bluuebunny/crossref_metadata_2025 huggingface dataset:
The Maternal Mortality Review Meeting: Experiences from Kalabo District Hospital, Zambia
Authors: Stekelenburg Jelle , van Roosmalen Jos
Published: January 2017

We report on our experiences with a maternal mortality review meeting in Kalabo District Hospital between 1999 and 2001. Patient files and minutes of the maternal mortality review meetings of 15 cases of maternal death were reviewed. Causes of death, classification, substandard care factors, recommendations and implementation were analysed. In nine cases of maternal death 20 different substandard care factors were found; 12 caused by organizational weaknesses, eight by substandard clinical care. In nine cases, recommendations were formulated, which were completely implemented in five and partially implemented in two cases.

A maternal mortality review meeting can be an important tool for improving essential obstetric services in a district hospital. It can easily and directly correct some substandard care factors, has a high educational value for staff and leads to a better understanding of maternal mortality for everyone involved.
Palliation by Coeliac Plexus Block for Upper Abdominal Visceral Cancer Pain
Authors: Firdousi Faizul Hasan , Sharma Dhananjaya , Raina V K
Published: January 2017

Palliation of cancer related pain is one of the major concerns of patients suffering from cancer of the upper abdominal organs. The non-availability of imaging techniques to guide needle placement prompted us to use a blind technique of neurolytic coeliac plexus block. Thirty consecutive patients with intractable pain, due to documented inoperable upper abdominal visceral cancers, underwent neurolytic coeliac plexus block by blind percutaneous retrocrural unilateral neurolysis. The severity of pain was documented on a 0–10 visual analogue scale (VAS) performed pre-block and post-block at 1 day, 1 week, 1 month and 3 months. Pain relief was graded as excellent if the score was 0–2, good when VAS was 3–5, satisfactory when VAS was 6–7 and unsatisfactory if VAS was 8–10. Excellent pain relief was obtained in 26/30 patients (86.6%). Relief from pain diminished with time and after 3 months, 16/30 patients (53.35) graded their pain relief as excellent. Transient but severe hypotension complicated 73% of blocks.

Despite the proximity of vital structures, blind unilateral retrocrural neurolytic coeliac plexus blockade is a safe and effective means to relieve the terminal pain associated with upper abdominal visceral cancer. It deserves more widespread use in patients with upper abdominal cancer. Results of the present study are encouraging and relevant for clinicians working in developing countries.
Measuring the Burden of Ocular Morbidity
Authors: Panda Anita , Upadhyay M P , Kumar Narayan , Badhu B , Koirala Shekhar
Published: January 2017

This hospital-based study highlights the spectrum of eye ailments in 35 273 patients who attended the Department of Ophthalmology at the B P Koirala Institute of Health Sciences, Eastern Nepal, during a 5-year period with varied clinical diagnosis. The attendance each year showed a progressive increase with a male preponderance. More than 13% of the patients were children. Cataract was the most common problem for which patients needed ophthalmic advice; diabetic and hypertensive retinopathy were frequent occurrences and infection was a common problem. Over 21% of the eyes examined had a refractive error: as high as 2.54% were amyblyopic caused by non-correction of refractive errors. Allergic conjunctivitis was frequently encountered. As shown by the magnitude of the problem, the existing eye care facilities must be enhanced and new strategies developed.
Facial Dog Bites in Southwestern Nigerian Children: An Analysis of Eight Cases
Authors: Oginni F O , Akinwande J A , Fagade O O , Arole G F , Odusanya S A
Published: January 2017

This paper analyses the prevalence, pattern and treatment outcome of eight cases of facial dog bite in Nigerian children seen and managed at the Obafemi Awolowo University Teaching Hospital's Complex, a tertiary hospital located in Southwestern Nigeria. During the study period of 18 months (July 1996–December 1997), a total of 174 cases of facial soft tissue injuries in children were managed, two of which resulted in rabies and death of the patients. Based on the findings of this analysis, we suggest that unprovoked facial dog bites inflicted by familiar domestic dogs may be complicated by rabies. Ignorance about the risk of uncompleted treatment, financial constraints and scarcity of the vaccine may be implicated in the outcome. The need to improve community knowledge of rabies and the availability and affordability of rabies vaccine are highlighted.
Urinary Schistosomiasis in Schoolchildren
Authors: Patwari A K , Aneja S
Published: January 2017

