may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without written permission from the publisher. Printed in the United States of America. Last digit indicates print number: 10 9 8 7 6 4 5 3 2 1

Publisher, Health Care: Philip Parker, Ph.D. Editor(s): James Parker, M.D., Philip Parker, Ph.D. Publisher's note: The ideas, procedures, and suggestions contained in this book are not intended for the diagnosis or treatment of a health problem. As new medical or scientific information becomes available from academic and clinical research, recommended treatments and drug therapies may undergo changes. The authors, editors, and publisher have attempted to make the information in this book up to date and accurate in accord with accepted standards at the time of publication. The authors, editors, and publisher are not responsible for errors or omissions or for consequences from application of the book, and make no warranty, expressed or implied, in regard to the contents of this book. Any practice described in this book should be applied by the reader in accordance with professional standards of care used in regard to the unique circumstances that may apply in each situation. The reader is advised to always check product information (package inserts) for changes and new information regarding dosage and contraindications before prescribing any drug or pharmacological product. Caution is especially urged when using new or infrequently ordered drugs, herbal remedies, vitamins and supplements, alternative therapies, complementary therapies and medicines, and integrative medical treatments. Cataloging-in-Publication Data Parker, James N., 1961Parker, Philip M., 1960Coumadin: A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References / James N. Parker and Philip M. Parker, editors p. cm. Includes bibliographical references, glossary, and index. ISBN: 0-597-83844-5 1. Coumadin-Popular works. I. Title.

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Disclaimer This publication is not intended to be used for the diagnosis or treatment of a health problem. It is sold with the understanding that the publisher, editors, and authors are not engaging in the rendering of medical, psychological, financial, legal, or other professional services. References to any entity, product, service, or source of information that may be contained in this publication should not be considered an endorsement, either direct or implied, by the publisher, editors, or authors. ICON Group International, Inc., the editors, and the authors are not responsible for the content of any Web pages or publications referenced in this publication.

Copyright Notice If a physician wishes to copy limited passages from this book for patient use, this right is automatically granted without written permission from ICON Group International, Inc. (ICON Group). However, all of ICON Group publications have copyrights. With exception to the above, copying our publications in whole or in part, for whatever reason, is a violation of copyright laws and can lead to penalties and fines. Should you want to copy tables, graphs, or other materials, please contact us to request permission (E-mail: [email protected]). ICON Group often grants permission for very limited reproduction of our publications for internal use, press releases, and academic research. Such reproduction requires confirmed permission from ICON Group International Inc. The disclaimer above must accompany all reproductions, in whole or in part, of this book.

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Acknowledgements The collective knowledge generated from academic and applied research summarized in various references has been critical in the creation of this book which is best viewed as a comprehensive compilation and collection of information prepared by various official agencies which produce publications on Coumadin. Books in this series draw from various agencies and institutions associated with the United States Department of Health and Human Services, and in particular, the Office of the Secretary of Health and Human Services (OS), the Administration for Children and Families (ACF), the Administration on Aging (AOA), the Agency for Healthcare Research and Quality (AHRQ), the Agency for Toxic Substances and Disease Registry (ATSDR), the Centers for Disease Control and Prevention (CDC), the Food and Drug Administration (FDA), the Healthcare Financing Administration (HCFA), the Health Resources and Services Administration (HRSA), the Indian Health Service (IHS), the institutions of the National Institutes of Health (NIH), the Program Support Center (PSC), and the Substance Abuse and Mental Health Services Administration (SAMHSA). In addition to these sources, information gathered from the National Library of Medicine, the United States Patent Office, the European Union, and their related organizations has been invaluable in the creation of this book. Some of the work represented was financially supported by the Research and Development Committee at INSEAD. This support is gratefully acknowledged. Finally, special thanks are owed to Tiffany Freeman for her excellent editorial support.

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About the Editors James N. Parker, M.D. Dr. James N. Parker received his Bachelor of Science degree in Psychobiology from the University of California, Riverside and his M.D. from the University of California, San Diego. In addition to authoring numerous research publications, he has lectured at various academic institutions. Dr. Parker is the medical editor for health books by ICON Health Publications. Philip M. Parker, Ph.D. Philip M. Parker is the Eli Lilly Chair Professor of Innovation, Business and Society at INSEAD (Fontainebleau, France and Singapore). Dr. Parker has also been Professor at the University of California, San Diego and has taught courses at Harvard University, the Hong Kong University of Science and Technology, the Massachusetts Institute of Technology, Stanford University, and UCLA. Dr. Parker is the associate editor for ICON Health Publications.

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About ICON Health Publications To discover more about ICON Health Publications, simply check with your preferred online booksellers, including Barnes & Noble.com and Amazon.com which currently carry all of our titles. Or, feel free to contact us directly for bulk purchases or institutional discounts: ICON Group International, Inc. 4370 La Jolla Village Drive, Fourth Floor San Diego, CA 92122 USA Fax: 858-546-4341 Web site: www.icongrouponline.com/health

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Table of Contents FORWARD .......................................................................................................................................... 1 CHAPTER 1. STUDIES ON COUMADIN ............................................................................................... 3 Overview........................................................................................................................................ 3 The Combined Health Information Database................................................................................. 3 Federally Funded Research on Coumadin...................................................................................... 4 E-Journals: PubMed Central ......................................................................................................... 5 The National Library of Medicine: PubMed .................................................................................. 6 CHAPTER 2. NUTRITION AND COUMADIN ....................................................................................... 9 Overview........................................................................................................................................ 9 Finding Nutrition Studies on Coumadin ...................................................................................... 9 Federal Resources on Nutrition ................................................................................................... 13 Additional Web Resources ........................................................................................................... 14 CHAPTER 3. ALTERNATIVE MEDICINE AND COUMADIN ............................................................... 17 Overview...................................................................................................................................... 17 National Center for Complementary and Alternative Medicine.................................................. 17 Additional Web Resources ........................................................................................................... 23 General References ....................................................................................................................... 26 CHAPTER 4. BOOKS ON COUMADIN ............................................................................................... 27 Overview...................................................................................................................................... 27 Book Summaries: Online Booksellers........................................................................................... 27 The National Library of Medicine Book Index ............................................................................. 27 Chapters on Coumadin ................................................................................................................ 28 CHAPTER 5. PERIODICALS AND NEWS ON COUMADIN .................................................................. 29 Overview...................................................................................................................................... 29 News Services and Press Releases................................................................................................ 29 Academic Periodicals covering Coumadin ................................................................................... 31 APPENDIX A. PHYSICIAN RESOURCES ............................................................................................ 35 Overview...................................................................................................................................... 35 NIH Guidelines............................................................................................................................ 35 NIH Databases............................................................................................................................. 37 Other Commercial Databases....................................................................................................... 40 APPENDIX B. PATIENT RESOURCES ................................................................................................. 41 Overview...................................................................................................................................... 41 Patient Guideline Sources............................................................................................................ 41 Finding Associations.................................................................................................................... 43 APPENDIX C. FINDING MEDICAL LIBRARIES .................................................................................. 45 Overview...................................................................................................................................... 45 Preparation................................................................................................................................... 45 Finding a Local Medical Library.................................................................................................. 45 Medical Libraries in the U.S. and Canada ................................................................................... 45 ONLINE GLOSSARIES.................................................................................................................. 51 Online Dictionary Directories ..................................................................................................... 51 COUMADIN DICTIONARY......................................................................................................... 53 INDEX ................................................................................................................................................ 73

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FORWARD In March 2001, the National Institutes of Health issued the following warning: "The number of Web sites offering health-related resources grows every day. Many sites provide valuable information, while others may have information that is unreliable or misleading."1 Furthermore, because of the rapid increase in Internet-based information, many hours can be wasted searching, selecting, and printing. Since only the smallest fraction of information dealing with Coumadin is indexed in search engines, such as www.google.com or others, a non-systematic approach to Internet research can be not only time consuming, but also incomplete. This book was created for medical professionals, students, and members of the general public who want to know as much as possible about Coumadin, using the most advanced research tools available and spending the least amount of time doing so. In addition to offering a structured and comprehensive bibliography, the pages that follow will tell you where and how to find reliable information covering virtually all topics related to Coumadin, from the essentials to the most advanced areas of research. Public, academic, government, and peer-reviewed research studies are emphasized. Various abstracts are reproduced to give you some of the latest official information available to date on Coumadin. Abundant guidance is given on how to obtain free-of-charge primary research results via the Internet. While this book focuses on the field of medicine, when some sources provide access to non-medical information relating to Coumadin, these are noted in the text. E-book and electronic versions of this book are fully interactive with each of the Internet sites mentioned (clicking on a hyperlink automatically opens your browser to the site indicated). If you are using the hard copy version of this book, you can access a cited Web site by typing the provided Web address directly into your Internet browser. You may find it useful to refer to synonyms or related terms when accessing these Internet databases. NOTE: At the time of publication, the Web addresses were functional. However, some links may fail due to URL address changes, which is a common occurrence on the Internet. For readers unfamiliar with the Internet, detailed instructions are offered on how to access electronic resources. For readers unfamiliar with medical terminology, a comprehensive glossary is provided. For readers without access to Internet resources, a directory of medical libraries, that have or can locate references cited here, is given. We hope these resources will prove useful to the widest possible audience seeking information on Coumadin. The Editors

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From the NIH, National Cancer Institute (NCI): http://www.cancer.gov/cancerinfo/ten-things-to-know.

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CHAPTER 1. STUDIES ON COUMADIN Overview In this chapter, we will show you how to locate peer-reviewed references and studies on Coumadin.

The Combined Health Information Database The Combined Health Information Database summarizes studies across numerous federal agencies. To limit your investigation to research studies and Coumadin, you will need to use the advanced search options. First, go to http://chid.nih.gov/index.html. From there, select the “Detailed Search” option (or go directly to that page with the following hyperlink: http://chid.nih.gov/detail/detail.html). The trick in extracting studies is found in the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Journal Article.” At the top of the search form, select the number of records you would like to see (we recommend 100) and check the box to display “whole records.” We recommend that you type “Coumadin” (or synonyms) into the “For these words:” box. Consider using the option “anywhere in record” to make your search as broad as possible. If you want to limit the search to only a particular field, such as the title of the journal, then select this option in the “Search in these fields” drop box. The following is what you can expect from this type of search: •

Warfarin Sodium (Coumadin) Anticoagulant Therapy for Vascular Access Patency Source: ANNA Journal. American Nephrology Nurses' Association Journal. 25(2): 195204. April 1998. Contact: Available from American Nephrology Nurses' Association. Box 56, East Holly Avenue, Pitman, NJ 08071. (609) 256-2320. Summary: The increase of patients who are older or have diabetes brings about a corresponding increase in the use of synthetic vascular access grafts, placed for hemodialysis access. Synthetic grafts are often chosen for patients with poor vasculature because compromised blood vessels cannot support native arteriovenous fistulas. This article discusses the use of warfarin sodium (Coumadin), a drug used as anticoagulant therapy to help maintain vascular access patency. Warfarin sodium is often chosen

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because of its predictability and bioavailability to interrupt the coagulation cascade to prevent thrombus formation. The author discusses the actions, interactions, monitoring, and adverse effects of this drug. The main complication of warfarin sodium is bleeding, or hemorrhage, that can occur in any tissue or organ. The risk for bleeding increases in the presence of certain conditions, including older age, history of gastrointestinal bleeding, renal insufficiency, or anemia. The author stresses that once nephrology nurses have an understanding of warfarin sodium and the methods of monitoring, it is important for them to provide education for patients about the drug. The author concludes that, although it has not been truly determined if warfarin sodium use will help prolong access patency, the use of the drug will most likely be continued to prevent thrombosis because of its mechanism of action to interrupt coagulation. The article includes extensive charts listing medications with which warfarin sodium may interact, indications, and contraindications. The article is worth 2.5 contact hours of continuing education credit from the American Nephrology Nurses Association (ANNA); the posttest is included at the end of the article. 1 figure. 5 tables. 21 references. (AA-M).

Federally Funded Research on Coumadin The U.S. Government supports a variety of research studies relating to Coumadin. These studies are tracked by the Office of Extramural Research at the National Institutes of Health.2 CRISP (Computerized Retrieval of Information on Scientific Projects) is a searchable database of federally funded biomedical research projects conducted at universities, hospitals, and other institutions. Search the CRISP Web site at http://crisp.cit.nih.gov/crisp/crisp_query.generate_screen. You will have the option to perform targeted searches by various criteria, including geography, date, and topics related to Coumadin. For most of the studies, the agencies reporting into CRISP provide summaries or abstracts. As opposed to clinical trial research using patients, many federally funded studies use animals or simulated models to explore Coumadin. The following is typical of the type of information found when searching the CRISP database for Coumadin: •

Project Title: PREVENT: THROMBOEMBOLISM

PREVENTION

OF

RECURRENT

VENOUS

Principal Investigator & Institution: Key, Nigel S.; Associate Professor; University of Minnesota Twin Cities 200 Oak Street Se Minneapolis, Mn 554552070 Timing: Fiscal Year 2001 Summary: Standard of care for patients with deep venous thrombosis (blood clot in the leg or arm) and the complication of pulmonary embolus (blood clot in the lung) typically includes anti coagulation (blood thinning) medication for a 3 to 6 month period with full dosewarfarin (Coumadin). Patients following this regimen experience high rates of recurrent thrombosis, and re-hospitalization in the years immediately following cessation of anticoagulation. This is true for patients at average risk of disease recurrence, and for patients at increased risk due to the presence of inherited defects of 2

Healthcare projects are funded by the National Institutes of Health (NIH), Substance Abuse and Mental Health Services (SAMHSA), Health Resources and Services Administration (HRSA), Food and Drug Administration (FDA), Centers for Disease Control and Prevention (CDCP), Agency for Healthcare Research and Quality (AHRQ), and Office of Assistant Secretary of Health (OASH).

Studies

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anticoagulation such as the factor V Leiden mutation. No clinical regimen currently available has proven to have sufficient benefit to support long term prophylaxis. Simply put, using current standards of anticoagulation with warfarin in the long term, the undoubted benefit in preventing clots is often negated by the excess risk of bleeding. In contrast, while targeted low dose warfarin is safe for long term therapy with respect to bleeding risk, the effectiveness of this approach is untested. The research question is: Will long term low dose warfarin effectively prevent venous thromboembolic disease? The Prevention of Recurrent Venous Thromboembolism (PREVENT) trial will evaluate the effectiveness of long term therapy with low dose warfarin in the secondary prevention of venous thromboembolism (VTE). Patients with a history of documented unexplained venous thrombosis who have completed a standard course of anticoagulation therapy will be enrolled in a randomized, double-blind, placebocontrolled trial comparing usual care plus low-dose warfarin to usual care plus placebo for a period of up to 4years. Trial end-points will include recurrent VTE, major bleeding episodes, and all deaths in the total patient population and separately in those patients with factor V Leiden. The potential clinical impact of the PREVENT trial is broad since a positive finding would strongly support chronic low dose anticoagulation among patients with venous thrmobosis who are at risk for recurrence following cessation of standard outpatient anticoagulation. This intervention trial will be conducted among 800 men and women ages 40 and over who have had a prior venous thrombosis, and thus may be at risk for future recurrence. With 40 centers nationwide participating in this trial we estimate approximately 30 patients will be recruited from FairviewUniversity Medical Center (F-UMC). Participation will involve 3-4 years of study treatment and follow-up. The General Clinical Research Center (GCRC) will provide physical space to facilitate all patient visits at each time point. GCRC nursing and ancillary staff will be asked to obtain applicable measurements, vital signs, perform venipuncture, necessary centrifuging of blood speciments, and point of care unblinded Coag-u-check testing for INR (see physician orders). In addition, nursing staff will be asked to document current medications at all time points. An in-service will be provided to nursing staff who will need to perform Coag-u-check INR. Although 29 visits are expected per patient there may be accasional unscheduled visits. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

E-Journals: PubMed Central3 PubMed Central (PMC) is a digital archive of life sciences journal literature developed and managed by the National Center for Biotechnology Information (NCBI) at the U.S. National Library of Medicine (NLM).4 Access to this growing archive of e-journals is free and unrestricted.5 To search, go to http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Pmc, and type “Coumadin” (or synonyms) into the search box. This search gives you access to full-text articles. The following is a sample of items found for Coumadin in the PubMed Central database:

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Adapted from the National Library of Medicine: http://www.pubmedcentral.nih.gov/about/intro.html.

With PubMed Central, NCBI is taking the lead in preservation and maintenance of open access to electronic literature, just as NLM has done for decades with printed biomedical literature. PubMed Central aims to become a world-class library of the digital age. 5 The value of PubMed Central, in addition to its role as an archive, lies in the availability of data from diverse sources stored in a common format in a single repository. Many journals already have online publishing operations, and there is a growing tendency to publish material online only, to the exclusion of print.

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Dichotomal Effect of the Coumadin Derivative Warfarin on Inflammatory Signal Transduction. by Kater AP, Peppelenbosch MP, Brandjes DP, Lumbantobing M.; 2002 Nov; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&rendertype=exter nal&artid=130100

The National Library of Medicine: PubMed One of the quickest and most comprehensive ways to find academic studies in both English and other languages is to use PubMed, maintained by the National Library of Medicine.6 The advantage of PubMed over previously mentioned sources is that it covers a greater number of domestic and foreign references. It is also free to use. If the publisher has a Web site that offers full text of its journals, PubMed will provide links to that site, as well as to sites offering other related data. User registration, a subscription fee, or some other type of fee may be required to access the full text of articles in some journals. To generate your own bibliography of studies dealing with Coumadin, simply go to the PubMed Web site at http://www.ncbi.nlm.nih.gov/pubmed. Type “Coumadin” (or synonyms) into the search box, and click “Go.” The following is the type of output you can expect from PubMed for Coumadin (hyperlinks lead to article summaries): •

Aspirin and coumadin after acute coronary syndromes (the ASPECT-2 study): a randomised controlled trial. Author(s): van Es RF, Jonker JJ, Verheugt FW, Deckers JW, Grobbee DE; Antithrombotics in the Secondary Preventionof Events in Coronary Thrombosis-2 (ASPECT-2) Research Group. Source: Lancet. 2002 July 13; 360(9327): 109-13. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12126819&dopt=Abstract

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By the way, doctor. Drugs for atrial fibrillation. I had atrial fibrillation and was zapped back into sinus rhythm several weeks ago. It seems like I'm going to have to take either aspirin or Coumadin. Which is better, and why? Author(s): Lee TH. Source: Harvard Health Letter / from Harvard Medical School. 2001 April; 26(6): 8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11340029&dopt=Abstract

6 PubMed was developed by the National Center for Biotechnology Information (NCBI) at the National Library of Medicine (NLM) at the National Institutes of Health (NIH). The PubMed database was developed in conjunction with publishers of biomedical literature as a search tool for accessing literature citations and linking to full-text journal articles at Web sites of participating publishers. Publishers that participate in PubMed supply NLM with their citations electronically prior to or at the time of publication.

Studies

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•

Comparison of two aspirin doses on ischemic stroke in post-myocardial infarction patients in the warfarin (Coumadin) Aspirin Reinfarction Study (CARS). Author(s): O'Connor CM, Gattis WA, Hellkamp AS, Langer A, Larsen RL, Harrington RA, Berkowitz SD, O'Gara PT, Kopecky SL, Gheorghiade M, Daly R, Califf RM, Fuster V. Source: The American Journal of Cardiology. 2001 September 1; 88(5): 541-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11524065&dopt=Abstract

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Correlation of the change in the International Normalized Ratio and decreasing the Coumadin dosage following total joint arthroplasty. Author(s): Rosenbaum CC, Woods SE, Hasselfeld KA. Source: Orthopedics. 2002 December; 25(12): 1359-63; Discussion 1363. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12502198&dopt=Abstract

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Coumadin knowledge deficits: do recently hospitalized patients know how to safely manage the medication? Author(s): Cheah GM, Martens KH. Source: Home Healthcare Nurse. 2003 February; 21(2): 94-100; Quiz 101. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12574677&dopt=Abstract

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Coumadin-induced lingual hemorrhage mimicking angioedema. Author(s): Shojania KG. Source: The American Journal of Medicine. 2000 July; 109(1): 77-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10991748&dopt=Abstract

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Fontan's operation: is aspirin enough? Is coumadin too much? Author(s): Jacobs ML, Pourmoghadam KK, Geary EM, Reyes AT, Madan N, McGrath LB, Moore JW. Source: The Annals of Thoracic Surgery. 2002 January; 73(1): 64-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11834064&dopt=Abstract

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Heparin and coumadin versus acetylsalicylic acid for prevention of restenosis after coronary angioplasty. Author(s): Garachemani AR, Fleisch M, Windecker S, Pfiffner D, Meier B. Source: Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions. 2002 March; 55(3): 315-20. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11870934&dopt=Abstract

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Heparin and coumadin: delayed postpolypectomy bleeding. Author(s): Langdon DE. Source: Gastrointestinal Endoscopy. 2001 February; 53(2): 270. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11174318&dopt=Abstract

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Higher rates of coronary angiography and revascularization following myocardial infarction may be associated with greater survival in the United States than in Canada. The CARS Investigators (Coumadin/Aspirin Reinfarction Study). Author(s): Langer A, Fisher M, Califf RM, Goodman S, O'Connor CM, Harrington RA, Fuster V. Source: The Canadian Journal of Cardiology. 1999 October; 15(10): 1095-102. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10523476&dopt=Abstract

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I have heard that eating green or leafy vegetables can be a problem when a person is taking the blood thinner Coumadin. Is this true? Author(s): Lilly LS. Source: Health News. 2000 August; 6(8): 10. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10948878&dopt=Abstract

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Interaction of herbal medicine with Coumadin. Author(s): Cheng TO. Source: The Journal of Emergency Medicine. 2000 January; 18(1): 122. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10645853&dopt=Abstract

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Parameters of the tissue factor pathway with coumadin/dipyridamole versus ticlopidine as adjunct antithrombotic-drug regimen in coronary artery stenting. Author(s): Kopp CW, Steiner S, Priglinger U, Christ G, Probst P, Maurer G, Minar E, Huber K. Source: Blood Coagulation & Fibrinolysis : an International Journal in Haemostasis and Thrombosis. 2003 June; 14(4): 379-86. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12945880&dopt=Abstract

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Substitution of generic warfarin for Coumadin in an HMO setting. Author(s): Milligan PE, Banet GA, Waterman AD, Gatchel SK, Gage BF. Source: The Annals of Pharmacotherapy. 2002 May; 36(5): 764-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11978149&dopt=Abstract

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Vocal fold hemorrhage associated with coumadin therapy in an opera singer. Author(s): Neely JL, Rosen C. Source: Journal of Voice : Official Journal of the Voice Foundation. 2000 June; 14(2): 2727. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10875579&dopt=Abstract

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CHAPTER 2. NUTRITION AND COUMADIN Overview In this chapter, we will show you how to find studies dedicated specifically to nutrition and Coumadin.

