Presentation of problem-specific, text-based medical knowledge: XML and related technologies.

Systematic reviews of the impact of clinical decision support systems on provider behavior and patient outcome have shown evidence of benefit. Knowledge-based functions for decision support or monitoring that are integrated in clinical information systems are a potentially effective way. But these concepts are restricted by the efforts required for development and maintenance of the information systems and the limited number of implemented medical rules. Physicians are familiar to get their information from text-based sources. It seems to be straight-forward to rely on a document-based solution in order to present problem-specific information at the point of care. We have developed a concept for context-sensitive retrieving and presentation of text-based medical knowledge (textbook of internal medicine) using the eXtensible Markup Language (XML) and related technologies. This concept can facilitate the electronic query and presentation of this resource. XML may replace narrative text as a storage format and allows to structure the data in a stepwise fashion. On the basis of structured data we are able to improve the search quality for clinical information and its presentation which forms a crucial pre-requisite for the use of the information and the implementation of evidence-based care in the clinical routine.

Cardiovascular effects of single doses of the antidepressants amitriptyline and lofepramine in healthy subjects.

In a placebo-controlled double blind study, single oral doses of lofepramine (140 mg and 210 mg) and amitriptyline (100 mg and 150 mg) were given to 5 healthy volunteers. Heart rate, blood pressure, systolic time intervals, and electrical impedance cardiogram were recorded in supine and upright position for 8 hours after drug administration. In addition, plasma drug concentrations were measured simultaneously. Amitriptyline caused a more pronounced increase in heart rate, especially under orthostatic stress, than did lofepramine. Both drugs reduced total peripheral resistance; amitriptyline's effect was greater. A rise in blood pressure (supine position) and shortening of the electromechanical systole under lofepramine indicated an improvement of cardiac performance. In contrast amitriptyline, particularly, in the upright position, lowered blood pressure and lengthened electromechanical systole. Since both drugs have a comparable antidepressant activity, lofepramine is suggested to induce fewer untoward cardiovascular reactions than amitriptyline.