Two hundred schoolboys aged from 5–18 years with urinary schistosomiasis were studied. Terminal haematuria was observed to be the commonest presentation, though haematuria may be microscopic initially. Haematuria was painless in only a small percentage of cases, as most of them had associated urinary symptoms. Pain and burning sensation in the epigastrium was an outstanding feature of recent onset of schistosomiasis. Most cases had moderate proteinuria which was directly related to intensity of haematuria and egg count in urine. Ignorance about the transmission of the disease, false cultural beliefs and poor drug compliance seem to be important factors in the high prevalence in children. An extensive health education campaign, particularly in educational institutions, will help to control the disease in endemic areas.
Nutritional Status of Normal and Handicapped Children in Benin City, Nigeria
Authors: Alakija Wole
Published: January 2017

Using an age-independent anthropometric method, the nutritional status of handicapped children in Benin City was found to be below normal. Apparently normal children aged 6–8 years from poor socioeconomic environments were also found to be below normal. However, children from better socioeconomic environments compared well with average American children.
How Do African Voluntary Agency Hospitals Spend Their Money?
Authors: Van Lemmen Freek , Van Amelsvoort V
Published: January 2017

The recurrent expenditure over the years 1981–83 was analysed in 50 voluntary agency hospitals from 12 African countries. The percentage distribution, averaged across all hospitals, of 7 major categories was: personal emoluments 48%; drugs and dressings 18%; transport, electricity, water 11%; food 6%; hospital supplies 5%; repair and maintenance 5%; other expenditure 7%.

The first two items differed widely in two subgroups of hospitals. Personal emoluments took 38% in hospitals depending mainly on patient fees, as against 54% in hospitals receiving substantial government grants. The expenditure for drugs and dressings was 24% and 14% respectively for the same hospital subgroups.
Self-Administered Drug Compliance in Nepali Leprosy Patients
Authors: Roche P W , Failbus S , Britton W
Published: January 2017

The self administration of dapsone by Nepali leprosy patients receiving multidrug therapy was assessed by a colorimetric and a filter paper spot test. Overall 45 out of 337 (13.3%) patients were found to be non-compliant. The relation of non-compliance to sex, age, leprosy classification, therapy type and length of therapy was investigated. The spot test was compared with the colorimetric assay and found to have a relative sensitivity of 99.3% and specificity of 95.4%. Follow up of patients was successful in that two-thirds of non-compliant patients were compliant on their follow-up test.
Mortality Risk Factors in Acute Protein-Energy Malnutrition
Authors: Gillam S J
Published: January 2017

The records of 45 children admitted to the Save The Children Fund (UK) Clinic, Dhankuta, East Nepal for nutritional rehabilitation, and who subsequently died, were compared with those of 200 survivors admitted during the same period. Children who died were more likely to have attended the clinic previously (P<0.02), and tended to be younger and lighter than controls. A poor outcome was associated with oedema (P< 0.02), hepatomegaly (P<0.01), suspected tuberculosis (P<0.001) and various socioeconomic factors: children who died came from larger families, ‘single parent’ families (P< 0.01), and were more likely to have lost a sibling (P< 0.01). The irrigated landholdings of dying children's families were on average approximately half the size of those of survivors' families. These socioeconomic factors were associated with more severe malnutrition at presentation. The identification of factors associated with a poor prognosis can help to focus admission criteria and to monitor especially high-risk children where services for the acutely malnourished are limited.
Primary Medical Care in Seychelles
Authors: Sullivan F M , Shamlaye C
Published: January 2017

This paper describes some of the current health problems faced by a tropical country whose standard of living and lifestyle is approaching that of many countries in Western Europe. Long-term health problems such as cardiovascular diseases and diabetes have become at least as important as infectious diseases. A change in approach to a more proactive style of primary care is needed to allow the contribution of community doctors to be effective. The system of primary care in the Republic of Seychelles is based on the UK model of general practice where recent improvements in education and organization are raising standards. How some of these improvements might be transferred elsewhere is discussed.
The Health Consequences of Intrauterine Growth Retardation in Southwestern Ethiopia
Authors: Kebede Assegid , Larson Charles
Published: January 2017