Finding Nutrition Studies on Coumadin The National Institutes of Health’s Office of Dietary Supplements (ODS) offers a searchable bibliographic database called the IBIDS (International Bibliographic Information on Dietary Supplements; National Institutes of Health, Building 31, Room 1B29, 31 Center Drive, MSC 2086, Bethesda, Maryland 20892-2086, Tel: 301-435-2920, Fax: 301-480-1845, E-mail: [email protected]). The IBIDS contains over 460,000 scientific citations and summaries about dietary supplements and nutrition as well as references to published international, scientific literature on dietary supplements such as vitamins, minerals, and botanicals.7 The IBIDS includes references and citations to both human and animal research studies. As a service of the ODS, access to the IBIDS database is available free of charge at the following Web address: http://ods.od.nih.gov/databases/ibids.html. After entering the search area, you have three choices: (1) IBIDS Consumer Database, (2) Full IBIDS Database, or (3) Peer Reviewed Citations Only. Now that you have selected a database, click on the “Advanced” tab. An advanced search allows you to retrieve up to 100 fully explained references in a comprehensive format. Type “Coumadin” (or synonyms) into the search box, and click “Go.” To narrow the search, you can also select the “Title” field.

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Adapted from http://ods.od.nih.gov. IBIDS is produced by the Office of Dietary Supplements (ODS) at the National Institutes of Health to assist the public, healthcare providers, educators, and researchers in locating credible, scientific information on dietary supplements. IBIDS was developed and will be maintained through an interagency partnership with the Food and Nutrition Information Center of the National Agricultural Library, U.S. Department of Agriculture.

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The following information is typical of that found when using the “Full IBIDS Database” to search for “Coumadin” (or a synonym): •

A hydroxyapatite system for the continuous release of coumadin an anticoagulant. Author(s): Department of Biology, University of Dayton, Ohio 45469-2320, USA. Source: Tarr, E R Lasserre, A Szmulowicz, U Bajpai, P K Biomed-Sci-Instrum. 1997; 33143-8 0067-8856

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Abdominal pain while on coumadin. Author(s): Vanderbilt University Medical Center, USA. Source: McCurdy, L Sutton, H D Tenn-Med. 1998 September; 91(9): 365 1088-6222

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Acute carpal tunnel syndrome in a patient taking coumadin. Author(s): Division of Plastic & Reconstructive Surgery, University of Missouri Health Sciences Center, Columbia 65212. Source: Copeland, J Wells, H G Puckett, C L J-Trauma. 1989 January; 29(1): 131-2 00225282

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Aspirin and coumadin after acute coronary syndromes (the ASPECT-2 study): a randomised controlled trial. Author(s): Julius Centre for General Practice and Patient Oriented Research, University Medical Centre Utrecht, Netherlands. Source: van Es, Robert F Jonker, January J C Verheugt, Freek W A Deckers, Jaap W Grobbee, Diederick E Lancet. 2002 July 13; 360(9327): 109-13 0140-6736

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By the way, doctor. Drugs for atrial fibrillation. I had atrial fibrillation and was zapped back into sinus rhythm several weeks ago. It seems like I'm going to have to take either aspirin or Coumadin. Which is better, and why? Source: Lee, T H Harv-Health-Lett. 2001 April; 26(6): 8 1052-1577

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CARS trial: warfarin and thrombin generation. Coumadin Aspirin Reinfarction Study. Source: Peverill, R E Harper, R W Smolich, J J Lancet. 1997 October 18; 350(9085): 1177-8 0140-6736

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Comparison of the efficacy and safety of aspirin alone with coumadin plus aspirin after provisional coronary stenting: final and follow-up results of a randomized study. Author(s): Department of Cardiology, Bergmannsheil, Bochum, Germany. [email protected] Source: Machraoui, A Germing, A von Dryander, S Lange, S Jager, D Lemke, B Barmeyer, J Am-Heart-J. 1999 October; 138(4 Pt 1): 663-9 0002-8703

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Comparison of two aspirin doses on ischemic stroke in post-myocardial infarction patients in the warfarin (Coumadin) Aspirin Reinfarction Study (CARS). Author(s): Department of Medicine, Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina 27710, USA. [email protected] Source: O'Connor, C M Gattis, W A Hellkamp, A S Langer, A Larsen, R L Harrington, R A Berkowitz, S D O'Gara, P T Kopecky, S L Gheorghiade, M Daly, R Califf, R M Fuster, V Am-J-Cardiol. 2001 September 1; 88(5): 541-6 0002-9149

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Coumadin and 111In-labeled platelet uptake on experimental thrombi in dogs. Preliminary observations. Source: Sostman, H D Zoghbi, S S Carbo, P Lord, P F Invest-Radiol. 1987 March; 22(3): 216-22 0020-9996

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Coumadin Clinic: a disease management enterprise. Author(s): Boyce and Bynum Pathology Laboratories in Columbia, USA.

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Source: McIntire, T Mo-Med. 1997 February; 94(2): 65-6 0026-6620 •

Coumadin necrosis of the skin: report of four patients. Author(s): Section of Plastic Surgery, West Virginia University, Morgantown, USA. Source: Miura, Y Ardenghy, M Ramasastry, S Kovach, R Hochberg, J Ann-Plast-Surg. 1996 September; 37(3): 332-7 0148-7043

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Coumadin skin necrosis in a patient with a free protein S deficiency: case report and literature review. Author(s): Indiana University Medical Center, Indianapolis. Source: Berkompas, D C Indiana-Med. 1991 November; 84(11): 788-91 0746-8288

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Coumadin: principles of use. Author(s): Department of Surgery, University of Missouri-Columbia 65212, USA. Source: Liem, T K Silver, D Semin-Vasc-Surg. 1996 December; 9(4): 354-61 0895-7967

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Coumadin-induced gastrointestinal hemorrhage associated with an ileal duplication. Author(s): Nuclear Medicine Section, Department of Veterans Affairs Medical Center, Seattle, WA 98108. Source: Staunton, D A Jacobson, A F Thorning, D Lynch, M K J-Clin-Gastroenterol. 1990 December; 12(6): 685-9 0192-0790

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Creating a Coumadin Clinic. Author(s): Silverton (Ore.) Hospital, USA. Source: Hart, D F RN. 1998 August; 61(8): 22-4 0033-7021

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Fontan's operation: is aspirin enough? Is coumadin too much? Author(s): Sections of Cardiothoracic Surgery and Cardiology, St. Christopher's Hospital for Children, Philadelphia, Pennsylvania 19134, USA. Source: Jacobs, Marshall L Pourmoghadam, Kamal K Geary, Elaine M Reyes, Angelo T Madan, Nandini McGrath, Lynn B Moore, John W Ann-Thorac-Surg. 2002 January; 73(1): 64-8 0003-4975

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Hematological complications with the St. Jude valve and reduced-dose Coumadin. Author(s): Division of Cardiac Surgery, Brigham and Women's Hospital, Boston, Massachusetts 02115. Source: DiSesa, V J Collins, J J Cohn, L H Ann-Thorac-Surg. 1989 August; 48(2): 280-3 0003-4975

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Hematuria, flank pain, allergy to intravenous pyelogram dye and use of coumadin in Munchausen syndrome. Source: Reed, M C DeBold, C R J-Tenn-Med-Assoc. 1987 March; 80(3): 139-40 0040-3318

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Heparin and coumadin versus acetylsalicylic acid for prevention of restenosis after coronary angioplasty. Author(s): Swiss Cardiovascular Center, University Hospital, Bern, Switzerland. Source: Garachemani, Ali Reza Fleisch, Martin Windecker, Stephan Pfiffner, Dorothy Meier, Bernhard Catheter-Cardiovasc-Intervolume 2002 Mar; 55(3): 315-20 1522-1946

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Higher rates of coronary angiography and revascularization following myocardial infarction may be associated with greater survival in the United States than in Canada. The CARS Investigators (Coumadin/Aspirin Reinfarction Study). Author(s): St Michael's Hospital, Toronto, Canada. Source: Langer, A Fisher, M Califf, R M Goodman, S O'Connor, C M Harrington, R A Fuster, V Can-J-Cardiol. 1999 October; 15(10): 1095-102 0828-282X

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I have heard that eating green or leafy vegetables can be a problem when a person is taking the blood thinner Coumadin. Is this true? Author(s): Harvard Medical School, USA. Source: Lilly, L S Health-News. 2000 August; 6(8): 10 1081-5880

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Improved Coumadin therapy using a continuous quality improvement process. Author(s): North Iowa Mercy Health Center, Mason City, USA. Source: Eckhart, J Gilbert, P Clin-Lab-Manage-Revolume 1996 Mar-April; 10(2): 153-6 0888-7950

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In favor of Coumadin over generic warfarin. Author(s): ValueRx, Plymouth, MN 55442-2599, USA. [email protected] Source: Benson, S R Vance Bryan, K Am-J-Health-Syst-Pharm. 1998 April 1; 55(7): 727-9 1079-2082

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Incidence of pulmonary embolism after total knee arthroplasty with low-dose coumadin prophylaxis. Author(s): Rothman Institute, Philadelphia, Pennsylvania. Source: Vresilovic, E J Hozack, W J Booth, R E Rothman, R H Clin-Orthopage 1993 January; (286): 27-31 0009-921X

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Intermittent pneumatic compression versus coumadin. Prevention of deep vein thrombosis in lower-extremity total joint arthroplasty. Author(s): Department of Orthopaedic Surgery, State University of New York, Buffalo School of Medicine 14215. Source: Kaempffe, F A Lifeso, R M Meinking, C Clin-Orthopage 1991 August; (269): 8997 0009-921X

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Monitoring coumadin therapy. Source: Catania, U M RN. 1994 February; 57(2): 29-34 0033-7021

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OH: nurses fail to follow orders re Coumadin: complications follow--patient's death results. Source: Anonymous Nurs-Law-Regan-Repage 2001 August; 42(3): 3 1528-848X

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Prevention of deep vein thrombosis after total knee arthroplasty. Coumadin versus pneumatic calf compression. Author(s): Massachusetts General Hospital, Boston 02114. Source: Hodge, W A Clin-Orthopage 1991 October; (271): 101-5 0009-921X

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Randomised double-blind trial of fixed low-dose warfarin with aspirin after myocardial infarction. Coumadin Aspirin Reinfarction Study (CARS) Investigators. Source: Anonymous Lancet. 1997 August 9; 350(9075): 389-96 0140-6736

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Recurrent coumadin-induced soft tissue necrosis resulting in mastectomy. Author(s): Department of General Surgery, National Naval Medical Center, Bethesda, MD 20814-5011. Source: Harveil, J D Furman, R L Mil-Med. 1993 April; 158(4): 283-4 0026-4075

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Safety and anticoagulation effect of a low-dose combination of warfarin and aspirin in clinically stable coronary artery disease. Coumadin Aspirin Reinfarction (CARS) Pilot Study Group. Author(s): Department of Medicine, St. Michael's Hospital, University of Toronto, Canada. Source: Goodman, S G Langer, A Durica, S S Raskob, G E Comp, P C Gray, R J Hall, J H Kelley, R P Hua, T A Lee, R J et al. Am-J-Cardiol. 1994 October 1; 74(7): 657-61 0002-9149

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Substitution of generic warfarin for Coumadin in an HMO setting. Author(s): Division of General Medical Sciences, Barnes-Jewish Hospital Blood Thinner Clinic, School of Medicine, Washington University, 660 S. Euclid Avenue, St. Louis, MO 63110-1093, USA. Source: Milligan, P E Banet, G A Waterman, A D Gatchel, S K Gage, B F AnnPharmacother. 2002 May; 36(5): 764-8 1060-0280

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The management of patients on chronic Coumadin therapy undergoing subsequent surgical procedures. Author(s): Department of Surgery, Indiana University School of Medicine, Indianapolis. Source: Madura, J A Rookstool, M Wease, G Am-Surg. 1994 July; 60(7): 542-6; discussion 546-7 0003-1348

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The role of coumadin and aspirin in atrial fibrillation. Author(s): Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston 02114, USA. Source: Hutter, A M Trans-Am-Clin-Climatol-Assoc. 1995; 10779-85; discussion 85-6 0065-7778

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Thoracic hematomyelia secondary to coumadin anticoagulant therapy: a case report. Author(s): Department of Neurosurgery, Hadassah University Hospital, Jerusalem, Israel. Source: Constantini, S Ashkenazi, E Shoshan, Y Israel, Z Umansky, F Eur-Neurol. 1992; 32(2): 109-11 0014-3022

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Treatment of the patient receiving Coumadin anticoagulant therapy. Author(s): Department of Oral Medicine and Diagnostic Sciences, University of Illinois College of Dentistry, USA. Source: Rada, R E Lamberghini, F CDS-Revolume 1997 September; 90(6): 34-8 0091-1666

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Vitamin E and blood thinners. You advised readers not to take extra vitamin E if they were taking aspirin or Coumadin. Why? Source: Anonymous Johns-Hopkins-Med-Lett-Health-After-50. 1999 October; 11(8): 8 1042-1882

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Vocal fold hemorrhage associated with coumadin therapy in an opera singer. Author(s): West Virginia University, Morgantown, USA. Source: Neely, J L Rosen, C J-Voice. 2000 June; 14(2): 272-7 0892-1997

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Warfarin sodium (Coumadin) anticoagulant therapy for vascular access patency. Source: Kinzner, C L ANNA-J. 1998 April; 25(2): 195-203; quiz 204, 209 8750-0779

Federal Resources on Nutrition In addition to the IBIDS, the United States Department of Health and Human Services (HHS) and the United States Department of Agriculture (USDA) provide many sources of information on general nutrition and health. Recommended resources include: •

healthfinder®, HHS’s gateway to health information, including diet and nutrition: http://www.healthfinder.gov/scripts/SearchContext.asp?topic=238&page=0

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The United States Department of Agriculture’s Web site dedicated to nutrition information: www.nutrition.gov

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The Food and Drug Administration’s Web site for federal food safety information: www.foodsafety.gov

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The National Action Plan on Overweight and Obesity sponsored by the United States Surgeon General: http://www.surgeongeneral.gov/topics/obesity/

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The Center for Food Safety and Applied Nutrition has an Internet site sponsored by the Food and Drug Administration and the Department of Health and Human Services: http://vm.cfsan.fda.gov/

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Center for Nutrition Policy and Promotion sponsored by the United States Department of Agriculture: http://www.usda.gov/cnpp/

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Food and Nutrition Information Center, National Agricultural Library sponsored by the United States Department of Agriculture: http://www.nal.usda.gov/fnic/

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Food and Nutrition Service sponsored by the United States Department of Agriculture: http://www.fns.usda.gov/fns/

Additional Web Resources A number of additional Web sites offer encyclopedic information covering food and nutrition. The following is a representative sample: •

AOL: http://search.aol.com/cat.adp?id=174&layer=&from=subcats

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Family Village: http://www.familyvillage.wisc.edu/med_nutrition.html

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Google: http://directory.google.com/Top/Health/Nutrition/

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Healthnotes: http://www.healthnotes.com/

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Open Directory Project: http://dmoz.org/Health/Nutrition/

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Yahoo.com: http://dir.yahoo.com/Health/Nutrition/

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WebMDHealth: http://my.webmd.com/nutrition

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WholeHealthMD.com: http://www.wholehealthmd.com/reflib/0,1529,00.html

The following is a specific Web list relating to Coumadin; please note that any particular subject below may indicate either a therapeutic use, or a contraindication (potential danger), and does not reflect an official recommendation: •

Vitamins Vitamin C Source: Prima Communications, Inc.www.personalhealthzone.com Vitamin E Source: Prima Communications, Inc.www.personalhealthzone.com Vitamin K Source: Prima Communications, Inc.www.personalhealthzone.com

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Minerals Bromelain/quercetin Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,941,00.html Vinpocetine Source: Prima Communications, Inc.www.personalhealthzone.com

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Food and Diet Bruising Source: Healthnotes, Inc.; www.healthnotes.com Garlic Source: Prima Communications, Inc.www.personalhealthzone.com

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CHAPTER 3. ALTERNATIVE MEDICINE AND COUMADIN Overview In this chapter, we will begin by introducing you to official information sources on complementary and alternative medicine (CAM) relating to Coumadin. At the conclusion of this chapter, we will provide additional sources.

National Center for Complementary and Alternative Medicine The National Center for Complementary and Alternative Medicine (NCCAM) of the National Institutes of Health (http://nccam.nih.gov/) has created a link to the National Library of Medicine’s databases to facilitate research for articles that specifically relate to Coumadin and complementary medicine. To search the database, go to the following Web site: http://www.nlm.nih.gov/nccam/camonpubmed.html. Select “CAM on PubMed.” Enter “Coumadin” (or synonyms) into the search box. Click “Go.” The following references provide information on particular aspects of complementary and alternative medicine that are related to Coumadin: •

“Resistance” to warfarin due to unrecognized vitamin K supplementation. Author(s): O'Reilly RA, Rytand DA. Source: The New England Journal of Medicine. 1980 July 17; 303(3): 160-1. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7383081&dopt=Abstract

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A monoclonal-antibody-based radioimmunoassay for measurement of protein C in plasma. Author(s): Howard PR, Bovill EG, Mann KG, Tracy RP. Source: Clinical Chemistry. 1988 February; 34(2): 324-30. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3124980&dopt=Abstract

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A prospective randomized trial of aspirin-clopidogrel combination therapy and doseadjusted warfarin on indices of thrombogenesis and platelet activation in atrial fibrillation. Author(s): Kamath S, Blann AD, Chin BS, Lip GY.

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Source: Journal of the American College of Cardiology. 2002 August 7; 40(3): 484-90. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12142115&dopt=Abstract •

A randomized trial of anticoagulation with warfarin and of alternating chemotherapy in extensive small-cell lung cancer by the Cancer and Leukemia Group B. Author(s): Chahinian AP, Propert KJ, Ware JH, Zimmer B, Perry MC, Hirsh V, Skarin A, Kopel S, Holland JF, Comis RL, et al. Source: Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology. 1989 August; 7(8): 993-1002. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2547030&dopt=Abstract

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A taste of Chinese medicine! Author(s): Izzat MB, Yim AP, El-Zufari MH. Source: The Annals of Thoracic Surgery. 1998 September; 66(3): 941-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9768962&dopt=Abstract

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Accidental poisoning by warfarin-contaminated herbal tea. Author(s): Norcross WA, Ganiats TG, Ralph LP, Seidel RG, Ikeda TS. Source: The Western Journal of Medicine. 1993 July; 159(1): 80-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8351917&dopt=Abstract

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Action of dipyridamole and warfarin on growth of human endothelial cells cultured in serum-free media. Author(s): Liem LK, Choong LH, Woo KT. Source: Clinical Biochemistry. 2001 March; 34(2): 141-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11311224&dopt=Abstract

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An adverse interaction between warfarin and 5-fluorouracil: A case report and review of the literature. Author(s): Brown MC. Source: Chemotherapy. 1999 September-October; 45(5): 392-5. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10473927&dopt=Abstract

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Anaesthesia for caesarean section in a patient with myotonic dystrophy receiving warfarin therapy. Author(s): Campbell AM, Thompson N. Source: Canadian Journal of Anaesthesia = Journal Canadien D'anesthesie. 1995 May; 42(5 Pt 1): 409-14. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7614649&dopt=Abstract

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Anticoagulants prevent monocrotaline-induced hepatic parenchymal cell injury but not endothelial cell injury in the rat. Author(s): Copple BL, Woolley B, Banes A, Ganey PE, Roth RA.