Although over 90% of low birth weight deliveries occur in the developing world, knowledge of its occurrence and consequences are largely based on studies in developed populations. The aim of this investigation was to determine the health consequences of intrauterine growth retardation (IUGR) among an historical cohort of children delivered in a regional hospital located in southwestern Ethiopia. Following a census of all births over a three year period 116 full-term, IUGR and normal birth weight (NBW) matched pairs between 3 and 40 months of age were identified. IUGR children were found to be at elevated risk for moderate to severe malnutrition [relative risk (RR) = 2.26 (1.15, 4.43)], frequent illnesses (RR = 1.29 (1.13, 1.46)), and current illness (RR 1.52 (1.10, 2.09)). Catch-up growth among IUGR children did not occur. A steady decline in the growth of NBW children resulted in similar anthropometric outcomes by 2 years of age between the two groups.
Ghana: Selective versus Comprehensive Primary Health Care
Authors: Amofah George K
Published: January 2017

The furore which surrounded the debate over selective versus comprehensive primary health care (PHC) world wide appears to have died down. After 10 years of PHC implementation in Ghana, however, it is imperative that we revisit the issue in the Ghanaian context.

This is because the choice either way has implications for programme planning, implementation, financing and the achievement of stated health policy goals in Ghana.

Here I shall attempt to analyse the issues involved in Selective and Comprehensive PHC, outline the advantages and disadvantages of each strategy and suggest a compromise strategy in the Ghanaian context.
Prevalence of Paediatric Skin Diseases in Rural Honduras
Authors: Kottenhahn Renee K , Heck Jeffery E
Published: January 2017

Although review of medical literature suggests that skin disease is a common cause of morbidity in developing countries, there have been few prospective primary care studies to document the prevalence of dermatologic conditions. The goal of this study was to determine the prevalence of paediatric skin diseases in rural Honduras. The study was conducted in October 1992, during a medical mission sponsored by the University of Cincinnati, Children's Hospital Medical Center (Cincinnati) and the Honduran Ministry of Health.
“Why Did You Blend My Learning?” A Comparison of Student Success in Lecture and Blended Learning Introduction to Sociology Courses
Authors: Luna Yvonne M. , Winters Stephanie A.
Published: January 2017

Introduction to Sociology at a large public university was taught in two separate formats, blended learning and lecture, during the same semester by the first author. While some similarities existed, the distinction was in delivery of course content. Additionally, the blended class had one-third less in-class time that was primarily devoted to active learning. In this quasi-experimental study, the researchers tested differences in learning using grades and pre-posttests. Although there were no statistically significant differences across sections in exams and final grades, the blended class had significantly greater improvement on the overall pre- to posttest. Additionally, students of color and non–first year students in that class had significantly greater improvement on the pre-posttest compared to those subpopulations in the lecture course. The authors conclude that blended learning, employing flipped pedagogy and centered on active learning, may be more effective than lecture, particularly in narrowing the achievement gap between white and non-white students.
When You Reach a Fork in the Road, Take it: Science and Product Development as Linked Paths
Authors: Keusch Gerald T.
Published: January 2017

Increasingly, health is recognized as a major force for economic development; and because economic development is central to political and social stability, health is being looked at as the great hope for the future of the world, as population sizes and disparities among them increase. This perspective has been growing ever since the 1993 World Development Report was released by the World Bank, and it has fueled an intensive scrutiny of health care around the world, focusing on systems and health care delivery on the one hand, and equitable access to the products of research on the other hand. In the middle of all of is this is a concern about how health care (which must include both the training of personnel from the basic low level health care worker to the physician), and research and development (which must include the financing of research in academia and the development of products primarily in the private sector) are organized, and how they do or do not address inequities between and within populations and nations.
“Trust Me”: Patent Offices in Developing Countries
Authors: Drahos Peter
Published: January 2017

Patent rules matter to the structure and evolution of pharmaceutical markets. If they did not, pharmaceutical multinationals would not spend resources on their globalization and content. The role of pharmaceutical multinationals in shaping the patent provisions of the Agreement on the Trade-Related Aspects of Intellectual Property Rights (TRIPS) has been well documented. The contributions of developing country coalitions and nongovernmental organizations (NGOs) in the World Trade Organization (WTO) on TRIPS and access to medicines have also been studied.

One actor, the patent office, has largely escaped detailed scrutiny in the literature that has grown around intellectual property law and access to medicines. There is an obvious explanation. Patent offices are administrative bodies. They administer patent standards that are decided and defined by others – the courts, legislatures or the executive acting in the context of treaty negotiation. For those interested in the structural reform of pharmaceutical markets, reforming patent office administration has not been a high priority.
Demand Forecasting for Essential Medical Technologies
Authors: Levine Ruth , Pickett Jessica , Sekhri Neelam , Yadav Prashant
Published: January 2017

Today's global health programs will attain their objectives only if products appropriate to the health problems in low- and middle-income countries are developed, manufactured and made available when and where they are needed. Achieving this requires mobilizing public and charitable money for more and better products to diagnose, prevent and treat HIV/AIDS, tuberculosis, malaria, reproductive health problems and childhood killers. But more money is only one part of the story. Weak links in the global health value chain—from research and development through service delivery—are constraining on-the-ground access to essential products. The consequences of those weak links are many: supply shortages, inefficient use of scarce funding, reluctance to invest in R&D for developing country needs and, most importantly, the loss of life among those who need essential products.
Should Access to Medicines and TRIPS Flexibilities Be Limited to Specific Diseases?
Authors: Outterson Kevin
Published: January 2017

The health needs of most of the world's population are not well served by patent-based pharmaceutical markets. The poor in low- and medium-income countries (LMICs) lack the financial resources to sustain the attention of global commercial drug companies. After an extensive consultation process, in 2006, the World Health Organization's Commission on Innovation, Intellectual Property and Public Health issued its Report (the WHO CIPIH Report), finding this concern to be significant:

In the context of our work one of the important points is that, where the market has very limited purchasing power, as is the case for diseases affecting millions of poor people in developing countries, patents are not a relevant factor or effective in stimulating R&D and bringing new products to market.

On this issue, the WHO CIPIH Report was preceded by the Access to Medicines movement, an informal coalition of civil society organizations such as Médecins Sans Frontières, Treatment Action Campaign, Health GAP, Oxfam, and Knowledge Ecology International (formerly the Consumer Project on Technology).
Access to Medicines, BRICS Alliances, and Collective Action
Authors: Yu Peter K.
Published: January 2017

On December 6, 2005, shortly before the World Trade Organization (“WTO”) Ministerial Conference in Hong Kong, WTO member states agreed to accept a protocol of amendment to the Agreement on Trade-Related Aspects of Intellectual Property Rights (“TRIPs Agreement”). This amendment sought to provide a permanent solution to implement paragraph 6 of the Doha Declaration on the TRIPS Agreement and Public Health (“Doha Declaration”). If ratified, the new article 31bis of the TRIPs Agreement will allow countries with insufficient or no manufacturing capacity to import generic versions of on-patent pharmaceuticals.

To facilitate the supply of essential medicines to countries with insufficient or no manufacturing capacity, article 31bis(3) creates a special arrangement not only for the affected countries, but also for those belonging to a regional trade agreement. Such an arrangement allows less developed countries to aggregate their markets to generate the purchasing power needed to make the development of an indigenous pharmaceutical industry attractive.
Are Developing Countries Going Too Far on TRIPS? A Closer Look at the New Laws in India
Authors: Bhattacharya Radhika
Published: January 2017

The goal of the Trade-Related Aspects of Intellectual Property Rights (TRIPS) Agreement is to harmonize the intellectual property rights of World Trade Organization (WTO) member countries to a certain minimum standard. As a WTO member, the organization required India to enact legislation that enforces TRIPS by 2005. Part of India's motivation to pass its 2005 Patents Act stemmed from its obligations as a WTO member nation, as well as the government's desire to stimulate greater foreign investment, innovative research and economic growth.