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Source: Toxicology and Applied Pharmacology. 2002 May 1; 180(3): 186-96. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12009858&dopt=Abstract •

Assays of ligand-human serum albumin binding using pulsed ultrafiltration and liquid chromatography-mass spectrometry. Author(s): Gu C, Nikolic D, Lai J, Xu X, van Breemen RB. Source: Combinatorial Chemistry & High Throughput Screening. 1999 December; 2(6): 353-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10644860&dopt=Abstract

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Autoprothrombin ii-a, thrombin, and epinephrine: interrelated effects on platelet aggregation. Author(s): Herman GE, Seegers WH, Henry RL. Source: Bibl Haematol. 1977; 44: 21-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=617782&dopt=Abstract

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Beware of trailing zeros. Author(s): Davis NM. Source: The American Journal of Nursing. 1994 June; 94(6): 17. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8203402&dopt=Abstract

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Bosentan and warfarin interaction. Author(s): Murphey LM, Hood EH. Source: The Annals of Pharmacotherapy. 2003 July-August; 37(7-8): 1028-31. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12841813&dopt=Abstract

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Changes in phylloquinone epoxidase activity related to prothrombin synthesis and microsomal clotting activity in the rat. Author(s): Willingham AK, Matschiner JT. Source: The Biochemical Journal. 1974 June; 140(3): 435-41. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=4155625&dopt=Abstract

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Chinese herbs and warfarin potentiation by 'danshen'. Author(s): Yu CM, Chan JC, Sanderson JE. Source: Journal of Internal Medicine. 1997 April; 241(4): 337-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9159606&dopt=Abstract

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Clinical studies of the influence of anticoagulants on the resin sponge uptake of I-131 triiodothyronine. Author(s): Quaife MA, Matoole JJ.

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Source: American Journal of Clinical Pathology. 1967 July; 48(1): 87-94. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=4961503&dopt=Abstract •

Danggui (Angelica sinensis) affects the pharmacodynamics but not the pharmacokinetics of warfarin in rabbits. Author(s): Lo AC, Chan K, Yeung JH, Woo KS. Source: Eur J Drug Metab Pharmacokinet. 1995 January-March; 20(1): 55-60. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7588995&dopt=Abstract

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Development and evaluation of three immunofluorometric assays that measure different forms of osteocalcin in serum. Author(s): Kakonen SM, Hellman J, Karp M, Laaksonen P, Obrant KJ, Vaananen HK, Lovgren T, Pettersson K. Source: Clinical Chemistry. 2000 March; 46(3): 332-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10702519&dopt=Abstract

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Development and validation of a sensitive and robust LC-tandem MS method for the analysis of warfarin enantiomers in human plasma. Author(s): Naidong W, Ring PR, Midtlien C, Jiang X. Source: Journal of Pharmaceutical and Biomedical Analysis. 2001 May; 25(2): 219-26. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11275431&dopt=Abstract

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Dietary supplement-drug interactions. Author(s): Smolinske SC. Source: J Am Med Womens Assoc. 1999 Fall; 54(4): 191-2,195. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10531760&dopt=Abstract

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Discrimination of normal and abnormal prothrombin and protein C in plasma using a calcium ion-inhibited monoclonal antibody to a common epitope on several vitamin K-dependent proteins. Author(s): Church WR, Bhushan FH, Mann KG, Bovill EG. Source: Blood. 1989 November 15; 74(7): 2418-25. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2804372&dopt=Abstract

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Does PC-SPEs interact with warfarin? Author(s): Davis NB, Nahlik L, Vogelzang NJ. Source: The Journal of Urology. 2002 April; 167(4): 1793. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11912419&dopt=Abstract

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Drug interactions as a cause of overanticoagulation and bleedings in Chinese patients receiving warfarin. Author(s): Chan TY.

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Source: Int J Clin Pharmacol Ther. 1998 July; 36(7): 403-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9707357&dopt=Abstract •

Drug interactions update: drugs, herbs, and oral anticoagulation. Author(s): Wittkowsky AK. Source: Journal of Thrombosis and Thrombolysis. 2001 September; 12(1): 67-71. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11711691&dopt=Abstract

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Drug-protein binding: recent advances in methodology: spectroscopic techniques. Author(s): Chignell CF. Source: Annals of the New York Academy of Sciences. 1973 November 26; 226: 44-59. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=4129140&dopt=Abstract

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Effect of coenzyme Q10 and Ginkgo biloba on warfarin dosage in stable, long-term warfarin treated outpatients. A randomised, double blind, placebo-crossover trial. Author(s): Engelsen J, Nielsen JD, Winther K. Source: Thrombosis and Haemostasis. 2002 June; 87(6): 1075-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12083489&dopt=Abstract

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Effect of niacin supplementation on fibrinogen levels in patients with peripheral vascular disease. Author(s): Philipp CS, Cisar LA, Saidi P, Kostis JB. Source: The American Journal of Cardiology. 1998 September 1; 82(5): 697-9, A9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9732910&dopt=Abstract

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Effect of oxygen tension on drug levels and pharmacological action in the intact animal. Author(s): Mustala OO, Azarnoff DL. Source: Proceedings of the Society for Experimental Biology and Medicine. Society for Experimental Biology and Medicine (New York, N. Y.). 1969 October; 132(1): 37-41. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=5344863&dopt=Abstract

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Effect of soy milk on warfarin efficacy. Author(s): Cambria-Kiely JA. Source: The Annals of Pharmacotherapy. 2002 December; 36(12): 1893-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12452752&dopt=Abstract

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Effects of arachidonic acid, prostaglandins, retinol, retinoic acid and cholecalciferol on xenobiotic oxidations catalysed by human cytochrome P450 enzymes. Author(s): Yamazaki H, Shimada T.

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Source: Xenobiotica; the Fate of Foreign Compounds in Biological Systems. 1999 March; 29(3): 231-41. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10219964&dopt=Abstract •

Effects of monocytopenia and anticoagulation in experimental Streptococcus sanguis endocarditis. Author(s): Thorig L, Thompson J, Eulderink F, Emeis JJ, Van Furth R. Source: Br J Exp Pathol. 1980 February; 61(1): 108-16. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7378272&dopt=Abstract

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Enhancement of warfarin response in a patient receiving etoposide and carboplatin chemotherapy. Author(s): Le AT, Hasson NK, Lum BL. Source: The Annals of Pharmacotherapy. 1997 September; 31(9): 1006-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9296241&dopt=Abstract

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Grapefruit juice and the response to warfarin. Author(s): Sullivan DM, Ford MA, Boyden TW. Source: American Journal of Health-System Pharmacy : Ajhp : Official Journal of the American Society of Health-System Pharmacists. 1998 August 1; 55(15): 1581-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9706183&dopt=Abstract

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Herbal composition PC-SPES for management of prostate cancer: identification of active principles. Author(s): Sovak M, Seligson AL, Konas M, Hajduch M, Dolezal M, Machala M, Nagourney R. Source: Journal of the National Cancer Institute. 2002 September 4; 94(17): 1275-81. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12208892&dopt=Abstract

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Herbal drug curbicin and anticoagulant effect with and without warfarin: possibly related to the vitamin E component. Author(s): Yue QY, Jansson K. Source: Journal of the American Geriatrics Society. 2001 June; 49(6): 838. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11454132&dopt=Abstract

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Herbal product use among anticoagulation clinic patients. Author(s): Zuckerman IH, Steinberger EK, Ryder PT, Haines S. Source: American Journal of Health-System Pharmacy : Ajhp : Official Journal of the American Society of Health-System Pharmacists. 2002 February 15; 59(4): 379-80. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11885405&dopt=Abstract

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Herbal remedies. Author(s): Cheng TO.

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Source: American Family Physician. 1999 October 15; 60(6): 1661; Author Reply 1665-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10537380&dopt=Abstract •

Herbs and the brain: friend or foe? The effects of ginkgo and garlic on warfarin use. Author(s): Evans V. Source: The Journal of Neuroscience Nursing : Journal of the American Association of Neuroscience Nurses. 2000 August; 32(4): 229-32. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10994537&dopt=Abstract

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Human plasma protein Z antigen: range in normal subjects and effect of warfarin therapy. Author(s): Miletich JP, Broze GJ Jr. Source: Blood. 1987 June; 69(6): 1580-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3580568&dopt=Abstract

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Inhibition of the hypoprothrombinemic effect of warfarin (Coumadin) by Ensure Plus, a dietary supplement. Author(s): Michaelson R, Kempin SJ, Navia B, Gold JW. Source: Clin Bull. 1980; 10(4): 171-2. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7214706&dopt=Abstract

•

Interaction of herbal medicine with Coumadin. Author(s): Cheng TO. Source: The Journal of Emergency Medicine. 2000 January; 18(1): 122. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10645853&dopt=Abstract

Additional Web Resources A number of additional Web sites offer encyclopedic information covering CAM and related topics. The following is a representative sample: •

Alternative Medicine Foundation, Inc.: http://www.herbmed.org/

•

AOL: http://search.aol.com/cat.adp?id=169&layer=&from=subcats

•

Chinese Medicine: http://www.newcenturynutrition.com/

•

drkoop.com: http://www.drkoop.com/InteractiveMedicine/IndexC.html

•

Family Village: http://www.familyvillage.wisc.edu/med_altn.htm

•

Google: http://directory.google.com/Top/Health/Alternative/

•

Healthnotes: http://www.healthnotes.com/

•

MedWebPlus: http://medwebplus.com/subject/Alternative_and_Complementary_Medicine

•

Open Directory Project: http://dmoz.org/Health/Alternative/

24

Coumadin

•

HealthGate: http://www.tnp.com/

•

WebMDHealth: http://my.webmd.com/drugs_and_herbs

•

WholeHealthMD.com: http://www.wholehealthmd.com/reflib/0,1529,00.html

•

Yahoo.com: http://dir.yahoo.com/Health/Alternative_Medicine/

The following is a specific Web list relating to Coumadin; please note that any particular subject below may indicate either a therapeutic use, or a contraindication (potential danger), and does not reflect an official recommendation: •

General Overview Atherosclerosis and Heart Disease Prevention Source: Prima Communications, Inc.www.personalhealthzone.com Cancer Prevention (reducing the Risk) Source: Prima Communications, Inc.www.personalhealthzone.com Capillary Fragility Source: Healthnotes, Inc.; www.healthnotes.com Cataracts (Prevention) Source: Prima Communications, Inc.www.personalhealthzone.com Cyclic Mastalgia Alternative names: Cyclic Mastitis, Fibrocystic Breast Disease Source: Prima Communications, Inc.www.personalhealthzone.com Dysmenorrhea Alternative names: Painful Menstruation Source: Prima Communications, Inc.www.personalhealthzone.com Eczema Source: Prima Communications, Inc.www.personalhealthzone.com Edema Source: Healthnotes, Inc.; www.healthnotes.com High Cholesterol Source: Prima Communications, Inc.www.personalhealthzone.com Hypertension Alternative names: High Blood Pressure Source: Prima Communications, Inc.www.personalhealthzone.com Migraine Headaches Source: Prima Communications, Inc.www.personalhealthzone.com Nausea Source: Prima Communications, Inc.www.personalhealthzone.com

Alternative Medicine 25

Osteoporosis Source: Prima Communications, Inc.www.personalhealthzone.com Prostate Cancer Source: Healthnotes, Inc.; www.healthnotes.com Psoriasis Source: Prima Communications, Inc.www.personalhealthzone.com Rheumatoid Arthritis Source: Prima Communications, Inc.www.personalhealthzone.com Varicose Veins Source: Prima Communications, Inc.www.personalhealthzone.com •

Herbs and Supplements Aortic Glycosaminoglycans Source: Prima Communications, Inc.www.personalhealthzone.com Bromelain Source: Prima Communications, Inc.www.personalhealthzone.com Coleus Forskohlii Source: Prima Communications, Inc.www.personalhealthzone.com Devil's Claw Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,970,00.html Dipyridamole Source: Healthnotes, Inc.; www.healthnotes.com Feverfew Source: Prima Communications, Inc.www.personalhealthzone.com Ginger Source: Prima Communications, Inc.www.personalhealthzone.com Ginkgo Source: Prima Communications, Inc.www.personalhealthzone.com Ginseng Source: Prima Communications, Inc.www.personalhealthzone.com Horse Chestnut Source: Prima Communications, Inc.www.personalhealthzone.com Horse Chestnut Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com

26

Coumadin

Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,10037,00.html Ipriflavone Source: Prima Communications, Inc.www.personalhealthzone.com MSM Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,807,00.html OPCS (Oligomeric Proanthocyanidins) Source: Prima Communications, Inc.www.personalhealthzone.com Red Clover Source: Prima Communications, Inc.www.personalhealthzone.com Reishi Source: Prima Communications, Inc.www.personalhealthzone.com Warfarin Alternative names: Coumadin Source: Prima Communications, Inc.www.personalhealthzone.com

General References A good place to find general background information on CAM is the National Library of Medicine. It has prepared within the MEDLINEplus system an information topic page dedicated to complementary and alternative medicine. To access this page, go to the MEDLINEplus site at http://www.nlm.nih.gov/medlineplus/alternativemedicine.html. This Web site provides a general overview of various topics and can lead to a number of general sources.

27

CHAPTER 4. BOOKS ON COUMADIN Overview This chapter provides bibliographic book references relating to Coumadin. In addition to online booksellers such as www.amazon.com and www.bn.com, excellent sources for book titles on Coumadin include the Combined Health Information Database and the National Library of Medicine. Your local medical library also may have these titles available for loan.

Book Summaries: Online Booksellers Commercial Internet-based booksellers, such as Amazon.com and Barnes&Noble.com, offer summaries which have been supplied by each title’s publisher. Some summaries also include customer reviews. Your local bookseller may have access to in-house and commercial databases that index all published books (e.g. Books in Print). IMPORTANT NOTE: Online booksellers typically produce search results for medical and non-medical books. When searching for “Coumadin” at online booksellers’ Web sites, you may discover non-medical books that use the generic term “Coumadin” (or a synonym) in their titles. The following is indicative of the results you might find when searching for “Coumadin” (sorted alphabetically by title; follow the hyperlink to view more details at Amazon.com): •

The Coumadin Cookbook: A Complete Guide to Healthy Meals When Taking Coumadin by Rene Desmarais, MD, et al; ISBN: 0966430816; http://www.amazon.com/exec/obidos/ASIN/0966430816/icongroupinterna

The National Library of Medicine Book Index The National Library of Medicine at the National Institutes of Health has a massive database of books published on healthcare and biomedicine. Go to the following Internet site, http://locatorplus.gov/, and then select “Search LOCATORplus.” Once you are in the search area, simply type “Coumadin” (or synonyms) into the search box, and select “books only.”

28

Coumadin

From there, results can be sorted by publication date, author, or relevance. The following was recently catalogued by the National Library of Medicine:8 •

Studies on proteins and lipoproteins in canine experimental nephrosis; with special reference to the effects of coumadin, heparin, and nicotinic acid. Author: Gall, John Christian,; Year: 1957; [Minneapolis] 1957

Chapters on Coumadin In order to find chapters that specifically relate to Coumadin, an excellent source of abstracts is the Combined Health Information Database. You will need to limit your search to book chapters and Coumadin using the “Detailed Search” option. Go to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find book chapters, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Book Chapter.” Type “Coumadin” (or synonyms) into the “For these words:” box.

8

In addition to LOCATORPlus, in collaboration with authors and publishers, the National Center for Biotechnology Information (NCBI) is currently adapting biomedical books for the Web. The books may be accessed in two ways: (1) by searching directly using any search term or phrase (in the same way as the bibliographic database PubMed), or (2) by following the links to PubMed abstracts. Each PubMed abstract has a "Books" button that displays a facsimile of the abstract in which some phrases are hypertext links. These phrases are also found in the books available at NCBI. Click on hyperlinked results in the list of books in which the phrase is found. Currently, the majority of the links are between the books and PubMed. In the future, more links will be created between the books and other types of information, such as gene and protein sequences and macromolecular structures. See http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Books.

29

CHAPTER 5. PERIODICALS AND NEWS ON COUMADIN Overview In this chapter, we suggest a number of news sources and present various periodicals that cover Coumadin.

News Services and Press Releases One of the simplest ways of tracking press releases on Coumadin is to search the news wires. In the following sample of sources, we will briefly describe how to access each service. These services only post recent news intended for public viewing. PR Newswire To access the PR Newswire archive, simply go to http://www.prnewswire.com/. Select your country. Type “Coumadin” (or synonyms) into the search box. You will automatically receive information on relevant news releases posted within the last 30 days. The search results are shown by order of relevance. Reuters Health The Reuters’ Medical News and Health eLine databases can be very useful in exploring news archives relating to Coumadin. While some of the listed articles are free to view, others are available for purchase for a nominal fee. To access this archive, go to http://www.reutershealth.com/en/index.html and search by “Coumadin” (or synonyms). The following was recently listed in this archive for Coumadin: •

DuPont reaches $44.5 million preliminary settlement for Coumadin suits Source: Reuters Industry Breifing Date: August 07, 2001

•

New Coumadin packaging insert warns against duplicate dosing Source: Reuters Medical News Date: June 11, 1998

30

Coumadin

•

Summer Fare Can Affect Coumadin Dose Source: Reuters Health eLine Date: August 11, 1997

•

DuPont Merck Markets New Strengths Of Coumadin Source: Reuters Medical News Date: February 13, 1997

•

Dupont Merck Gets New Indication For Coumadin Source: Reuters Medical News Date: June 15, 1995 The NIH

Within MEDLINEplus, the NIH has made an agreement with the New York Times Syndicate, the AP News Service, and Reuters to deliver news that can be browsed by the public. Search news releases at http://www.nlm.nih.gov/medlineplus/alphanews_a.html. MEDLINEplus allows you to browse across an alphabetical index. Or you can search by date at the following Web page: http://www.nlm.nih.gov/medlineplus/newsbydate.html. Often, news items are indexed by MEDLINEplus within its search engine. Business Wire Business Wire is similar to PR Newswire. To access this archive, simply go to http://www.businesswire.com/. You can scan the news by industry category or company name. Market Wire Market Wire is more focused on technology than the other wires. To browse the latest press releases by topic, such as alternative medicine, biotechnology, fitness, healthcare, legal, nutrition, and pharmaceuticals, access Market Wire’s Medical/Health channel at http://www.marketwire.com/mw/release_index?channel=MedicalHealth. Or simply go to Market Wire’s home page at http://www.marketwire.com/mw/home, type “Coumadin” (or synonyms) into the search box, and click on “Search News.” As this service is technology oriented, you may wish to use it when searching for press releases covering diagnostic procedures or tests. Search Engines Medical news is also available in the news sections of commercial Internet search engines. See the health news page at Yahoo (http://dir.yahoo.com/Health/News_and_Media/), or you can use this Web site’s general news search page at http://news.yahoo.com/. Type in “Coumadin” (or synonyms). If you know the name of a company that is relevant to Coumadin, you can go to any stock trading Web site (such as http://www.etrade.com/) and search for the company name there. News items across various news sources are reported on indicated hyperlinks. Google offers a similar service at http://news.google.com/.

Periodicals and News

31

BBC Covering news from a more European perspective, the British Broadcasting Corporation (BBC) allows the public free access to their news archive located at http://www.bbc.co.uk/. Search by “Coumadin” (or synonyms).

Academic Periodicals covering Coumadin Numerous periodicals are currently indexed within the National Library of Medicine’s PubMed database that are known to publish articles relating to Coumadin. In addition to these sources, you can search for articles covering Coumadin that have been published by any of the periodicals listed in previous chapters. To find the latest studies published, go to http://www.ncbi.nlm.nih.gov/pubmed, type the name of the periodical into the search box, and click “Go.” If you want complete details about the historical contents of a journal, you can also visit the following Web site: http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi. Here, type in the name of the journal or its abbreviation, and you will receive an index of published articles. At http://locatorplus.gov/, you can retrieve more indexing information on medical periodicals (e.g. the name of the publisher). Select the button “Search LOCATORplus.” Then type in the name of the journal and select the advanced search option “Journal Title Search.”

33

APPENDICES

35

APPENDIX A. PHYSICIAN RESOURCES Overview In this chapter, we focus on databases and Internet-based guidelines and information resources created or written for a professional audience.