India's implementation of the TRIPS Agreement has generated a great deal of controversy. Disagreement exists about whether the Indian Patents Act overzealously protects intellectual property rights and whether the Patents Act goes beyond the spirit of the TRIPS Agreement. Many health officials and non-governmental organizations (NGOs) are seriously concerned about what the Patents Act implies for people suffering from diseases in less developed countries. Nonprofit and some World Health Organization officials argue that the new law prevents India from producing and supplying generic drugs within its borders and to other developing countries.
Comparative Effectiveness Research under the Patient Protection and Affordable Care Act: Can New Bottles Accommodate Old Wine?
Authors: Kinney Eleanor D.
Published: January 2017

The Patient Protection and Affordable Care Act (PPACA), as amended by the Health Care and Education Reconciliation Act of 2010, initiated comprehensive health reform for the healthcare sector of the United States. PPACA includes strategies to make the American healthcare sector more efficient and effective. PPACA's comparative effectiveness research initiative and the establishment of the Patient-Centered Outcomes Research Institute are major strategies in this regard. PPACA's comparative effectiveness research initiative is one in a long line of federal initiatives to address the rising costs of healthcare as well as to obtain better value for healthcare expenditures. The key question is whether the governance and design features of the institute that will oversee the initiative will enable it to succeed where other federal efforts have faltered. This Article analyzes the federal government's quest to ensure value for money expended in publically funded healthcare programs and the health sector generally. This Article will also analyze what factors contribute to the possible success or failure of the comparative effectiveness research initiative. Success can be defined as the use of the findings of comparative effectiveness to make medical practice less costly, more efficient and effective, and ultimately, to bend the cost curve.
Cholesterol-lowering drugs: science and marketing
Authors: Garattini Livio , Padula Anna
Published: January 2017

Long-term use of statin therapy is essential to obtain clinical benefits, but adherence is often suboptimal and some patients are also reported to fail because of ‘statin resistance'. The identification of PCSK9 as a key factor in the LDL clearance pathway has led to the development of new monoclonal antibodies. Here we critically review the economic evaluations published in Europe and focused on statins. We searched the PubMed database to select the studies published from July 2006 to June 2016 and finally selected 19 articles. Overall, the majority of studies were conducted from a third-party payer's viewpoint and recurred to modelling. Most studies were sponsored by industry and funding seemed to play a pivotal role in the study design. Patients resistant to LDL-C level reduction were considered only in a few studies. The place in therapy of the new class of biologic should be considered a kind of ‘third line' for cholesterol-lowering, after patients have failed with restricted dietary regimens and then with current drug therapies. Otherwise they could result in hardly sustainable expenses even for developed countries.
Executive programs for Brazilian mid-career public managers
Authors: Pacheco Regina Silvia , Franzese Cibele
Published: January 2017

This paper discusses the challenges of professional education for mid-career public managers at graduate level, pointing out pitfalls to avoid and obstacles to face. Analyzing the Brazilian case, the goal is to raise issues that may also be present in other cases. The main argument developed here is that the puzzle faced by graduate programs on public administration requires an equal distance from training and from academic programs. Education programs for professionals in public administration should address their own challenges – namely problem-solving and interdisciplinarity.
Catheter‐Related Bloodstream Infections in Adults Receiving Home Parenteral Nutrition: Substantial Differences in Incidence Comparing a Strict Microbiological to a Clinically Based Diagnosis
Authors: Tribler Siri , Brandt Christopher F. , Hvistendahl Mark , Staun Michael , Brøbech Per , Moser Claus E. , Jeppesen Palle B.
Published: January 2017

Background: A common complication in patients receiving home parenteral nutrition (HPN) is catheter‐related bloodstream infections (CRBSIs). The CRBSI incidence has been advocated as an outcome parameter assessing the quality of care. This study aimed to illustrate how the use of different CRBSI definitions affects the reported incidence. Materials and Methods: In an observational study based on the Copenhagen intestinal failure database, all clinically reported CRBSIs from 2002–2013 were compared with data from the affiliated microbiological database according to recommended CRBSI criteria. Results: Clinically, 1034 CRBSIs were observed in 548 adults receiving HPN for 1410 catheter‐years. Thus, the clinically assessed CRBSI incidence was 1.95/1000 catheter‐days. However, based on the microbiological evaluation, only 47% of our episodes fulfilled the Centers for Disease Control and Prevention (CDC) and European Society for Clinical Nutrition (ESPEN) CRBSI criteria. Employing a catheter‐salvaging strategy, 40% of the CRBSI diagnoses were supported by the paired blood culture positivity criteria and only 6% by a positive catheter tip. In 53%, CRBSIs were categorized as a clinical or “probable CRBSI” diagnosis. In 20% of all episodes, missing information/blood cultures hampered a CDC/ESPEN CRBSI diagnosis. Thereby, according to CDC/ESPEN CRBSI definitions, the incidence was 0.92/1000 days or 46% lower than clinically assessed. Conclusion: This study illustrates the practical and methodological challenges and great variability in reporting of the CRBSI incidence. Nonetheless, it is recommended as a marker of the quality of care. Consensus regarding CRBSI definitions is a prerequisite for a meaningful comparison of this important outcome parameter between HPN centers.
When Bureaucracy Meets the Crowd: Studying “Open Government” in the Vienna City Administration
Authors: Kornberger Martin , Meyer Renate E. , Brandtner Christof , Höllerer Markus A.
Published: January 2017