NIH Guidelines Commonly referred to as “clinical” or “professional” guidelines, the National Institutes of Health publish physician guidelines for the most common diseases. Publications are available at the following by relevant Institute9: •

Office of the Director (OD); guidelines consolidated across agencies available at http://www.nih.gov/health/consumer/conkey.htm

•

National Institute of General Medical Sciences (NIGMS); fact sheets available at http://www.nigms.nih.gov/news/facts/

•

National Library of Medicine (NLM); extensive encyclopedia (A.D.A.M., Inc.) with guidelines: http://www.nlm.nih.gov/medlineplus/healthtopics.html

•

National Cancer Institute (NCI); guidelines available at http://www.cancer.gov/cancerinfo/list.aspx?viewid=5f35036e-5497-4d86-8c2c714a9f7c8d25

•

National Eye Institute (NEI); guidelines available at http://www.nei.nih.gov/order/index.htm

•

National Heart, Lung, and Blood Institute (NHLBI); guidelines available at http://www.nhlbi.nih.gov/guidelines/index.htm

•

National Human Genome Research Institute (NHGRI); research available at http://www.genome.gov/page.cfm?pageID=10000375

•

National Institute on Aging (NIA); guidelines available at http://www.nia.nih.gov/health/

9

These publications are typically written by one or more of the various NIH Institutes.

36

Coumadin

•

National Institute on Alcohol Abuse and Alcoholism (NIAAA); guidelines available at http://www.niaaa.nih.gov/publications/publications.htm

•

National Institute of Allergy and Infectious Diseases (NIAID); guidelines available at http://www.niaid.nih.gov/publications/

•

National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS); fact sheets and guidelines available at http://www.niams.nih.gov/hi/index.htm

•

National Institute of Child Health and Human Development (NICHD); guidelines available at http://www.nichd.nih.gov/publications/pubskey.cfm

•

National Institute on Deafness and Other Communication Disorders (NIDCD); fact sheets and guidelines at http://www.nidcd.nih.gov/health/

•

National Institute of Dental and Craniofacial Research (NIDCR); guidelines available at http://www.nidr.nih.gov/health/

•

National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK); guidelines available at http://www.niddk.nih.gov/health/health.htm

•

National Institute on Drug Abuse (NIDA); guidelines available at http://www.nida.nih.gov/DrugAbuse.html

•

National Institute of Environmental Health Sciences (NIEHS); environmental health information available at http://www.niehs.nih.gov/external/facts.htm

•

National Institute of Mental Health (NIMH); guidelines available at http://www.nimh.nih.gov/practitioners/index.cfm

•

National Institute of Neurological Disorders and Stroke (NINDS); neurological disorder information pages available at http://www.ninds.nih.gov/health_and_medical/disorder_index.htm

•

National Institute of Nursing Research (NINR); publications on selected illnesses at http://www.nih.gov/ninr/news-info/publications.html

•

National Institute of Biomedical Imaging and Bioengineering; general information at http://grants.nih.gov/grants/becon/becon_info.htm

•

Center for Information Technology (CIT); referrals to other agencies based on keyword searches available at http://kb.nih.gov/www_query_main.asp

•

National Center for Complementary and Alternative Medicine (NCCAM); health information available at http://nccam.nih.gov/health/

•

National Center for Research Resources (NCRR); various information directories available at http://www.ncrr.nih.gov/publications.asp

•

Office of Rare Diseases; various fact sheets available at http://rarediseases.info.nih.gov/html/resources/rep_pubs.html

•

Centers for Disease Control and Prevention; various fact sheets on infectious diseases available at http://www.cdc.gov/publications.htm

Physician Resources

37

NIH Databases In addition to the various Institutes of Health that publish professional guidelines, the NIH has designed a number of databases for professionals.10 Physician-oriented resources provide a wide variety of information related to the biomedical and health sciences, both past and present. The format of these resources varies. Searchable databases, bibliographic citations, full-text articles (when available), archival collections, and images are all available. The following are referenced by the National Library of Medicine:11 •

Bioethics: Access to published literature on the ethical, legal, and public policy issues surrounding healthcare and biomedical research. This information is provided in conjunction with the Kennedy Institute of Ethics located at Georgetown University, Washington, D.C.: http://www.nlm.nih.gov/databases/databases_bioethics.html

•

HIV/AIDS Resources: Describes various links and databases dedicated to HIV/AIDS research: http://www.nlm.nih.gov/pubs/factsheets/aidsinfs.html

•

NLM Online Exhibitions: Describes “Exhibitions in the History of Medicine”: http://www.nlm.nih.gov/exhibition/exhibition.html. Additional resources for historical scholarship in medicine: http://www.nlm.nih.gov/hmd/hmd.html

•

Biotechnology Information: Access to public databases. The National Center for Biotechnology Information conducts research in computational biology, develops software tools for analyzing genome data, and disseminates biomedical information for the better understanding of molecular processes affecting human health and disease: http://www.ncbi.nlm.nih.gov/

•

Population Information: The National Library of Medicine provides access to worldwide coverage of population, family planning, and related health issues, including family planning technology and programs, fertility, and population law and policy: http://www.nlm.nih.gov/databases/databases_population.html

•

Cancer Information: Access to cancer-oriented databases: http://www.nlm.nih.gov/databases/databases_cancer.html

•

Profiles in Science: Offering the archival collections of prominent twentieth-century biomedical scientists to the public through modern digital technology: http://www.profiles.nlm.nih.gov/

•

Chemical Information: Provides links to various chemical databases and references: http://sis.nlm.nih.gov/Chem/ChemMain.html

•

Clinical Alerts: Reports the release of findings from the NIH-funded clinical trials where such release could significantly affect morbidity and mortality: http://www.nlm.nih.gov/databases/alerts/clinical_alerts.html

•

Space Life Sciences: Provides links and information to space-based research (including NASA): http://www.nlm.nih.gov/databases/databases_space.html

•

MEDLINE: Bibliographic database covering the fields of medicine, nursing, dentistry, veterinary medicine, the healthcare system, and the pre-clinical sciences: http://www.nlm.nih.gov/databases/databases_medline.html

10

Remember, for the general public, the National Library of Medicine recommends the databases referenced in MEDLINEplus (http://medlineplus.gov/ or http://www.nlm.nih.gov/medlineplus/databases.html). 11 See http://www.nlm.nih.gov/databases/databases.html.

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Coumadin

•

Toxicology and Environmental Health Information (TOXNET): Databases covering toxicology and environmental health: http://sis.nlm.nih.gov/Tox/ToxMain.html

•

Visible Human Interface: Anatomically detailed, three-dimensional representations of normal male and female human bodies: http://www.nlm.nih.gov/research/visible/visible_human.html The Combined Health Information Database

A comprehensive source of information on clinical guidelines written for professionals is the Combined Health Information Database. You will need to limit your search to one of the following: Brochure/Pamphlet, Fact Sheet, or Information Package, and “Coumadin” using the “Detailed Search” option. Go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find associations, use the drop boxes at the bottom of the search page where “You may refine your search by.” For the publication date, select “All Years.” Select your preferred language and the format option “Fact Sheet.” Type “Coumadin” (or synonyms) into the “For these words:” box. The following is a sample result: •

Case studies from the quality improvement support system Source: Silver Spring, MD: Agency for Health Care Policy and Research, U.S. Department of Health and Human Services. 1997. 107 pp. Contact: Available from AHCPR Clearinghouse, U.S. Agency for Healthcare Research and Quality , 2101 East Jefferson Street, Suite 501, Rockville, MD 20852. Telephone: (800) 358-9295 clearinghouse or (301) 594-1364 AHCPR public affairs / Web site: http://www.ahcpr.gov. Available at no charge. Summary: This report consists of several case studies of attempts to improve the quality of patient care in various clinical settings. Each case example defines the project's purpose; methods; professions involved, such as physicians, pharmacists, nurses, patient self-care; results; lessons learned; a brief reference list; and comments by a reviewer. The topics are: acute chest pain management; applications of pharmaceutical clinical algorithms; asthma self-management, and reducing asthma visits to emergency room; cardiac surgery clinical pathway, recovery, and outcome improvement; carotid endarterectomy; reducing cesarean section rates; management of chronic obstructive pulmonary disease; Coumadin management; partnership in pregnancy and parenting program; surgical preparedness; and total hip replacement care.

The NLM Gateway12 The NLM (National Library of Medicine) Gateway is a Web-based system that lets users search simultaneously in multiple retrieval systems at the U.S. National Library of Medicine (NLM). It allows users of NLM services to initiate searches from one Web interface, providing one-stop searching for many of NLM’s information resources or databases.13 To use the NLM Gateway, simply go to the search site at http://gateway.nlm.nih.gov/gw/Cmd.

12 13

Adapted from NLM: http://gateway.nlm.nih.gov/gw/Cmd?Overview.x.

The NLM Gateway is currently being developed by the Lister Hill National Center for Biomedical Communications (LHNCBC) at the National Library of Medicine (NLM) of the National Institutes of Health (NIH).

Physician Resources

39

Type “Coumadin” (or synonyms) into the search box and click “Search.” The results will be presented in a tabular form, indicating the number of references in each database category. Results Summary Category Journal Articles Books / Periodicals / Audio Visual Consumer Health Meeting Abstracts Other Collections Total

Items Found 7722 44 1012 20 8 8806

HSTAT14 HSTAT is a free, Web-based resource that provides access to full-text documents used in healthcare decision-making.15 These documents include clinical practice guidelines, quickreference guides for clinicians, consumer health brochures, evidence reports and technology assessments from the Agency for Healthcare Research and Quality (AHRQ), as well as AHRQ’s Put Prevention Into Practice.16 Simply search by “Coumadin” (or synonyms) at the following Web site: http://text.nlm.nih.gov.

Coffee Break: Tutorials for Biologists17 Coffee Break is a general healthcare site that takes a scientific view of the news and covers recent breakthroughs in biology that may one day assist physicians in developing treatments. Here you will find a collection of short reports on recent biological discoveries. Each report incorporates interactive tutorials that demonstrate how bioinformatics tools are used as a part of the research process. Currently, all Coffee Breaks are written by NCBI staff.18 Each report is about 400 words and is usually based on a discovery reported in one or more articles from recently published, peer-reviewed literature.19 This site has new articles every few weeks, so it can be considered an online magazine of sorts. It is intended for general background information. You can access the Coffee Break Web site at the following hyperlink: http://www.ncbi.nlm.nih.gov/Coffeebreak/. 14

Adapted from HSTAT: http://www.nlm.nih.gov/pubs/factsheets/hstat.html.

15

The HSTAT URL is http://hstat.nlm.nih.gov/.

16

Other important documents in HSTAT include: the National Institutes of Health (NIH) Consensus Conference Reports and Technology Assessment Reports; the HIV/AIDS Treatment Information Service (ATIS) resource documents; the Substance Abuse and Mental Health Services Administration's Center for Substance Abuse Treatment (SAMHSA/CSAT) Treatment Improvement Protocols (TIP) and Center for Substance Abuse Prevention (SAMHSA/CSAP) Prevention Enhancement Protocols System (PEPS); the Public Health Service (PHS) Preventive Services Task Force's Guide to Clinical Preventive Services; the independent, nonfederal Task Force on Community Services’ Guide to Community Preventive Services; and the Health Technology Advisory Committee (HTAC) of the Minnesota Health Care Commission (MHCC) health technology evaluations. 17 Adapted from http://www.ncbi.nlm.nih.gov/Coffeebreak/Archive/FAQ.html. 18

The figure that accompanies each article is frequently supplied by an expert external to NCBI, in which case the source of the figure is cited. The result is an interactive tutorial that tells a biological story. 19 After a brief introduction that sets the work described into a broader context, the report focuses on how a molecular understanding can provide explanations of observed biology and lead to therapies for diseases. Each vignette is accompanied by a figure and hypertext links that lead to a series of pages that interactively show how NCBI tools and resources are used in the research process.

40

Coumadin

Other Commercial Databases In addition to resources maintained by official agencies, other databases exist that are commercial ventures addressing medical professionals. Here are some examples that may interest you: •

CliniWeb International: Index and table of contents to selected clinical information on the Internet; see http://www.ohsu.edu/cliniweb/.

•

Medical World Search: Searches full text from thousands of selected medical sites on the Internet; see http://www.mwsearch.com/.

41

APPENDIX B. PATIENT RESOURCES Overview Official agencies, as well as federally funded institutions supported by national grants, frequently publish a variety of guidelines written with the patient in mind. These are typically called “Fact Sheets” or “Guidelines.” They can take the form of a brochure, information kit, pamphlet, or flyer. Often they are only a few pages in length. Since new guidelines on Coumadin can appear at any moment and be published by a number of sources, the best approach to finding guidelines is to systematically scan the Internet-based services that post them.

Patient Guideline Sources The remainder of this chapter directs you to sources which either publish or can help you find additional guidelines on topics related to Coumadin. Due to space limitations, these sources are listed in a concise manner. Do not hesitate to consult the following sources by either using the Internet hyperlink provided, or, in cases where the contact information is provided, contacting the publisher or author directly. The National Institutes of Health The NIH gateway to patients is located at http://health.nih.gov/. From this site, you can search across various sources and institutes, a number of which are summarized below. Topic Pages: MEDLINEplus The National Library of Medicine has created a vast and patient-oriented healthcare information portal called MEDLINEplus. Within this Internet-based system are “health topic pages” which list links to available materials relevant to Coumadin. To access this system, log on to http://www.nlm.nih.gov/medlineplus/healthtopics.html. From there you can either search using the alphabetical index or browse by broad topic areas. Recently, MEDLINEplus listed the following when searched for “Coumadin”:

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Coumadin

•

Other guides Bleeding Disorders http://www.nlm.nih.gov/medlineplus/bleedingdisorders.html Pulmonary Embolism http://www.nlm.nih.gov/medlineplus/pulmonaryembolism.html Stroke http://www.nlm.nih.gov/medlineplus/stroke.html Thrombophlebitis http://www.nlm.nih.gov/medlineplus/thrombophlebitis.html Transient Ischemic Attack http://www.nlm.nih.gov/medlineplus/transientischemicattack.html

You may also choose to use the search utility provided by MEDLINEplus at the following Web address: http://www.nlm.nih.gov/medlineplus/. Simply type a keyword into the search box and click “Search.” This utility is similar to the NIH search utility, with the exception that it only includes materials that are linked within the MEDLINEplus system (mostly patient-oriented information). It also has the disadvantage of generating unstructured results. We recommend, therefore, that you use this method only if you have a very targeted search. The Combined Health Information Database (CHID) CHID Online is a reference tool that maintains a database directory of thousands of journal articles and patient education guidelines on Coumadin. CHID offers summaries that describe the guidelines available, including contact information and pricing. CHID’s general Web site is http://chid.nih.gov/. To search this database, go to http://chid.nih.gov/detail/detail.html. In particular, you can use the advanced search options to look up pamphlets, reports, brochures, and information kits. The following was recently posted in this archive: •

Just the Facts: Skin and Hair Problems on Dialysis Source: Madison, WI: Life Options Rehabilitation Program. 2000. [2 p.]. Contact: Available from Life Options Rehabilitation Program. Medical Education Institute, Inc, 414 D'Onofrid Drive., Suite 200, Madison, WI 53719. (608) 833-8033. Email: [email protected]. PRICE: Single copy free to health professionals only. Summary: This fact sheet offers information for patients on dialysis about skin and hair problems that they may encounter. Many people on dialysis have skin changes, primarily an increased tendency to bruise and dry, itching, or cracking skin. The fact sheet answers common questions related to skin and hair problems. Bruising can occur if the patient's dose of blood thinner (heparin) is too high, or if the blood level of platelets (clotting cells) is too low. Some drugs, such as prednisone or coumadin, can increase bruising. Itching has many causes, including high blood levels of phosphorus, not enough dialysis, dry skin, allergy to drugs or other products used at the dialysis center. Other skin problems can indicate porphyria, which needs to be treated by a skin specialist. Hair loss can be due to malnourishment, zinc deficiency, thyroid problems, or drug reactions. The reverse side of the fact sheet offers a chart that summarizes the problems under discussion, how each can be prevented, and recommended questions to

Patient Resources

43

ask the health care provider about each problem. The fact sheet includes the contact information for the Life Options Rehabilitation Program (800-468-7777, [email protected]). The NIH Search Utility The NIH search utility allows you to search for documents on over 100 selected Web sites that comprise the NIH-WEB-SPACE. Each of these servers is “crawled” and indexed on an ongoing basis. Your search will produce a list of various documents, all of which will relate in some way to Coumadin. The drawbacks of this approach are that the information is not organized by theme and that the references are often a mix of information for professionals and patients. Nevertheless, a large number of the listed Web sites provide useful background information. We can only recommend this route, therefore, for relatively rare or specific disorders, or when using highly targeted searches. To use the NIH search utility, visit the following Web page: http://search.nih.gov/index.html. Additional Web Sources A number of Web sites are available to the public that often link to government sites. These can also point you in the direction of essential information. The following is a representative sample: •

AOL: http://search.aol.com/cat.adp?id=168&layer=&from=subcats

•

Family Village: http://www.familyvillage.wisc.edu/specific.htm

•

Google: http://directory.google.com/Top/Health/Conditions_and_Diseases/

•

Med Help International: http://www.medhelp.org/HealthTopics/A.html

•

Open Directory Project: http://dmoz.org/Health/Conditions_and_Diseases/

•

Yahoo.com: http://dir.yahoo.com/Health/Diseases_and_Conditions/

•

WebMDHealth: http://my.webmd.com/health_topics

Finding Associations There are several Internet directories that provide lists of medical associations with information on or resources relating to Coumadin. By consulting all of associations listed in this chapter, you will have nearly exhausted all sources for patient associations concerned with Coumadin. The National Health Information Center (NHIC) The National Health Information Center (NHIC) offers a free referral service to help people find organizations that provide information about Coumadin. For more information, see the NHIC’s Web site at http://www.health.gov/NHIC/ or contact an information specialist by calling 1-800-336-4797.

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Directory of Health Organizations The Directory of Health Organizations, provided by the National Library of Medicine Specialized Information Services, is a comprehensive source of information on associations. The Directory of Health Organizations database can be accessed via the Internet at http://www.sis.nlm.nih.gov/Dir/DirMain.html. It is composed of two parts: DIRLINE and Health Hotlines. The DIRLINE database comprises some 10,000 records of organizations, research centers, and government institutes and associations that primarily focus on health and biomedicine. To access DIRLINE directly, go to the following Web site: http://dirline.nlm.nih.gov/. Simply type in “Coumadin” (or a synonym), and you will receive information on all relevant organizations listed in the database. Health Hotlines directs you to toll-free numbers to over 300 organizations. You can access this database directly at http://www.sis.nlm.nih.gov/hotlines/. On this page, you are given the option to search by keyword or by browsing the subject list. When you have received your search results, click on the name of the organization for its description and contact information. The Combined Health Information Database Another comprehensive source of information on healthcare associations is the Combined Health Information Database. Using the “Detailed Search” option, you will need to limit your search to “Organizations” and “Coumadin”. Type the following hyperlink into your Web browser: http://chid.nih.gov/detail/detail.html. To find associations, use the drop boxes at the bottom of the search page where “You may refine your search by.” For publication date, select “All Years.” Then, select your preferred language and the format option “Organization Resource Sheet.” Type “Coumadin” (or synonyms) into the “For these words:” box. You should check back periodically with this database since it is updated every three months. The National Organization for Rare Disorders, Inc. The National Organization for Rare Disorders, Inc. has prepared a Web site that provides, at no charge, lists of associations organized by health topic. You can access this database at the following Web site: http://www.rarediseases.org/search/orgsearch.html. Type “Coumadin” (or a synonym) into the search box, and click “Submit Query.”

45

APPENDIX C. FINDING MEDICAL LIBRARIES Overview In this Appendix, we show you how to quickly find a medical library in your area.

Preparation Your local public library and medical libraries have interlibrary loan programs with the National Library of Medicine (NLM), one of the largest medical collections in the world. According to the NLM, most of the literature in the general and historical collections of the National Library of Medicine is available on interlibrary loan to any library. If you would like to access NLM medical literature, then visit a library in your area that can request the publications for you.20

Finding a Local Medical Library The quickest method to locate medical libraries is to use the Internet-based directory published by the National Network of Libraries of Medicine (NN/LM). This network includes 4626 members and affiliates that provide many services to librarians, health professionals, and the public. To find a library in your area, simply visit http://nnlm.gov/members/adv.html or call 1-800-338-7657.

Medical Libraries in the U.S. and Canada In addition to the NN/LM, the National Library of Medicine (NLM) lists a number of libraries with reference facilities that are open to the public. The following is the NLM’s list and includes hyperlinks to each library’s Web site. These Web pages can provide information on hours of operation and other restrictions. The list below is a small sample of

20

Adapted from the NLM: http://www.nlm.nih.gov/psd/cas/interlibrary.html.

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libraries recommended by the National Library of Medicine (sorted alphabetically by name of the U.S. state or Canadian province where the library is located)21: •

Alabama: Health InfoNet of Jefferson County (Jefferson County Library Cooperative, Lister Hill Library of the Health Sciences), http://www.uab.edu/infonet/

•

Alabama: Richard M. Scrushy Library (American Sports Medicine Institute)

•

Arizona: Samaritan Regional Medical Center: The Learning Center (Samaritan Health System, Phoenix, Arizona), http://www.samaritan.edu/library/bannerlibs.htm

•

California: Kris Kelly Health Information Center (St. Joseph Health System, Humboldt), http://www.humboldt1.com/~kkhic/index.html

•

California: Community Health Library of Los Gatos, http://www.healthlib.org/orgresources.html

•

California: Consumer Health Program and Services (CHIPS) (County of Los Angeles Public Library, Los Angeles County Harbor-UCLA Medical Center Library) - Carson, CA, http://www.colapublib.org/services/chips.html

•

California: Gateway Health Library (Sutter Gould Medical Foundation)

•

California: Health Library (Stanford University Medical Center), http://wwwmed.stanford.edu/healthlibrary/

•

California: Patient Education Resource Center - Health Information and Resources (University of California, San Francisco), http://sfghdean.ucsf.edu/barnett/PERC/default.asp

•

California: Redwood Health Library (Petaluma Health Care District), http://www.phcd.org/rdwdlib.html

•

California: Los Gatos PlaneTree Health Library, http://planetreesanjose.org/

•

California: Sutter Resource Library (Sutter Hospitals Foundation, Sacramento), http://suttermedicalcenter.org/library/

•

California: Health Sciences Libraries (University of California, Davis), http://www.lib.ucdavis.edu/healthsci/

•

California: ValleyCare Health Library & Ryan Comer Cancer Resource Center (ValleyCare Health System, Pleasanton), http://gaelnet.stmarysca.edu/other.libs/gbal/east/vchl.html

•

California: Washington Community Health Resource Library (Fremont), http://www.healthlibrary.org/

•

Colorado: William V. Gervasini Memorial Library (Exempla Healthcare), http://www.saintjosephdenver.org/yourhealth/libraries/

•

Connecticut: Hartford Hospital Health Science Libraries (Hartford Hospital), http://www.harthosp.org/library/

•

Connecticut: Healthnet: Connecticut Consumer Health Information Center (University of Connecticut Health Center, Lyman Maynard Stowe Library), http://library.uchc.edu/departm/hnet/

21

Abstracted from http://www.nlm.nih.gov/medlineplus/libraries.html.

Finding Medical Libraries

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•

Connecticut: Waterbury Hospital Health Center Library (Waterbury Hospital, Waterbury), http://www.waterburyhospital.com/library/consumer.shtml

•

Delaware: Consumer Health Library (Christiana Care Health System, Eugene du Pont Preventive Medicine & Rehabilitation Institute, Wilmington), http://www.christianacare.org/health_guide/health_guide_pmri_health_info.cfm

•

Delaware: Lewis B. Flinn Library (Delaware Academy of Medicine, Wilmington), http://www.delamed.org/chls.html

•

Georgia: Family Resource Library (Medical College of Georgia, Augusta), http://cmc.mcg.edu/kids_families/fam_resources/fam_res_lib/frl.htm

•

Georgia: Health Resource Center (Medical Center of Central Georgia, Macon), http://www.mccg.org/hrc/hrchome.asp

•

Hawaii: Hawaii Medical Library: Consumer Health Information Service (Hawaii Medical Library, Honolulu), http://hml.org/CHIS/

•

Idaho: DeArmond Consumer Health Library (Kootenai Medical Center, Coeur d’Alene), http://www.nicon.org/DeArmond/index.htm

•

Illinois: Health Learning Center of Northwestern Memorial Hospital (Chicago), http://www.nmh.org/health_info/hlc.html

•

Illinois: Medical Library (OSF Saint Francis Medical Center, Peoria), http://www.osfsaintfrancis.org/general/library/

•

Kentucky: Medical Library - Services for Patients, Families, Students & the Public (Central Baptist Hospital, Lexington), http://www.centralbap.com/education/community/library.cfm

•

Kentucky: University of Kentucky - Health Information Library (Chandler Medical Center, Lexington), http://www.mc.uky.edu/PatientEd/

•

Louisiana: Alton Ochsner Medical Foundation Library (Alton Ochsner Medical Foundation, New Orleans), http://www.ochsner.org/library/

•

Louisiana: Louisiana State University Health Sciences Center Medical LibraryShreveport, http://lib-sh.lsuhsc.edu/

•

Maine: Franklin Memorial Hospital Medical Library (Franklin Memorial Hospital, Farmington), http://www.fchn.org/fmh/lib.htm

•

Maine: Gerrish-True Health Sciences Library (Central Maine Medical Center, Lewiston), http://www.cmmc.org/library/library.html

•

Maine: Hadley Parrot Health Science Library (Eastern Maine Healthcare, Bangor), http://www.emh.org/hll/hpl/guide.htm

•

Maine: Maine Medical Center Library (Maine Medical Center, Portland), http://www.mmc.org/library/

•

Maine: Parkview Hospital (Brunswick), http://www.parkviewhospital.org/

•

Maine: Southern Maine Medical Center Health Sciences Library (Southern Maine Medical Center, Biddeford), http://www.smmc.org/services/service.php3?choice=10

•

Maine: Stephens Memorial Hospital’s Health Information Library (Western Maine Health, Norway), http://www.wmhcc.org/Library/

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•

Manitoba, Canada: Consumer & Patient Health Information Service (University of Manitoba Libraries), http://www.umanitoba.ca/libraries/units/health/reference/chis.html

•

Manitoba, Canada: J.W. Crane Memorial Library (Deer Lodge Centre, Winnipeg), http://www.deerlodge.mb.ca/crane_library/about.asp

•

Maryland: Health Information Center at the Wheaton Regional Library (Montgomery County, Dept. of Public Libraries, Wheaton Regional Library), http://www.mont.lib.md.us/healthinfo/hic.asp

•

Massachusetts: Baystate Medical Center Library (Baystate Health System), http://www.baystatehealth.com/1024/

•

Massachusetts: Boston University Medical Center Alumni Medical Library (Boston University Medical Center), http://med-libwww.bu.edu/library/lib.html

•

Massachusetts: Lowell General Hospital Health Sciences Library (Lowell General Hospital, Lowell), http://www.lowellgeneral.org/library/HomePageLinks/WWW.htm

•

Massachusetts: Paul E. Woodard Health Sciences Library (New England Baptist Hospital, Boston), http://www.nebh.org/health_lib.asp

•

Massachusetts: St. Luke’s Hospital Health Sciences Library (St. Luke’s Hospital, Southcoast Health System, New Bedford), http://www.southcoast.org/library/

•

Massachusetts: Treadwell Library Consumer Health Reference Center (Massachusetts General Hospital), http://www.mgh.harvard.edu/library/chrcindex.html

•

Massachusetts: UMass HealthNet (University of Massachusetts Medical School, Worchester), http://healthnet.umassmed.edu/

•

Michigan: Botsford General Hospital Library - Consumer Health (Botsford General Hospital, Library & Internet Services), http://www.botsfordlibrary.org/consumer.htm

•

Michigan: Helen DeRoy Medical Library (Providence Hospital and Medical Centers), http://www.providence-hospital.org/library/

•

Michigan: Marquette General Hospital - Consumer Health Library (Marquette General Hospital, Health Information Center), http://www.mgh.org/center.html

•

Michigan: Patient Education Resouce Center - University of Michigan Cancer Center (University of Michigan Comprehensive Cancer Center, Ann Arbor), http://www.cancer.med.umich.edu/learn/leares.htm

•

Michigan: Sladen Library & Center for Health Information Resources - Consumer Health Information (Detroit), http://www.henryford.com/body.cfm?id=39330

•

Montana: Center for Health Information (St. Patrick Hospital and Health Sciences Center, Missoula)

•

National: Consumer Health Library Directory (Medical Library Association, Consumer and Patient Health Information Section), http://caphis.mlanet.org/directory/index.html

•

National: National Network of Libraries of Medicine (National Library of Medicine) provides library services for health professionals in the United States who do not have access to a medical library, http://nnlm.gov/

•

National: NN/LM List of Libraries Serving the Public (National Network of Libraries of Medicine), http://nnlm.gov/members/

Finding Medical Libraries

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•

Nevada: Health Science Library, West Charleston Library (Las Vegas-Clark County Library District, Las Vegas), http://www.lvccld.org/special_collections/medical/index.htm

•

New Hampshire: Dartmouth Biomedical Libraries (Dartmouth College Library, Hanover), http://www.dartmouth.edu/~biomed/resources.htmld/conshealth.htmld/

•

New Jersey: Consumer Health Library (Rahway Hospital, Rahway), http://www.rahwayhospital.com/library.htm

•

New Jersey: Dr. Walter Phillips Health Sciences Library (Englewood Hospital and Medical Center, Englewood), http://www.englewoodhospital.com/links/index.htm

•

New Jersey: Meland Foundation (Englewood Hospital and Medical Center, Englewood), http://www.geocities.com/ResearchTriangle/9360/

•

New York: Choices in Health Information (New York Public Library) - NLM Consumer Pilot Project participant, http://www.nypl.org/branch/health/links.html

•

New York: Health Information Center (Upstate Medical University, State University of New York, Syracuse), http://www.upstate.edu/library/hic/

•

New York: Health Sciences Library (Long Island Jewish Medical Center, New Hyde Park), http://www.lij.edu/library/library.html

•

New York: ViaHealth Medical Library (Rochester General Hospital), http://www.nyam.org/library/

•

Ohio: Consumer Health Library (Akron General Medical Center, Medical & Consumer Health Library), http://www.akrongeneral.org/hwlibrary.htm

•

Oklahoma: The Health Information Center at Saint Francis Hospital (Saint Francis Health System, Tulsa), http://www.sfh-tulsa.com/services/healthinfo.asp

•

Oregon: Planetree Health Resource Center (Mid-Columbia Medical Center, The Dalles), http://www.mcmc.net/phrc/

•

Pennsylvania: Community Health Information Library (Milton S. Hershey Medical Center, Hershey), http://www.hmc.psu.edu/commhealth/

•

Pennsylvania: Community Health Resource Library (Geisinger Medical Center, Danville), http://www.geisinger.edu/education/commlib.shtml

•

Pennsylvania: HealthInfo Library (Moses Taylor Hospital, Scranton), http://www.mth.org/healthwellness.html

•

Pennsylvania: Hopwood Library (University of Pittsburgh, Health Sciences Library System, Pittsburgh), http://www.hsls.pitt.edu/guides/chi/hopwood/index_html

•

Pennsylvania: Koop Community Health Information Center (College of Physicians of Philadelphia), http://www.collphyphil.org/kooppg1.shtml

•

Pennsylvania: Learning Resources Center - Medical Library (Susquehanna Health System, Williamsport), http://www.shscares.org/services/lrc/index.asp

•

Pennsylvania: Medical Library (UPMC Health System, Pittsburgh), http://www.upmc.edu/passavant/library.htm

•

Quebec, Canada: Medical Library (Montreal General Hospital), http://www.mghlib.mcgill.ca/

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•

South Dakota: Rapid City Regional Hospital Medical Library (Rapid City Regional Hospital), http://www.rcrh.org/Services/Library/Default.asp

•

Texas: Houston HealthWays (Houston Academy of Medicine-Texas Medical Center Library), http://hhw.library.tmc.edu/

•

Washington: Community Health Library (Kittitas Valley Community Hospital), http://www.kvch.com/

•

Washington: Southwest Washington Medical Center Library (Southwest Washington Medical Center, Vancouver), http://www.swmedicalcenter.com/body.cfm?id=72

51

ONLINE GLOSSARIES The Internet provides access to a number of free-to-use medical dictionaries. The National Library of Medicine has compiled the following list of online dictionaries: •

ADAM Medical Encyclopedia (A.D.A.M., Inc.), comprehensive medical reference: http://www.nlm.nih.gov/medlineplus/encyclopedia.html

•

MedicineNet.com Medical Dictionary (MedicineNet, Inc.): http://www.medterms.com/Script/Main/hp.asp

•

Merriam-Webster Medical Dictionary (Inteli-Health, Inc.): http://www.intelihealth.com/IH/

•

Multilingual Glossary of Technical and Popular Medical Terms in Eight European Languages (European Commission) - Danish, Dutch, English, French, German, Italian, Portuguese, and Spanish: http://allserv.rug.ac.be/~rvdstich/eugloss/welcome.html

•

On-line Medical Dictionary (CancerWEB): http://cancerweb.ncl.ac.uk/omd/

•

Rare Diseases Terms (Office of Rare Diseases): http://ord.aspensys.com/asp/diseases/diseases.asp

•

Technology Glossary (National Library of Medicine) - Health Care Technology: http://www.nlm.nih.gov/nichsr/ta101/ta10108.htm

Beyond these, MEDLINEplus contains a very patient-friendly encyclopedia covering every aspect of medicine (licensed from A.D.A.M., Inc.). The ADAM Medical Encyclopedia can be accessed at http://www.nlm.nih.gov/medlineplus/encyclopedia.html. ADAM is also available on commercial Web sites such as drkoop.com (http://www.drkoop.com/) and Web MD (http://my.webmd.com/adam/asset/adam_disease_articles/a_to_z/a).

Online Dictionary Directories The following are additional online directories compiled by the National Library of Medicine, including a number of specialized medical dictionaries: •

Medical Dictionaries: Medical & Biological (World Health Organization): http://www.who.int/hlt/virtuallibrary/English/diction.htm#Medical

•

MEL-Michigan Electronic Library List of Online Health and Medical Dictionaries (Michigan Electronic Library): http://mel.lib.mi.us/health/health-dictionaries.html

•

Patient Education: Glossaries (DMOZ Open Directory Project): http://dmoz.org/Health/Education/Patient_Education/Glossaries/

•

Web of Online Dictionaries (Bucknell University): http://www.yourdictionary.com/diction5.html#medicine

53

COUMADIN DICTIONARY The definitions below are derived from official public sources, including the National Institutes of Health [NIH] and the European Union [EU]. Adenosine: A nucleoside that is composed of adenine and d-ribose. Adenosine or adenosine derivatives play many important biological roles in addition to being components of DNA and RNA. Adenosine itself is a neurotransmitter. [NIH] Adrenal Medulla: The inner part of the adrenal gland; it synthesizes, stores and releases catecholamines. [NIH] Adrenergic: Activated by, characteristic of, or secreting epinephrine or substances with similar activity; the term is applied to those nerve fibres that liberate norepinephrine at a synapse when a nerve impulse passes, i.e., the sympathetic fibres. [EU] Adverse Effect: An unwanted side effect of treatment. [NIH] Affinity: 1. Inherent likeness or relationship. 2. A special attraction for a specific element, organ, or structure. 3. Chemical affinity; the force that binds atoms in molecules; the tendency of substances to combine by chemical reaction. 4. The strength of noncovalent chemical binding between two substances as measured by the dissociation constant of the complex. 5. In immunology, a thermodynamic expression of the strength of interaction between a single antigen-binding site and a single antigenic determinant (and thus of the stereochemical compatibility between them), most accurately applied to interactions among simple, uniform antigenic determinants such as haptens. Expressed as the association constant (K litres mole -1), which, owing to the heterogeneity of affinities in a population of antibody molecules of a given specificity, actually represents an average value (mean intrinsic association constant). 6. The reciprocal of the dissociation constant. [EU] Albumin: 1. Any protein that is soluble in water and moderately concentrated salt solutions and is coagulable by heat. 2. Serum albumin; the major plasma protein (approximately 60 per cent of the total), which is responsible for much of the plasma colloidal osmotic pressure and serves as a transport protein carrying large organic anions, such as fatty acids, bilirubin, and many drugs, and also carrying certain hormones, such as cortisol and thyroxine, when their specific binding globulins are saturated. Albumin is synthesized in the liver. Low serum levels occur in protein malnutrition, active inflammation and serious hepatic and renal disease. [EU] Algorithms: A procedure consisting of a sequence of algebraic formulas and/or logical steps to calculate or determine a given task. [NIH] Alkaline: Having the reactions of an alkali. [EU] Alkaloid: A member of a large group of chemicals that are made by plants and have nitrogen in them. Some alkaloids have been shown to work against cancer. [NIH] Alternative medicine: Practices not generally recognized by the medical community as standard or conventional medical approaches and used instead of standard treatments. Alternative medicine includes the taking of dietary supplements, megadose vitamins, and herbal preparations; the drinking of special teas; and practices such as massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Amino Acids: Organic compounds that generally contain an amino (-NH2) and a carboxyl (COOH) group. Twenty alpha-amino acids are the subunits which are polymerized to form proteins. [NIH]

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Amino Acids: Organic compounds that generally contain an amino (-NH2) and a carboxyl (COOH) group. Twenty alpha-amino acids are the subunits which are polymerized to form proteins. [NIH] Analog: In chemistry, a substance that is similar, but not identical, to another. [NIH] Anemia: A reduction in the number of circulating erythrocytes or in the quantity of hemoglobin. [NIH] Anesthesia: A state characterized by loss of feeling or sensation. This depression of nerve function is usually the result of pharmacologic action and is induced to allow performance of surgery or other painful procedures. [NIH] Anesthetics: Agents that are capable of inducing a total or partial loss of sensation, especially tactile sensation and pain. They may act to induce general anesthesia, in which an unconscious state is achieved, or may act locally to induce numbness or lack of sensation at a targeted site. [NIH] Angioplasty: Endovascular reconstruction of an artery, which may include the removal of atheromatous plaque and/or the endothelial lining as well as simple dilatation. These are procedures performed by catheterization. When reconstruction of an artery is performed surgically, it is called endarterectomy. [NIH] Anions: Negatively charged atoms, radicals or groups of atoms which travel to the anode or positive pole during electrolysis. [NIH] Antibodies: Immunoglobulin molecules having a specific amino acid sequence by virtue of which they interact only with the antigen that induced their synthesis in cells of the lymphoid series (especially plasma cells), or with an antigen closely related to it. [NIH] Antibody: A type of protein made by certain white blood cells in response to a foreign substance (antigen). Each antibody can bind to only a specific antigen. The purpose of this binding is to help destroy the antigen. Antibodies can work in several ways, depending on the nature of the antigen. Some antibodies destroy antigens directly. Others make it easier for white blood cells to destroy the antigen. [NIH] Anticoagulant: A drug that helps prevent blood clots from forming. Also called a blood thinner. [NIH] Antigen: Any substance which is capable, under appropriate conditions, of inducing a specific immune response and of reacting with the products of that response, that is, with specific antibody or specifically sensitized T-lymphocytes, or both. Antigens may be soluble substances, such as toxins and foreign proteins, or particulate, such as bacteria and tissue cells; however, only the portion of the protein or polysaccharide molecule known as the antigenic determinant (q.v.) combines with antibody or a specific receptor on a lymphocyte. Abbreviated Ag. [EU] Anti-inflammatory: Having to do with reducing inflammation. [NIH] Anti-Inflammatory Agents: Substances that reduce or suppress inflammation. [NIH] Antimetabolite: A chemical that is very similar to one required in a normal biochemical reaction in cells. Antimetabolites can stop or slow down the reaction. [NIH] Antineoplastic: Inhibiting or preventing the development of neoplasms, checking the maturation and proliferation of malignant cells. [EU] Antithrombotic: Preventing or interfering with the formation of thrombi; an agent that so acts. [EU] Arachidonic Acid: An unsaturated, essential fatty acid. It is found in animal and human fat as well as in the liver, brain, and glandular organs, and is a constituent of animal

Dictionary 55

phosphatides. It is formed by the synthesis from dietary linoleic acid and is a precursor in the biosynthesis of prostaglandins, thromboxanes, and leukotrienes. [NIH] Arterial: Pertaining to an artery or to the arteries. [EU] Arteries: The vessels carrying blood away from the heart. [NIH] Arterioles: The smallest divisions of the arteries located between the muscular arteries and the capillaries. [NIH] Arteriosclerosis: Thickening and loss of elasticity of arterial walls. Atherosclerosis is the most common form of arteriosclerosis and involves lipid deposition and thickening of the intimal cell layers within arteries. Additional forms of arteriosclerosis involve calcification of the media of muscular arteries (Monkeberg medial calcific sclerosis) and thickening of the walls of small arteries or arterioles due to cell proliferation or hyaline deposition (arteriolosclerosis). [NIH] Arteriovenous: Both arterial and venous; pertaining to or affecting an artery and a vein. [EU] Arteriovenous Fistula: An abnormal communication between an artery and a vein. [NIH] Arthroplasty: Surgical reconstruction of a joint to relieve pain or restore motion. [NIH] Aspirin: A drug that reduces pain, fever, inflammation, and blood clotting. Aspirin belongs to the family of drugs called nonsteroidal anti-inflammatory agents. It is also being studied in cancer prevention. [NIH] Assay: Determination of the amount of a particular constituent of a mixture, or of the biological or pharmacological potency of a drug. [EU] Atherectomy: Endovascular procedure in which atheromatous plaque is excised by a cutting or rotating catheter. It differs from balloon and laser angioplasty procedures which enlarge vessels by dilation but frequently do not remove much plaque. If the plaque is removed by surgical excision under general anesthesia rather than by an endovascular procedure through a catheter, it is called endarterectomy. [NIH] Atrial: Pertaining to an atrium. [EU] Atrial Fibrillation: Disorder of cardiac rhythm characterized by rapid, irregular atrial impulses and ineffective atrial contractions. [NIH] Atrium: A chamber; used in anatomical nomenclature to designate a chamber affording entrance to another structure or organ. Usually used alone to designate an atrium of the heart. [EU] Attenuation: Reduction of transmitted sound energy or its electrical equivalent. [NIH] Bacteria: Unicellular prokaryotic microorganisms which generally possess rigid cell walls, multiply by cell division, and exhibit three principal forms: round or coccal, rodlike or bacillary, and spiral or spirochetal. [NIH] Base: In chemistry, the nonacid part of a salt; a substance that combines with acids to form salts; a substance that dissociates to give hydroxide ions in aqueous solutions; a substance whose molecule or ion can combine with a proton (hydrogen ion); a substance capable of donating a pair of electrons (to an acid) for the formation of a coordinate covalent bond. [EU] Bioavailability: The degree to which a drug or other substance becomes available to the target tissue after administration. [EU] Biochemical: Relating to biochemistry; characterized by, produced by, or involving chemical reactions in living organisms. [EU] Biosynthesis: The building up of a chemical compound in the physiologic processes of a living organism. [EU]