Open Government is en vogue, yet vague: while practitioners, policy-makers, and others praise its virtues, little is known about how Open Government relates to bureaucratic organization. This paper presents insights from a qualitative investigation into the City of Vienna, Austria. It demonstrates how the encounter between the city administration and “the open” juxtaposes the decentralizing principles of the crowd, such as transparency, participation, and distributed cognition, with the centralizing principles of bureaucracy, such as secrecy, expert knowledge, written files, and rules. The paper explores how this theoretical conundrum is played out and how senior city managers perceive Open Government in relation to the bureaucratic nature of their administration. The purpose of this paper is twofold: first, to empirically trace the complexities of the encounter between bureaucracy and Open Government; and second, to critically theorize the ongoing rationalization of public administration in spite of constant challenges to its bureaucratic principles. In so doing, the paper advances our understanding of modern bureaucratic organizations under the condition of increased openness, transparency, and interaction with their environments.
Blurred lines and false dichotomies: Integrating counterinsurgency into the UK’s domestic ‘war on terror’
Authors: Sabir Rizwaan
Published: January 2017

The UK’s counter-terrorism strategy (CONTEST) seeks to pursue individuals involved in suspected terrorism (‘Pursue’) and seeks to minimise the risk of people becoming ‘future’ terrorists by employing policies and practices structured to pre-emptively incapacitate and socially exclude them (‘Prevent’). This article demonstrates that this two-pronged approach is based on a framework of counterinsurgency; a military doctrine used against non-state actors that encourages, amongst other things, the blanket surveillance of populations and the targeting of propaganda at them. The use of counterinsurgency theory and practice in the UK’s ‘war on terror’ blurs the distinction between Pursue and Prevent, coercion and consent, and, ultimately, civilian and combatant. This challenges the liberal claim that counter-terrorism policies, especially Prevent, are about social inclusivity or ‘safeguarding’ and that the UK government is accountable to the people.
Implementing the evidence on young adult neuromaturation
Authors: Hughes Nathan , Strong Grace
Published: January 2017

Young adults constitute a disproportionately high percentage of the caseload of probation services and are at greatest risk of reoffending. Effectively supporting young adults is therefore crucial to the success of probation services. Research from developmental sciences presents early adulthood as a key stage of emotional and psychosocial maturation, distinct from adolescence or later adulthood, and offers insights into how services might appropriately respond. This practice note demonstrates how this research is informing the implementation of a bespoke pathway of intervention and support for young adults in two community rehabilitation companies.
A tool to predict perceived urban stress in open public spaces
Authors: Knöll Martin , Neuheuser Katrin , Cleff Thomas , Rudolph-Cleff Annette
Published: January 2017

This article presents an exploratory framework to predict ratings of subjectively perceived urban stress in open public spaces by analysing properties of the built environment with GIS and Space Syntax. The authors report on the findings of an empirical study in which the environmental properties of a sample of open public spaces in the city of Darmstadt, Germany were constructed and paired to users’ ratings. The data are analysed using different types of multivariate analyses with the aim to predict the ratings of perceived urban stress with a high explained variance and significance. The study finds that open public space typologies (park, square, courtyard, streets) are the best predictors for perceived urban stress, followed by isovist characteristics, street network characteristics and building density. Specifically, the isovist visibility, vertices number and perimeter, previously related to arousal and complexity in indoor spaces, show significant relation to perceived urban stress in open public spaces, but with different direction of effects. A model is presented that achieves a predictive power of R2 = 54.6%. It extends existing models that focused on green spaces and streetscapes with a first exploratory attempt to predict more complex reactions such as perceived urban stress.
Accounting for cognitive effort in random regret-only models: Effect of attribute variation and choice set size
Authors: Jang Sunghoon , Rasouli Soora , Timmermans Harry
Published: January 2017