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Biotechnology: Body of knowledge related to the use of organisms, cells or cell-derived constituents for the purpose of developing products which are technically, scientifically and clinically useful. Alteration of biologic function at the molecular level (i.e., genetic engineering) is a central focus; laboratory methods used include transfection and cloning technologies, sequence and structure analysis algorithms, computer databases, and gene and protein structure function analysis and prediction. [NIH] Biotransformation: The chemical alteration of an exogenous substance by or in a biological system. The alteration may inactivate the compound or it may result in the production of an active metabolite of an inactive parent compound. The alteration may be either nonsynthetic (oxidation-reduction, hydrolysis) or synthetic (glucuronide formation, sulfate conjugation, acetylation, methylation). This also includes metabolic detoxication and clearance. [NIH] Bladder: The organ that stores urine. [NIH] Blood Coagulation: The process of the interaction of blood coagulation factors that results in an insoluble fibrin clot. [NIH] Blood pressure: The pressure of blood against the walls of a blood vessel or heart chamber. Unless there is reference to another location, such as the pulmonary artery or one of the heart chambers, it refers to the pressure in the systemic arteries, as measured, for example, in the forearm. [NIH] Blood vessel: A tube in the body through which blood circulates. Blood vessels include a network of arteries, arterioles, capillaries, venules, and veins. [NIH] Body Fluids: Liquid components of living organisms. [NIH] Bradykinin: A nonapeptide messenger that is enzymatically produced from kallidin in the blood where it is a potent but short-lived agent of arteriolar dilation and increased capillary permeability. Bradykinin is also released from mast cells during asthma attacks, from gut walls as a gastrointestinal vasodilator, from damaged tissues as a pain signal, and may be a neurotransmitter. [NIH] Branch: Most commonly used for branches of nerves, but applied also to other structures. [NIH]

Bronchi: The larger air passages of the lungs arising from the terminal bifurcation of the trachea. [NIH] Bronchitis: Inflammation (swelling and reddening) of the bronchi. [NIH] Bypass: A surgical procedure in which the doctor creates a new pathway for the flow of body fluids. [NIH] Caesarean section: A surgical incision through the abdominal and uterine walls in order to deliver a baby. [NIH] Calcium: A basic element found in nearly all organized tissues. It is a member of the alkaline earth family of metals with the atomic symbol Ca, atomic number 20, and atomic weight 40. Calcium is the most abundant mineral in the body and combines with phosphorus to form calcium phosphate in the bones and teeth. It is essential for the normal functioning of nerves and muscles and plays a role in blood coagulation (as factor IV) and in many enzymatic processes. [NIH] Carboplatin: An organoplatinum compound that possesses antineoplastic activity. [NIH] Cardiac: Having to do with the heart. [NIH] Cardiopulmonary: Having to do with the heart and lungs. [NIH] Carpal Tunnel Syndrome: A median nerve injury inside the carpal tunnel that results in

Dictionary 57

symptoms of pain, numbness, tingling, clumsiness, and a lack of sweating, which can be caused by work with certain hand and wrist postures. [NIH] Carrier Proteins: Transport proteins that carry specific substances in the blood or across cell membranes. [NIH] Case report: A detailed report of the diagnosis, treatment, and follow-up of an individual patient. Case reports also contain some demographic information about the patient (for example, age, gender, ethnic origin). [NIH] Catheterization: Use or insertion of a tubular device into a duct, blood vessel, hollow organ, or body cavity for injecting or withdrawing fluids for diagnostic or therapeutic purposes. It differs from intubation in that the tube here is used to restore or maintain patency in obstructions. [NIH] Cell: The individual unit that makes up all of the tissues of the body. All living things are made up of one or more cells. [NIH] Cell Cycle: The complex series of phenomena, occurring between the end of one cell division and the end of the next, by which cellular material is divided between daughter cells. [NIH] Cell Division: The fission of a cell. [NIH] Centrifugation: A method of separating organelles or large molecules that relies upon differential sedimentation through a preformed density gradient under the influence of a gravitational field generated in a centrifuge. [NIH] Cerebral: Of or pertaining of the cerebrum or the brain. [EU] Cesarean Section: Extraction of the fetus by means of abdominal hysterotomy. [NIH] Chemotherapy: Treatment with anticancer drugs. [NIH] Chest Pain: Pressure, burning, or numbness in the chest. [NIH] Cholecalciferol: An antirachitic oil-soluble vitamin. [NIH] Chronic: A disease or condition that persists or progresses over a long period of time. [NIH] Chronic Obstructive Pulmonary Disease: Collective term for chronic bronchitis and emphysema. [NIH] Clinical trial: A research study that tests how well new medical treatments or other interventions work in people. Each study is designed to test new methods of screening, prevention, diagnosis, or treatment of a disease. [NIH] Cloning: The production of a number of genetically identical individuals; in genetic engineering, a process for the efficient replication of a great number of identical DNA molecules. [NIH] Coagulation: 1. The process of clot formation. 2. In colloid chemistry, the solidification of a sol into a gelatinous mass; an alteration of a disperse phase or of a dissolved solid which causes the separation of the system into a liquid phase and an insoluble mass called the clot or curd. Coagulation is usually irreversible. 3. In surgery, the disruption of tissue by physical means to form an amorphous residuum, as in electrocoagulation and photocoagulation. [EU] Coenzyme: An organic nonprotein molecule, frequently a phosphorylated derivative of a water-soluble vitamin, that binds with the protein molecule (apoenzyme) to form the active enzyme (holoenzyme). [EU] Cofactor: A substance, microorganism or environmental factor that activates or enhances the action of another entity such as a disease-causing agent. [NIH]

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Collagen: A polypeptide substance comprising about one third of the total protein in mammalian organisms. It is the main constituent of skin, connective tissue, and the organic substance of bones and teeth. Different forms of collagen are produced in the body but all consist of three alpha-polypeptide chains arranged in a triple helix. Collagen is differentiated from other fibrous proteins, such as elastin, by the content of proline, hydroxyproline, and hydroxylysine; by the absence of tryptophan; and particularly by the high content of polar groups which are responsible for its swelling properties. [NIH] Colloidal: Of the nature of a colloid. [EU] Combination Therapy: Association of 3 drugs to treat AIDS (AZT + DDC or DDI + protease inhibitor). [NIH] Complement: A term originally used to refer to the heat-labile factor in serum that causes immune cytolysis, the lysis of antibody-coated cells, and now referring to the entire functionally related system comprising at least 20 distinct serum proteins that is the effector not only of immune cytolysis but also of other biologic functions. Complement activation occurs by two different sequences, the classic and alternative pathways. The proteins of the classic pathway are termed 'components of complement' and are designated by the symbols C1 through C9. C1 is a calcium-dependent complex of three distinct proteins C1q, C1r and C1s. The proteins of the alternative pathway (collectively referred to as the properdin system) and complement regulatory proteins are known by semisystematic or trivial names. Fragments resulting from proteolytic cleavage of complement proteins are designated with lower-case letter suffixes, e.g., C3a. Inactivated fragments may be designated with the suffix 'i', e.g. C3bi. Activated components or complexes with biological activity are designated by a bar over the symbol e.g. C1 or C4b,2a. The classic pathway is activated by the binding of C1 to classic pathway activators, primarily antigen-antibody complexes containing IgM, IgG1, IgG3; C1q binds to a single IgM molecule or two adjacent IgG molecules. The alternative pathway can be activated by IgA immune complexes and also by nonimmunologic materials including bacterial endotoxins, microbial polysaccharides, and cell walls. Activation of the classic pathway triggers an enzymatic cascade involving C1, C4, C2 and C3; activation of the alternative pathway triggers a cascade involving C3 and factors B, D and P. Both result in the cleavage of C5 and the formation of the membrane attack complex. Complement activation also results in the formation of many biologically active complement fragments that act as anaphylatoxins, opsonins, or chemotactic factors. [EU] Complementary and alternative medicine: CAM. Forms of treatment that are used in addition to (complementary) or instead of (alternative) standard treatments. These practices are not considered standard medical approaches. CAM includes dietary supplements, megadose vitamins, herbal preparations, special teas, massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Complementary medicine: Practices not generally recognized by the medical community as standard or conventional medical approaches and used to enhance or complement the standard treatments. Complementary medicine includes the taking of dietary supplements, megadose vitamins, and herbal preparations; the drinking of special teas; and practices such as massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Computational Biology: A field of biology concerned with the development of techniques for the collection and manipulation of biological data, and the use of such data to make biological discoveries or predictions. This field encompasses all computational methods and theories applicable to molecular biology and areas of computer-based techniques for solving biological problems including manipulation of models and datasets. [NIH] Conjugated: Acting or operating as if joined; simultaneous. [EU] Contraindications: Any factor or sign that it is unwise to pursue a certain kind of action or

Dictionary 59

treatment, e. g. giving a general anesthetic to a person with pneumonia. [NIH] Coronary: Encircling in the manner of a crown; a term applied to vessels; nerves, ligaments, etc. The term usually denotes the arteries that supply the heart muscle and, by extension, a pathologic involvement of them. [EU] Coronary Angiography: Radiography of the vascular system of the heart muscle after injection of a contrast medium. [NIH] Coronary Thrombosis: Presence of a thrombus in a coronary artery, often causing a myocardial infarction. [NIH] Cortisone: A natural steroid hormone produced in the adrenal gland. It can also be made in the laboratory. Cortisone reduces swelling and can suppress immune responses. [NIH] Curative: Tending to overcome disease and promote recovery. [EU] Cytochrome: Any electron transfer hemoprotein having a mode of action in which the transfer of a single electron is effected by a reversible valence change of the central iron atom of the heme prosthetic group between the +2 and +3 oxidation states; classified as cytochromes a in which the heme contains a formyl side chain, cytochromes b, which contain protoheme or a closely similar heme that is not covalently bound to the protein, cytochromes c in which protoheme or other heme is covalently bound to the protein, and cytochromes d in which the iron-tetrapyrrole has fewer conjugated double bonds than the hemes have. Well-known cytochromes have been numbered consecutively within groups and are designated by subscripts (beginning with no subscript), e.g. cytochromes c, c1, C2, . New cytochromes are named according to the wavelength in nanometres of the absorption maximum of the a-band of the iron (II) form in pyridine, e.g., c-555. [EU] Databases, Bibliographic: Extensive collections, reputedly complete, of references and citations to books, articles, publications, etc., generally on a single subject or specialized subject area. Databases can operate through automated files, libraries, or computer disks. The concept should be differentiated from factual databases which is used for collections of data and facts apart from bibliographic references to them. [NIH] Diagnostic procedure: A method used to identify a disease. [NIH] Dialyzer: A part of the hemodialysis machine. (See hemodialysis under dialysis.) The dialyzer has two sections separated by a membrane. One section holds dialysate. The other holds the patient's blood. [NIH] Diffusion: The tendency of a gas or solute to pass from a point of higher pressure or concentration to a point of lower pressure or concentration and to distribute itself throughout the available space; a major mechanism of biological transport. [NIH] Dilatation: The act of dilating. [NIH] Dipyridamole: A drug that prevents blood cell clumping and enhances the effectiveness of fluorouracil and other chemotherapeutic agents. [NIH] Direct: 1. Straight; in a straight line. 2. Performed immediately and without the intervention of subsidiary means. [EU] Drug Interactions: The action of a drug that may affect the activity, metabolism, or toxicity of another drug. [NIH] Duke: A lamp which produces ultraviolet radiations for certain ophthalmologic therapy. [NIH]

Efficacy: The extent to which a specific intervention, procedure, regimen, or service produces a beneficial result under ideal conditions. Ideally, the determination of efficacy is based on the results of a randomized control trial. [NIH]

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Electrocoagulation: Electrosurgical procedures used to treat hemorrhage (e.g., bleeding ulcers) and to ablate tumors, mucosal lesions, and refractory arrhythmias. [NIH] Electrolyte: A substance that dissociates into ions when fused or in solution, and thus becomes capable of conducting electricity; an ionic solute. [EU] Emboli: Bit of foreign matter which enters the blood stream at one point and is carried until it is lodged or impacted in an artery and obstructs it. It may be a blood clot, an air bubble, fat or other tissue, or clumps of bacteria. [NIH] Embolism: Blocking of a blood vessel by a blood clot or foreign matter that has been transported from a distant site by the blood stream. [NIH] Embolization: The blocking of an artery by a clot or foreign material. Embolization can be done as treatment to block the flow of blood to a tumor. [NIH] Embolus: Bit of foreign matter which enters the blood stream at one point and is carried until it is lodged or impacted in an artery and obstructs it. It may be a blood clot, an air bubble, fat or other tissue, or clumps of bacteria. [NIH] Emphysema: A pathological accumulation of air in tissues or organs. [NIH] Endarterectomy: Surgical excision, performed under general anesthesia, of the atheromatous tunica intima of an artery. When reconstruction of an artery is performed as an endovascular procedure through a catheter, it is called atherectomy. [NIH] Endocarditis: Exudative and proliferative inflammatory alterations of the endocardium, characterized by the presence of vegetations on the surface of the endocardium or in the endocardium itself, and most commonly involving a heart valve, but sometimes affecting the inner lining of the cardiac chambers or the endocardium elsewhere. It may occur as a primary disorder or as a complication of or in association with another disease. [EU] Endocardium: The innermost layer of the heart, comprised of endothelial cells. [NIH] Endothelial cell: The main type of cell found in the inside lining of blood vessels, lymph vessels, and the heart. [NIH] Environmental Health: The science of controlling or modifying those conditions, influences, or forces surrounding man which relate to promoting, establishing, and maintaining health. [NIH]

Enzymatic: Phase where enzyme cuts the precursor protein. [NIH] Enzyme: A protein that speeds up chemical reactions in the body. [NIH] Enzyme Inhibitors: Compounds or agents that combine with an enzyme in such a manner as to prevent the normal substrate-enzyme combination and the catalytic reaction. [NIH] Epinephrine: The active sympathomimetic hormone from the adrenal medulla in most species. It stimulates both the alpha- and beta- adrenergic systems, causes systemic vasoconstriction and gastrointestinal relaxation, stimulates the heart, and dilates bronchi and cerebral vessels. It is used in asthma and cardiac failure and to delay absorption of local anesthetics. [NIH] Epitope: A molecule or portion of a molecule capable of binding to the combining site of an antibody. For every given antigenic determinant, the body can construct a variety of antibody-combining sites, some of which fit almost perfectly, and others which barely fit. [NIH]

Erythrocytes: Red blood cells. Mature erythrocytes are non-nucleated, biconcave disks containing hemoglobin whose function is to transport oxygen. [NIH] Etoposide: A semisynthetic derivative of podophyllotoxin that exhibits antitumor activity. Etoposide inhibits DNA synthesis by forming a complex with topoisomerase II and DNA.

Dictionary 61

This complex induces breaks in double stranded DNA and prevents repair by topoisomerase II binding. Accumulated breaks in DNA prevent entry into the mitotic phase of cell division, and lead to cell death. Etoposide acts primarily in the G2 and S phases of the cell cycle. [NIH] Exogenous: Developed or originating outside the organism, as exogenous disease. [EU] Extracellular: Outside a cell or cells. [EU] Extremity: A limb; an arm or leg (membrum); sometimes applied specifically to a hand or foot. [EU] Family Planning: Programs or services designed to assist the family in controlling reproduction by either improving or diminishing fertility. [NIH] Fat: Total lipids including phospholipids. [NIH] Fatty acids: A major component of fats that are used by the body for energy and tissue development. [NIH] Fetus: The developing offspring from 7 to 8 weeks after conception until birth. [NIH] Fibrillation: A small, local, involuntary contraction of muscle, invisible under the skin, resulting from spontaneous activation of single muscle cells or muscle fibres. [EU] Fibrin: A protein derived from fibrinogen in the presence of thrombin, which forms part of the blood clot. [NIH] Fibrinogen: Plasma glycoprotein clotted by thrombin, composed of a dimer of three nonidentical pairs of polypeptide chains (alpha, beta, gamma) held together by disulfide bonds. Fibrinogen clotting is a sol-gel change involving complex molecular arrangements: whereas fibrinogen is cleaved by thrombin to form polypeptides A and B, the proteolytic action of other enzymes yields different fibrinogen degradation products. [NIH] Flank Pain: Pain emanating from below the ribs and above the ilium. [NIH] Fluorouracil: A pyrimidine analog that acts as an antineoplastic antimetabolite and also has immunosuppressant. It interferes with DNA synthesis by blocking the thymidylate synthetase conversion of deoxyuridylic acid to thymidylic acid. [NIH] Fold: A plication or doubling of various parts of the body. [NIH] Gastrointestinal: Refers to the stomach and intestines. [NIH] Gastrointestinal Hemorrhage: Bleeding in the gastrointestinal tract. [NIH] Gastrointestinal tract: The stomach and intestines. [NIH] Gene: The functional and physical unit of heredity passed from parent to offspring. Genes are pieces of DNA, and most genes contain the information for making a specific protein. [NIH]

Gland: An organ that produces and releases one or more substances for use in the body. Some glands produce fluids that affect tissues or organs. Others produce hormones or participate in blood production. [NIH] Glucocorticoid: A compound that belongs to the family of compounds called corticosteroids (steroids). Glucocorticoids affect metabolism and have anti-inflammatory and immunosuppressive effects. They may be naturally produced (hormones) or synthetic (drugs). [NIH] Glucuronic Acid: Derivatives of uronic acid found throughout the plant and animal kingdoms. They detoxify drugs and toxins by conjugating with them to form glucuronides in the liver which are more water-soluble metabolites that can be easily eliminated from the body. [NIH]

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Glycoprotein: A protein that has sugar molecules attached to it. [NIH] Governing Board: The group in which legal authority is vested for the control of healthrelated institutions and organizations. [NIH] Growth: The progressive development of a living being or part of an organism from its earliest stage to maturity. [NIH] Haptens: Small antigenic determinants capable of eliciting an immune response only when coupled to a carrier. Haptens bind to antibodies but by themselves cannot elicit an antibody response. [NIH] Heme: The color-furnishing portion of hemoglobin. It is found free in tissues and as the prosthetic group in many hemeproteins. [NIH] Hemodiafiltration: The combination of hemodialysis and hemofiltration either simultaneously or sequentially. Convective transport (hemofiltration) may be better for removal of larger molecular weight substances and diffusive transport (hemodialysis) for smaller molecular weight solutes. [NIH] Hemodialysis: The use of a machine to clean wastes from the blood after the kidneys have failed. The blood travels through tubes to a dialyzer, which removes wastes and extra fluid. The cleaned blood then flows through another set of tubes back into the body. [NIH] Hemofiltration: Extracorporeal ultrafiltration technique without hemodialysis for treatment of fluid overload and electrolyte disturbances affecting renal, cardiac, or pulmonary function. [NIH] Hemoglobin: One of the fractions of glycosylated hemoglobin A1c. Glycosylated hemoglobin is formed when linkages of glucose and related monosaccharides bind to hemoglobin A and its concentration represents the average blood glucose level over the previous several weeks. HbA1c levels are used as a measure of long-term control of plasma glucose (normal, 4 to 6 percent). In controlled diabetes mellitus, the concentration of glycosylated hemoglobin A is within the normal range, but in uncontrolled cases the level may be 3 to 4 times the normal conentration. Generally, complications are substantially lower among patients with Hb levels of 7 percent or less than in patients with HbA1c levels of 9 percent or more. [NIH] Hemorrhage: Bleeding or escape of blood from a vessel. [NIH] Heparin: Heparinic acid. A highly acidic mucopolysaccharide formed of equal parts of sulfated D-glucosamine and D-glucuronic acid with sulfaminic bridges. The molecular weight ranges from six to twenty thousand. Heparin occurs in and is obtained from liver, lung, mast cells, etc., of vertebrates. Its function is unknown, but it is used to prevent blood clotting in vivo and vitro, in the form of many different salts. [NIH] Hepatic: Refers to the liver. [NIH] Heredity: 1. The genetic transmission of a particular quality or trait from parent to offspring. 2. The genetic constitution of an individual. [EU] Hormone: A substance in the body that regulates certain organs. Hormones such as gastrin help in breaking down food. Some hormones come from cells in the stomach and small intestine. [NIH] Hypertension: Persistently high arterial blood pressure. Currently accepted threshold levels are 140 mm Hg systolic and 90 mm Hg diastolic pressure. [NIH] Hypertrophy: General increase in bulk of a part or organ, not due to tumor formation, nor to an increase in the number of cells. [NIH] Hysterotomy: An incision in the uterus, performed through either the abdomen or the

Dictionary 63

vagina. [NIH] Id: The part of the personality structure which harbors the unconscious instinctive desires and strivings of the individual. [NIH] Ileal: Related to the ileum, the lowest end of the small intestine. [NIH] Ileum: The lower end of the small intestine. [NIH] Immune response: The activity of the immune system against foreign substances (antigens). [NIH]

Immunogenic: Producing immunity; evoking an immune response. [EU] Immunoglobulin: A protein that acts as an antibody. [NIH] Immunosuppressant: An agent capable of suppressing immune responses. [EU] In vivo: In the body. The opposite of in vitro (outside the body or in the laboratory). [NIH] Incision: A cut made in the body during surgery. [NIH] Indicative: That indicates; that points out more or less exactly; that reveals fairly clearly. [EU] Infarction: A pathological process consisting of a sudden insufficient blood supply to an area, which results in necrosis of that area. It is usually caused by a thrombus, an embolus, or a vascular torsion. [NIH] Inflammation: A pathological process characterized by injury or destruction of tissues caused by a variety of cytologic and chemical reactions. It is usually manifested by typical signs of pain, heat, redness, swelling, and loss of function. [NIH] Ingestion: Taking into the body by mouth [NIH] Inhalation: The drawing of air or other substances into the lungs. [EU] Internal Medicine: A medical specialty concerned with the diagnosis and treatment of diseases of the internal organ systems of adults. [NIH] Intestines: The section of the alimentary canal from the stomach to the anus. It includes the large intestine and small intestine. [NIH] Intravenous: IV. Into a vein. [NIH] Intravenous pyelogram: IVP. A series of x-rays of the kidneys, ureters, and bladder. The xrays are taken after a dye is injected into a blood vessel. The dye is concentrated in the urine, which outlines the kidneys, ureters, and bladder on the x-rays. [NIH] Involuntary: Reaction occurring without intention or volition. [NIH] Ions: An atom or group of atoms that have a positive or negative electric charge due to a gain (negative charge) or loss (positive charge) of one or more electrons. Atoms with a positive charge are known as cations; those with a negative charge are anions. [NIH] Ischemic stroke: A condition in which the blood supply to part of the brain is cut off. Also called "plug-type" strokes. Blocked arteries starve areas of the brain controlling sight, speech, sensation, and movement so that these functions are partially or completely lost. Ischemic stroke is the most common type of stroke, accounting for 80 percent of all strokes. Most ischemic strokes are caused by a blood clot called a thrombus, which blocks blood flow in the arteries feeding the brain, usually the carotid artery in the neck, the major vessel bringing blood to the brain. When it becomes blocked, the risk of stroke is very high. [NIH] Joint: The point of contact between elements of an animal skeleton with the parts that surround and support it. [NIH] Kb: A measure of the length of DNA fragments, 1 Kb = 1000 base pairs. The largest DNA fragments are up to 50 kilobases long. [NIH]

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Kinetic: Pertaining to or producing motion. [EU] Leukotrienes: A family of biologically active compounds derived from arachidonic acid by oxidative metabolism through the 5-lipoxygenase pathway. They participate in host defense reactions and pathophysiological conditions such as immediate hypersensitivity and inflammation. They have potent actions on many essential organs and systems, including the cardiovascular, pulmonary, and central nervous system as well as the gastrointestinal tract and the immune system. [NIH] Library Services: Services offered to the library user. They include reference and circulation. [NIH]

Ligament: A band of fibrous tissue that connects bones or cartilages, serving to support and strengthen joints. [EU] Liver: A large, glandular organ located in the upper abdomen. The liver cleanses the blood and aids in digestion by secreting bile. [NIH] Lymph: The almost colorless fluid that travels through the lymphatic system and carries cells that help fight infection and disease. [NIH] Lymphocyte: A white blood cell. Lymphocytes have a number of roles in the immune system, including the production of antibodies and other substances that fight infection and diseases. [NIH] Mastectomy: Surgery to remove the breast (or as much of the breast tissue as possible). [NIH] Median Nerve: A major nerve of the upper extremity. In humans, the fibers of the median nerve originate in the lower cervical and upper thoracic spinal cord (usually C6 to T1), travel via the brachial plexus, and supply sensory and motor innervation to parts of the forearm and hand. [NIH] MEDLINE: An online database of MEDLARS, the computerized bibliographic Medical Literature Analysis and Retrieval System of the National Library of Medicine. [NIH] Membranes: Thin layers of tissue which cover parts of the body, separate adjacent cavities, or connect adjacent structures. [NIH] MI: Myocardial infarction. Gross necrosis of the myocardium as a result of interruption of the blood supply to the area; it is almost always caused by atherosclerosis of the coronary arteries, upon which coronary thrombosis is usually superimposed. [NIH] Microsomal: Of or pertaining to microsomes : vesicular fragments of endoplasmic reticulum formed after disruption and centrifugation of cells. [EU] Mitochondrial Swelling: Increase in volume of mitochondria due to an influx of fluid; it occurs in hypotonic solutions due to osmotic pressure and in isotonic solutions as a result of altered permeability of the membranes of respiring mitochondria. [NIH] Mitotic: Cell resulting from mitosis. [NIH] Molecular: Of, pertaining to, or composed of molecules : a very small mass of matter. [EU] Molecule: A chemical made up of two or more atoms. The atoms in a molecule can be the same (an oxygen molecule has two oxygen atoms) or different (a water molecule has two hydrogen atoms and one oxygen atom). Biological molecules, such as proteins and DNA, can be made up of many thousands of atoms. [NIH] Monoclonal: An antibody produced by culturing a single type of cell. It therefore consists of a single species of immunoglobulin molecules. [NIH] Monocrotaline: A pyrrolizidine alkaloid and a toxic plant constituent that poisons livestock and humans through the ingestion of contaminated grains and other foods. The alkaloid causes pulmonary artery hypertension, right ventricular hypertrophy, and pathological

Dictionary 65

changes in the pulmonary vasculature. Significant attenuation of the cardiopulmonary changes are noted after oral magnesium treatment. [NIH] Myocardial infarction: Gross necrosis of the myocardium as a result of interruption of the blood supply to the area; it is almost always caused by atherosclerosis of the coronary arteries, upon which coronary thrombosis is usually superimposed. [NIH] Myocardium: The muscle tissue of the heart composed of striated, involuntary muscle known as cardiac muscle. [NIH] Myotonic Dystrophy: A condition presenting muscle weakness and wasting which may be progressive. [NIH] Necrosis: A pathological process caused by the progressive degradative action of enzymes that is generally associated with severe cellular trauma. It is characterized by mitochondrial swelling, nuclear flocculation, uncontrolled cell lysis, and ultimately cell death. [NIH] Need: A state of tension or dissatisfaction felt by an individual that impels him to action toward a goal he believes will satisfy the impulse. [NIH] Nephrology: A subspecialty of internal medicine concerned with the anatomy, physiology, and pathology of the kidney. [NIH] Nephrosis: Descriptive histopathologic term for renal disease without an inflammatory component. [NIH] Niacin: Water-soluble vitamin of the B complex occurring in various animal and plant tissues. Required by the body for the formation of coenzymes NAD and NADP. Has pellagra-curative, vasodilating, and antilipemic properties. [NIH] Nuclear: A test of the structure, blood flow, and function of the kidneys. The doctor injects a mildly radioactive solution into an arm vein and uses x-rays to monitor its progress through the kidneys. [NIH] Nursing Staff: Personnel who provide nursing service to patients in an organized facility, institution, or agency. [NIH] Ophthalmologic: Pertaining to ophthalmology (= the branch of medicine dealing with the eye). [EU] Osmotic: Pertaining to or of the nature of osmosis (= the passage of pure solvent from a solution of lesser to one of greater solute concentration when the two solutions are separated by a membrane which selectively prevents the passage of solute molecules, but is permeable to the solvent). [EU] Osteoblasts: Bone-forming cells which secrete an extracellular matrix. Hydroxyapatite crystals are then deposited into the matrix to form bone. [NIH] Osteocalcin: Vitamin K-dependent calcium-binding protein synthesized by osteoblasts and found primarily in bone. Serum osteocalcin measurements provide a noninvasive specific marker of bone metabolism. The protein contains three residues of the amino acid gammacarboxyglutamic acid (GLA), which, in the presence of calcium, promotes binding to hydroxyapatite and subsequent accumulation in bone matrix. [NIH] Outpatient: A patient who is not an inmate of a hospital but receives diagnosis or treatment in a clinic or dispensary connected with the hospital. [NIH] Oxidation: The act of oxidizing or state of being oxidized. Chemically it consists in the increase of positive charges on an atom or the loss of negative charges. Most biological oxidations are accomplished by the removal of a pair of hydrogen atoms (dehydrogenation) from a molecule. Such oxidations must be accompanied by reduction of an acceptor molecule. Univalent o. indicates loss of one electron; divalent o., the loss of two electrons. [EU]

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Palliative: 1. Affording relief, but not cure. 2. An alleviating medicine. [EU] Pathologic: 1. Indicative of or caused by a morbid condition. 2. Pertaining to pathology (= branch of medicine that treats the essential nature of the disease, especially the structural and functional changes in tissues and organs of the body caused by the disease). [EU] Patient Education: The teaching or training of patients concerning their own health needs. [NIH]

Pelvic: Pertaining to the pelvis. [EU] Peptide: Any compound consisting of two or more amino acids, the building blocks of proteins. Peptides are combined to make proteins. [NIH] Peripheral Vascular Disease: Disease in the large blood vessels of the arms, legs, and feet. People who have had diabetes for a long time may get this because major blood vessels in their arms, legs, and feet are blocked and these limbs do not receive enough blood. The signs of PVD are aching pains in the arms, legs, and feet (especially when walking) and foot sores that heal slowly. Although people with diabetes cannot always avoid PVD, doctors say they have a better chance of avoiding it if they take good care of their feet, do not smoke, and keep both their blood pressure and diabetes under good control. [NIH] Pharmacists: Those persons legally qualified by education and training to engage in the practice of pharmacy. [NIH] Pharmacodynamics: The study of the biochemical and physiological effects of drugs and the mechanisms of their actions, including the correlation of actions and effects of drugs with their chemical structure; also, such effects on the actions of a particular drug or drugs. [EU] Pharmacokinetic: The mathematical analysis of the time courses of absorption, distribution, and elimination of drugs. [NIH] Pharmacologic: Pertaining to pharmacology or to the properties and reactions of drugs. [EU] Phosphorus: A non-metallic element that is found in the blood, muscles, nevers, bones, and teeth, and is a component of adenosine triphosphate (ATP; the primary energy source for the body's cells.) [NIH] Phosphorylated: Attached to a phosphate group. [NIH] Photocoagulation: Using a special strong beam of light (laser) to seal off bleeding blood vessels such as in the eye. The laser can also burn away blood vessels that should not have grown in the eye. This is the main treatment for diabetic retinopathy. [NIH] Physiology: The science that deals with the life processes and functions of organismus, their cells, tissues, and organs. [NIH] Plaque: A clear zone in a bacterial culture grown on an agar plate caused by localized destruction of bacterial cells by a bacteriophage. The concentration of infective virus in a fluid can be estimated by applying the fluid to a culture and counting the number of. [NIH] Plasma: The clear, yellowish, fluid part of the blood that carries the blood cells. The proteins that form blood clots are in plasma. [NIH] Plasma protein: One of the hundreds of different proteins present in blood plasma, including carrier proteins ( such albumin, transferrin, and haptoglobin), fibrinogen and other coagulation factors, complement components, immunoglobulins, enzyme inhibitors, precursors of substances such as angiotension and bradykinin, and many other types of proteins. [EU] Platelet Activation: A series of progressive, overlapping events triggered by exposure of the platelets to subendothelial tissue. These events include shape change, adhesiveness, aggregation, and release reactions. When carried through to completion, these events lead to

Dictionary 67

the formation of a stable hemostatic plug. [NIH] Platelet Aggregation: The attachment of platelets to one another. This clumping together can be induced by a number of agents (e.g., thrombin, collagen) and is part of the mechanism leading to the formation of a thrombus. [NIH] Platelets: A type of blood cell that helps prevent bleeding by causing blood clots to form. Also called thrombocytes. [NIH] Podophyllotoxin: The main active constituent of the resin from the roots of may apple or mandrake (Podophyllum peltatum and P. emodi). It is a potent spindle poison, toxic if taken internally, and has been used as a cathartic. It is very irritating to skin and mucous membranes, has keratolytic actions, has been used to treat warts and keratoses, and may have antineoplastic properties, as do some of its congeners and derivatives. [NIH] Poisoning: A condition or physical state produced by the ingestion, injection or inhalation of, or exposure to a deleterious agent. [NIH] Pollen: The male fertilizing element of flowering plants analogous to sperm in animals. It is released from the anthers as yellow dust, to be carried by insect or other vectors, including wind, to the ovary (stigma) of other flowers to produce the embryo enclosed by the seed. The pollens of many plants are allergenic. [NIH] Polypeptide: A peptide which on hydrolysis yields more than two amino acids; called tripeptides, tetrapeptides, etc. according to the number of amino acids contained. [EU] Polysaccharide: A type of carbohydrate. It contains sugar molecules that are linked together chemically. [NIH] Porphyria: A group of disorders characterized by the excessive production of porphyrins or their precursors that arises from abnormalities in the regulation of the porphyrin-heme pathway. The porphyrias are usually divided into three broad groups, erythropoietic, hepatic, and erythrohepatic, according to the major sites of abnormal porphyrin synthesis. [NIH]

Porphyrins: A group of compounds containing the porphin structure, four pyrrole rings connected by methine bridges in a cyclic configuration to which a variety of side chains are attached. The nature of the side chain is indicated by a prefix, as uroporphyrin, hematoporphyrin, etc. The porphyrins, in combination with iron, form the heme component in biologically significant compounds such as hemoglobin and myoglobin. [NIH] Potentiation: An overall effect of two drugs taken together which is greater than the sum of the effects of each drug taken alone. [NIH] Practice Guidelines: Directions or principles presenting current or future rules of policy for the health care practitioner to assist him in patient care decisions regarding diagnosis, therapy, or related clinical circumstances. The guidelines may be developed by government agencies at any level, institutions, professional societies, governing boards, or by the convening of expert panels. The guidelines form a basis for the evaluation of all aspects of health care and delivery. [NIH] Precursor: Something that precedes. In biological processes, a substance from which another, usually more active or mature substance is formed. In clinical medicine, a sign or symptom that heralds another. [EU] Prednisolone: A glucocorticoid with the general properties of the corticosteroids. It is the drug of choice for all conditions in which routine systemic corticosteroid therapy is indicated, except adrenal deficiency states. [NIH] Prednisone: A synthetic anti-inflammatory glucocorticoid derived from cortisone. It is biologically inert and converted to prednisolone in the liver. [NIH]

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Progressive: Advancing; going forward; going from bad to worse; increasing in scope or severity. [EU] Prophylaxis: An attempt to prevent disease. [NIH] Prostaglandins: A group of compounds derived from unsaturated 20-carbon fatty acids, primarily arachidonic acid, via the cyclooxygenase pathway. They are extremely potent mediators of a diverse group of physiological processes. [NIH] Prostate: A gland in males that surrounds the neck of the bladder and the urethra. It secretes a substance that liquifies coagulated semen. It is situated in the pelvic cavity behind the lower part of the pubic symphysis, above the deep layer of the triangular ligament, and rests upon the rectum. [NIH] Protease: Proteinase (= any enzyme that catalyses the splitting of interior peptide bonds in a protein). [EU] Protein Binding: The process in which substances, either endogenous or exogenous, bind to proteins, peptides, enzymes, protein precursors, or allied compounds. Specific proteinbinding measures are often used as assays in diagnostic assessments. [NIH] Protein C: A vitamin-K dependent zymogen present in the blood, which, upon activation by thrombin and thrombomodulin exerts anticoagulant properties by inactivating factors Va and VIIIa at the rate-limiting steps of thrombin formation. [NIH] Protein S: The vitamin K-dependent cofactor of activated protein C. Together with protein C, it inhibits the action of factors VIIIa and Va. A deficiency in protein S can lead to recurrent venous and arterial thrombosis. [NIH] Proteins: Polymers of amino acids linked by peptide bonds. The specific sequence of amino acids determines the shape and function of the protein. [NIH] Proteolytic: 1. Pertaining to, characterized by, or promoting proteolysis. 2. An enzyme that promotes proteolysis (= the splitting of proteins by hydrolysis of the peptide bonds with formation of smaller polypeptides). [EU] Prothrombin: A plasma protein that is the inactive precursor of thrombin. It is converted to thrombin by a prothrombin activator complex consisting of factor Xa, factor V, phospholipid, and calcium ions. Deficiency of prothrombin leads to hypoprothrombinemia. [NIH]

Public Policy: A course or method of action selected, usually by a government, from among alternatives to guide and determine present and future decisions. [NIH] Publishing: "The business or profession of the commercial production and issuance of literature" (Webster's 3d). It includes the publisher, publication processes, editing and editors. Production may be by conventional printing methods or by electronic publishing. [NIH]

Pulmonary: Relating to the lungs. [NIH] Pulmonary Artery: The short wide vessel arising from the conus arteriosus of the right ventricle and conveying unaerated blood to the lungs. [NIH] Pulmonary Embolism: Embolism in the pulmonary artery or one of its branches. [NIH] Quercetin: Aglucon of quercetrin, rutin, and other glycosides. It is widely distributed in the plant kingdom, especially in rinds and barks, clover blossoms, and ragweed pollen. [NIH] Radioimmunoassay: Classic quantitative assay for detection of antigen-antibody reactions using a radioactively labeled substance (radioligand) either directly or indirectly to measure the binding of the unlabeled substance to a specific antibody or other receptor system. Nonimmunogenic substances (e.g., haptens) can be measured if coupled to larger carrier proteins (e.g., bovine gamma-globulin or human serum albumin) capable of inducing

Dictionary 69

antibody formation. [NIH] Randomized: Describes an experiment or clinical trial in which animal or human subjects are assigned by chance to separate groups that compare different treatments. [NIH] Receptor: A molecule inside or on the surface of a cell that binds to a specific substance and causes a specific physiologic effect in the cell. [NIH] Rectum: The last 8 to 10 inches of the large intestine. [NIH] Recurrence: The return of a sign, symptom, or disease after a remission. [NIH] Refer: To send or direct for treatment, aid, information, de decision. [NIH] Regimen: A treatment plan that specifies the dosage, the schedule, and the duration of treatment. [NIH] Remission: A decrease in or disappearance of signs and symptoms of cancer. In partial remission, some, but not all, signs and symptoms of cancer have disappeared. In complete remission, all signs and symptoms of cancer have disappeared, although there still may be cancer in the body. [NIH] Retinoids: Derivatives of vitamin A. Used clinically in the treatment of severe cystic acne, psoriasis, and other disorders of keratinization. Their possible use in the prophylaxis and treatment of cancer is being actively explored. [NIH] Retinol: Vitamin A. It is essential for proper vision and healthy skin and mucous membranes. Retinol is being studied for cancer prevention; it belongs to the family of drugs called retinoids. [NIH] Rutin: 3-((6-O-(6-Deoxy-alpha-L-mannopyranosyl)-beta-D-glucopyranosyl)oxy)-2-(3,4dihydroxyphenyl)-5,7-dihydroxy-4H-1-benzopyran-4-one. Found in many plants, including buckwheat, tobacco, forsythia, hydrangea, pansies, etc. It has been used therapeutically to decrease capillary fragility. [NIH] Screening: Checking for disease when there are no symptoms. [NIH] Semen: The thick, yellowish-white, viscid fluid secretion of male reproductive organs discharged upon ejaculation. In addition to reproductive organ secretions, it contains spermatozoa and their nutrient plasma. [NIH] Semisynthetic: Produced by chemical manipulation of naturally occurring substances. [EU] Serum: The clear liquid part of the blood that remains after blood cells and clotting proteins have been removed. [NIH] Serum Albumin: A major plasma protein that serves in maintaining the plasma colloidal osmotic pressure and transporting large organic anions. [NIH] Side effect: A consequence other than the one(s) for which an agent or measure is used, as the adverse effects produced by a drug, especially on a tissue or organ system other than the one sought to be benefited by its administration. [EU] Skeleton: The framework that supports the soft tissues of vertebrate animals and protects many of their internal organs. The skeletons of vertebrates are made of bone and/or cartilage. [NIH] Small intestine: The part of the digestive tract that is located between the stomach and the large intestine. [NIH] Sodium: An element that is a member of the alkali group of metals. It has the atomic symbol Na, atomic number 11, and atomic weight 23. With a valence of 1, it has a strong affinity for oxygen and other nonmetallic elements. Sodium provides the chief cation of the extracellular body fluids. Its salts are the most widely used in medicine. (From Dorland, 27th ed) Physiologically the sodium ion plays a major role in blood pressure regulation,

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maintenance of fluid volume, and electrolyte balance. [NIH] Soft tissue: Refers to muscle, fat, fibrous tissue, blood vessels, or other supporting tissue of the body. [NIH] Specialist: In medicine, one who concentrates on 1 special branch of medical science. [NIH] Species: A taxonomic category subordinate to a genus (or subgenus) and superior to a subspecies or variety, composed of individuals possessing common characters distinguishing them from other categories of individuals of the same taxonomic level. In taxonomic nomenclature, species are designated by the genus name followed by a Latin or Latinized adjective or noun. [EU] Stomach: An organ of digestion situated in the left upper quadrant of the abdomen between the termination of the esophagus and the beginning of the duodenum. [NIH] Stroke: Sudden loss of function of part of the brain because of loss of blood flow. Stroke may be caused by a clot (thrombosis) or rupture (hemorrhage) of a blood vessel to the brain. [NIH] Supplementation: Adding nutrients to the diet. [NIH] Sympathomimetic: 1. Mimicking the effects of impulses conveyed by adrenergic postganglionic fibres of the sympathetic nervous system. 2. An agent that produces effects similar to those of impulses conveyed by adrenergic postganglionic fibres of the sympathetic nervous system. Called also adrenergic. [EU] Symphysis: A secondary cartilaginous joint. [NIH] Systemic: Affecting the entire body. [NIH] Therapeutics: The branch of medicine which is concerned with the treatment of diseases, palliative or curative. [NIH] Thrombin: An enzyme formed from prothrombin that converts fibrinogen to fibrin. (Dorland, 27th ed) EC 3.4.21.5. [NIH] Thrombocytes: Blood cells that help prevent bleeding by causing blood clots to form. Also called platelets. [NIH] Thromboembolism: Obstruction of a vessel by a blood clot that has been transported from a distant site by the blood stream. [NIH] Thrombophlebitis: Inflammation of a vein associated with thrombus formation. [NIH] Thrombosis: The formation or presence of a blood clot inside a blood vessel. [NIH] Thromboxanes: Physiologically active compounds found in many organs of the body. They are formed in vivo from the prostaglandin endoperoxides and cause platelet aggregation, contraction of arteries, and other biological effects. Thromboxanes are important mediators of the actions of polyunsaturated fatty acids transformed by cyclooxygenase. [NIH] Thrombus: An aggregation of blood factors, primarily platelets and fibrin with entrapment of cellular elements, frequently causing vascular obstruction at the point of its formation. Some authorities thus differentiate thrombus formation from simple coagulation or clot formation. [EU] Thyroid: A gland located near the windpipe (trachea) that produces thyroid hormone, which helps regulate growth and metabolism. [NIH] Ticlopidine: Ticlopidine is an effective inhibitor of platelet aggregation. The drug has been found to significantly reduce infarction size in acute myocardial infarcts and is an effective antithrombotic agent in arteriovenous fistulas, aorto-coronary bypass grafts, ischemic heart disease, venous thrombosis, and arteriosclerosis. [NIH] Tin: A trace element that is required in bone formation. It has the atomic symbol Sn, atomic

Dictionary 71

number 50, and atomic weight 118.71. [NIH] Tissue: A group or layer of cells that are alike in type and work together to perform a specific function. [NIH] Toxic: Having to do with poison or something harmful to the body. Toxic substances usually cause unwanted side effects. [NIH] Toxicity: The quality of being poisonous, especially the degree of virulence of a toxic microbe or of a poison. [EU] Toxicokinetics: Study of the absorption, distribution, metabolism, and excretion of test substances. [NIH] Toxicology: The science concerned with the detection, chemical composition, and pharmacologic action of toxic substances or poisons and the treatment and prevention of toxic manifestations. [NIH] Toxins: Specific, characterizable, poisonous chemicals, often proteins, with specific biological properties, including immunogenicity, produced by microbes, higher plants, or animals. [NIH] Trachea: The cartilaginous and membranous tube descending from the larynx and branching into the right and left main bronchi. [NIH] Transfection: The uptake of naked or purified DNA into cells, usually eukaryotic. It is analogous to bacterial transformation. [NIH] Trauma: Any injury, wound, or shock, must frequently physical or structural shock, producing a disturbance. [NIH] Tunica Intima: The innermost coat of blood vessels, consisting of a thin lining of endothelial cells longitudinally oriented and continuous with the endothelium of capillaries on the one hand and the endocardium of the heart on the other. [NIH] Ultrafiltration: The separation of particles from a suspension by passage through a filter with very fine pores. In ultrafiltration the separation is accomplished by convective transport; in dialysis separation relies instead upon differential diffusion. Ultrafiltration occurs naturally and is a laboratory procedure. Artificial ultrafiltration of the blood is referred to as hemofiltration or hemodiafiltration (if combined with hemodialysis). [NIH] Unconscious: Experience which was once conscious, but was subsequently rejected, as the "personal unconscious". [NIH] Ureters: Tubes that carry urine from the kidneys to the bladder. [NIH] Urethra: The tube through which urine leaves the body. It empties urine from the bladder. [NIH]

Urine: Fluid containing water and waste products. Urine is made by the kidneys, stored in the bladder, and leaves the body through the urethra. [NIH] Vascular: Pertaining to blood vessels or indicative of a copious blood supply. [EU] Vasoconstriction: Narrowing of the blood vessels without anatomic change, for which constriction, pathologic is used. [NIH] Vein: Vessel-carrying blood from various parts of the body to the heart. [NIH] Venous: Of or pertaining to the veins. [EU] Venous Thrombosis: The formation or presence of a thrombus within a vein. [NIH] Ventricular: Pertaining to a ventricle. [EU] Venules: The minute vessels that collect blood from the capillary plexuses and join together to form veins. [NIH]

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Vesicular: 1. Composed of or relating to small, saclike bodies. 2. Pertaining to or made up of vesicles on the skin. [EU] Veterinary Medicine: The medical science concerned with the prevention, diagnosis, and treatment of diseases in animals. [NIH] Vitro: Descriptive of an event or enzyme reaction under experimental investigation occurring outside a living organism. Parts of an organism or microorganism are used together with artificial substrates and/or conditions. [NIH] Warfarin: An anticoagulant that acts by inhibiting the synthesis of vitamin K-dependent coagulation factors. Warfarin is indicated for the prophylaxis and/or treatment of venous thrombosis and its extension, pulmonary embolism, and atrial fibrillation with embolization. It is also used as an adjunct in the prophylaxis of systemic embolism after myocardial infarction. Warfarin is also used as a rodenticide. [NIH] White blood cell: A type of cell in the immune system that helps the body fight infection and disease. White blood cells include lymphocytes, granulocytes, macrophages, and others. [NIH]

Windpipe: A rigid tube, 10 cm long, extending from the cricoid cartilage to the upper border of the fifth thoracic vertebra. [NIH] X-ray: High-energy radiation used in low doses to diagnose diseases and in high doses to treat cancer. [NIH]

73

INDEX A Adenosine, 53, 66 Adrenal Medulla, 53, 60 Adrenergic, 53, 60, 70 Adverse Effect, 4, 53, 69 Affinity, 53, 69 Albumin, 53, 66 Algorithms, 38, 53, 56 Alkaline, 53, 56 Alkaloid, 53, 64 Alternative medicine, 30, 53 Amino Acids, 53, 54, 66, 67, 68 Analog, 54, 61 Anemia, 4, 54 Anesthesia, 54, 55, 60 Anesthetics, 54, 60 Angioplasty, 7, 11, 54, 55 Anions, 53, 54, 63, 69 Antibodies, 54, 62, 64 Antibody, 17, 20, 53, 54, 58, 60, 62, 63, 64, 68 Anticoagulant, 3, 10, 13, 22, 54, 68, 72 Antigen, 23, 53, 54, 58, 68 Anti-inflammatory, 54, 55, 61, 67 Anti-Inflammatory Agents, 54, 55 Antimetabolite, 54, 61 Antineoplastic, 54, 56, 61, 67 Antithrombotic, 8, 54, 70 Arachidonic Acid, 21, 54, 64, 68 Arterial, 55, 62, 68 Arteries, 55, 56, 59, 63, 64, 65, 70 Arterioles, 55, 56 Arteriosclerosis, 55, 70 Arteriovenous, 3, 55, 70 Arteriovenous Fistula, 3, 55, 70 Arthroplasty, 7, 12, 55 Aspirin, 6, 7, 8, 10, 11, 12, 13, 17, 55 Assay, 55, 68 Atherectomy, 55, 60 Atrial, 6, 10, 13, 17, 55, 72 Atrial Fibrillation, 6, 10, 13, 17, 55, 72 Atrium, 55 Attenuation, 55, 65 B Bacteria, 54, 55, 60 Base, 55, 63 Bioavailability, 4, 55 Biochemical, 19, 54, 55, 66

Biosynthesis, 55 Biotechnology, 5, 6, 28, 30, 37, 56 Biotransformation, 56 Bladder, 56, 63, 68, 71 Blood Coagulation, 8, 56 Blood pressure, 56, 62, 66, 69 Blood vessel, 3, 56, 57, 60, 63, 66, 70, 71 Body Fluids, 56, 69 Bradykinin, 56, 66 Branch, 49, 56, 65, 66, 70 Bronchi, 56, 60, 71 Bronchitis, 56, 57 Bypass, 56, 70 C Caesarean section, 18, 56 Calcium, 20, 56, 58, 65, 68 Carboplatin, 22, 56 Cardiac, 7, 11, 38, 55, 56, 60, 62, 65 Cardiopulmonary, 56, 65 Carpal Tunnel Syndrome, 10, 56 Carrier Proteins, 57, 66, 68 Case report, 11, 13, 18, 57 Catheterization, 7, 54, 57 Cell, 18, 55, 56, 57, 58, 59, 60, 61, 64, 65, 67, 69, 72 Cell Cycle, 57, 61 Cell Division, 55, 57, 61 Centrifugation, 57, 64 Cerebral, 57, 60 Cesarean Section, 38, 57 Chemotherapy, 18, 22, 57 Chest Pain, 38, 57 Cholecalciferol, 21, 57 Chronic, 5, 13, 38, 57 Chronic Obstructive Pulmonary Disease, 38, 57 Clinical trial, 4, 37, 57, 69 Cloning, 56, 57 Coagulation, 4, 56, 57, 66, 70, 72 Coenzyme, 21, 57 Cofactor, 57, 68 Collagen, 58, 67 Colloidal, 53, 58, 69 Combination Therapy, 17, 58 Complement, 58, 66 Complementary and alternative medicine, 17, 26, 58 Complementary medicine, 17, 58

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Computational Biology, 37, 58 Conjugated, 58, 59 Contraindications, ii, 4, 58 Coronary, 6, 7, 8, 10, 11, 12, 59, 64, 65, 70 Coronary Angiography, 8, 11, 59 Coronary Thrombosis, 6, 59, 64, 65 Cortisone, 59, 67 Curative, 59, 65, 70 Cytochrome, 21, 59 D Databases, Bibliographic, 37, 59 Diagnostic procedure, 30, 59 Dialyzer, 59, 62 Diffusion, 59, 71 Dilatation, 54, 59 Dipyridamole, 8, 18, 25, 59 Direct, iii, 59, 69 Drug Interactions, 20, 59 Duke, 10, 59 E Efficacy, 10, 21, 59 Electrocoagulation, 57, 60 Electrolyte, 60, 62, 70 Emboli, 60, 72 Embolism, 60, 68, 72 Embolization, 60, 72 Embolus, 4, 60, 63 Emphysema, 57, 60 Endarterectomy, 38, 54, 55, 60 Endocarditis, 22, 60 Endocardium, 60, 71 Endothelial cell, 18, 60, 71 Environmental Health, 36, 38, 60 Enzymatic, 56, 58, 60 Enzyme, 57, 60, 66, 68, 70, 72 Enzyme Inhibitors, 60, 66 Epinephrine, 19, 53, 60 Epitope, 20, 60 Erythrocytes, 54, 60 Etoposide, 22, 60 Exogenous, 56, 61, 68 Extracellular, 61, 65, 69 Extremity, 12, 61, 64 F Family Planning, 37, 61 Fat, 54, 60, 61, 70 Fatty acids, 53, 61, 68, 70 Fetus, 57, 61 Fibrillation, 6, 10, 61 Fibrin, 56, 61, 70 Fibrinogen, 21, 61, 66, 70 Flank Pain, 11, 61

Fluorouracil, 18, 59, 61 Fold, 8, 13, 61 G Gastrointestinal, 4, 7, 11, 56, 60, 61, 64 Gastrointestinal Hemorrhage, 11, 61 Gastrointestinal tract, 61, 64 Gene, 28, 56, 61 Gland, 53, 59, 61, 68, 70 Glucocorticoid, 61, 67 Glucuronic Acid, 61, 62 Glycoprotein, 61, 62 Governing Board, 62, 67 Growth, 18, 62, 70 H Haptens, 53, 62, 68 Heme, 59, 62, 67 Hemodiafiltration, 62, 71 Hemodialysis, 3, 59, 62, 71 Hemofiltration, 62, 71 Hemoglobin, 54, 60, 62, 67 Hemorrhage, 4, 7, 8, 13, 60, 62, 70 Heparin, 7, 11, 28, 42, 62 Hepatic, 18, 53, 62, 67 Heredity, 61, 62 Hormone, 59, 60, 62, 70 Hypertension, 24, 62, 64 Hypertrophy, 62, 64 Hysterotomy, 57, 62 I Id, 14, 23, 43, 48, 50, 63 Ileal, 11, 63 Ileum, 63 Immune response, 54, 59, 62, 63 Immunogenic, 63, 68 Immunoglobulin, 54, 63, 64 Immunosuppressant, 61, 63 In vivo, 62, 63, 70 Incision, 56, 62, 63 Indicative, 27, 63, 66, 71 Infarction, 63, 70 Inflammation, 53, 54, 55, 56, 63, 64, 70 Ingestion, 63, 64, 67 Inhalation, 63, 67 Internal Medicine, 19, 63, 65 Intestines, 61, 63 Intravenous, 11, 63 Intravenous pyelogram, 11, 63 Involuntary, 61, 63, 65 Ions, 55, 60, 63, 68 Ischemic stroke, 7, 10, 63 J Joint, 7, 12, 55, 63, 70

Index 75

K Kb, 36, 63 Kinetic, 64 L Leukotrienes, 55, 64 Library Services, 48, 64 Ligament, 64, 68 Liver, 53, 54, 61, 62, 64, 67 Lymph, 60, 64 Lymphocyte, 54, 64 M Mastectomy, 12, 64 Median Nerve, 56, 64 MEDLINE, 37, 64 Membranes, 57, 64, 67, 69 MI, 51, 64 Microsomal, 19, 64 Mitochondrial Swelling, 64, 65 Mitotic, 61, 64 Molecular, 37, 39, 56, 58, 61, 62, 64 Molecule, 54, 55, 57, 58, 60, 64, 65, 69 Monoclonal, 17, 20, 64 Monocrotaline, 18, 64 Myocardial infarction, 7, 8, 10, 11, 12, 59, 64, 65, 72 Myocardium, 64, 65 Myotonic Dystrophy, 18, 65 N Necrosis, 11, 12, 63, 64, 65 Need, 3, 5, 28, 38, 44, 65 Nephrology, 3, 4, 65 Nephrosis, 28, 65 Niacin, 21, 65 Nuclear, 11, 65 Nursing Staff, 5, 65 O Ophthalmologic, 59, 65 Osmotic, 53, 64, 65, 69 Osteoblasts, 65 Osteocalcin, 20, 65 Outpatient, 5, 65 Oxidation, 56, 59, 65 P Palliative, 66, 70 Pathologic, 59, 66, 71 Patient Education, 42, 46, 48, 51, 66 Pelvic, 66, 68 Peptide, 66, 67, 68 Peripheral Vascular Disease, 21, 66 Pharmacists, 22, 38, 66 Pharmacodynamics, 20, 66 Pharmacokinetic, 66

Pharmacologic, 54, 66, 71 Phosphorus, 42, 56, 66 Phosphorylated, 57, 66 Photocoagulation, 57, 66 Physiology, 65, 66 Plaque, 54, 55, 66 Plasma, 17, 20, 23, 53, 54, 61, 62, 66, 68, 69 Plasma protein, 23, 53, 66, 68, 69 Platelet Activation, 17, 66 Platelet Aggregation, 19, 67, 70 Platelets, 42, 66, 67, 70 Podophyllotoxin, 60, 67 Poisoning, 18, 67 Pollen, 67, 68 Polypeptide, 58, 61, 67 Polysaccharide, 54, 67 Porphyria, 42, 67 Porphyrins, 67 Potentiation, 19, 67 Practice Guidelines, 39, 67 Precursor, 55, 60, 67, 68 Prednisolone, 67 Prednisone, 42, 67 Progressive, 62, 65, 66, 68 Prophylaxis, 5, 12, 68, 69, 72 Prostaglandins, 21, 55, 68 Prostate, 22, 25, 68 Protease, 58, 68 Protein Binding, 21, 68 Protein C, 53, 65, 68 Protein S, 28, 56, 65, 68 Proteins, 20, 28, 53, 54, 57, 58, 64, 66, 68, 69, 71 Proteolytic, 58, 61, 68 Prothrombin, 19, 20, 68, 70 Public Policy, 37, 68 Publishing, 5, 68 Pulmonary, 4, 12, 42, 56, 62, 64, 68, 72 Pulmonary Artery, 56, 64, 68 Pulmonary Embolism, 12, 42, 68, 72 Q Quercetin, 15, 68 R Radioimmunoassay, 17, 68 Randomized, 5, 10, 17, 18, 59, 69 Receptor, 54, 68, 69 Rectum, 68, 69 Recurrence, 4, 69 Refer, 1, 58, 69 Regimen, 4, 8, 59, 69 Remission, 69 Retinoids, 69

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Retinol, 21, 69 Rutin, 68, 69 S Screening, 19, 57, 69 Semen, 68, 69 Semisynthetic, 60, 69 Serum, 18, 19, 20, 53, 58, 65, 68, 69 Serum Albumin, 19, 68, 69 Side effect, 53, 69, 71 Skeleton, 63, 69 Small intestine, 62, 63, 69 Sodium, 3, 13, 69 Soft tissue, 12, 69, 70 Specialist, 42, 43, 70 Species, 60, 64, 70 Stomach, 61, 62, 63, 69, 70 Stroke, 36, 42, 63, 70 Supplementation, 17, 21, 70 Sympathomimetic, 60, 70 Symphysis, 68, 70 Systemic, 56, 60, 67, 70, 72 T Therapeutics, 70 Thrombin, 10, 19, 61, 67, 68, 70 Thrombocytes, 67, 70 Thromboembolism, 5, 70 Thrombophlebitis, 42, 70 Thrombosis, 4, 8, 12, 21, 68, 70 Thromboxanes, 55, 70 Thrombus, 4, 59, 63, 67, 70, 71 Thyroid, 42, 70 Ticlopidine, 8, 70 Tin, 57, 70

Tissue, 4, 8, 54, 55, 57, 58, 60, 61, 64, 65, 66, 69, 70, 71 Toxic, iv, 64, 67, 71 Toxicity, 59, 71 Toxicokinetics, 71 Toxicology, 19, 38, 71 Toxins, 54, 61, 71 Trachea, 56, 70, 71 Transfection, 56, 71 Trauma, 10, 65, 71 Tunica Intima, 60, 71 U Ultrafiltration, 19, 62, 71 Unconscious, 54, 63, 71 Ureters, 63, 71 Urethra, 68, 71 Urine, 56, 63, 71 V Vascular, 3, 13, 59, 63, 70, 71 Vasoconstriction, 60, 71 Vein, 12, 55, 63, 65, 70, 71 Venous, 4, 55, 68, 70, 71, 72 Venous Thrombosis, 4, 70, 71, 72 Ventricular, 64, 71 Venules, 56, 71 Vesicular, 64, 72 Veterinary Medicine, 37, 72 Vitro, 62, 63, 72 W Warfarin, 3, 5, 6, 7, 8, 10, 12, 13, 17, 18, 19, 20, 21, 22, 23, 26, 72 White blood cell, 54, 64, 72 Windpipe, 70, 72 X X-ray, 63, 65, 72

Index 77

78

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Index 79

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Coumadin