Behaviorally, regret-based choice models implicitly assume that individuals anticipate the amount of attribute-level regret by comparing the attribute levels of a considered choice alternative against the attribute levels of the best or all other choice alternatives. Arguing that the amount of effort depends on attribute variation and number of paired comparisons, we suggest a way of incorporating the effects of these factors into two regret-based choice models. The cognitive effort involved in anticipating the amount of regret in paired comparisons of choice alternatives is incorporated into the scale of the regret function of each alternative. Because more cognitive effort causes higher randomness in the assessment of the amount of regret (i.e. higher variance of error terms), the cognitive effort is expressed as a flexible heteroscedastic scale factor, which is a decreasing function of attribute variation and number of paired comparisons. The models are applied to two different data sets, and compared with a heteroscedastic multinomial logit model. Estimation results of the suggested flexible heteroscedastic random regret models show a significant improvement in predictive performance over their homoscedastic formulations. A similar but smaller improvement is obtained for multinomial logit models. These results imply that the conventional assumption of identically distributed error terms underlying random regret models may not sufficiently reflect the process of anticipating the amount of regret.
Patients and physicians agree only partially in symptoms and clinical findings before and after treatment for varicose veins
Authors: Klitfod Lotte , Sillesen Henrik , Jensen Leif Panduro
Published: January 2017

Objective

Quality improvement in surgery has mainly been based on clinical database outcomes. This study compared variables from the patient-reported Aberdeen Varicose Vein Questionnaire with the Danish Clinical Vein Database, in order to reveal agreements and differences in symptoms and clinical findings.

Methods

In the period January–March 2011, 379 legs in 287 patients treated for varicose veins were registered in the Danish Clinical Vein Database and compared to the Aberdeen Varicose Vein Questionnaire.

Results

Patients and physicians agreed in reduction of symptoms after intervention with one or more complaints still present in 128 (93%) patients according to Aberdeen Varicose Vein Questionnaire compared to the Danish Clinical Vein Database with only 64 (47%) patients. Patients reported cosmetic complaints and teleangiectasies both before and after treatment (p < 0.001) more often than doctors.

Conclusion

The Aberdeen Varicose Vein Questionnaire has added valuable information to the dialogue between the doctor and patient on which symptoms expecting to improve and which not.
Injection—Compression Sclerotherapy of the Greater Saphenous Vein with PRoximal Incompetence (Crosse Insufficiency) as an Alternative Treatment to Surgery
Authors: Hoerdegen K.M. , Sigg K.
Published: January 2017

Injection compression treatment of the long saphenous vein with proximal incompetence can yield good results if two factors are taken into account: first, a reliable injection technique, executed over many years, and second, a suitable non-toxic sclerosant, which is sufficiently strong to close even the largest varicose veins. The investigation of 88 patients showed in nearly 100% of cases an obliteration of the sapheno-femoral junction and, after a follow-up period from 1 to 10 years, permanent closure of the sapheno-femoral junction in 91.2% was achieved. In using our technique we have never encountered intra-arterial or paravenous injections, nor have we noted deep vein thromboses or pulmonary embolisms.
High Injection Sclerotherapy for Varicose Veins in the Presence of Femoro-Saphenous Reflux
Authors: McFarland R.J. , Scott H.J. , Kay D.N. , Scott R.A.P.
Published: January 2017

Injection of distal varicose veins is widely practised, but sapheno-femoral incompetence is commonly treated by operative ligation. In a double-blind prospective trial, 44 limbs in 22 patients underwent bilateral high saphenous injection using STD and saline. The initial results are promising. The proximal segment of the long saphenous vein was occluded in 63.3% of limbs and both saline and STD can produce occlusion. This may be a quick safe and reliable alternative to surgery.
Deep Venous Thrombosis of the Upper Limbs
Authors: Gutman Haim , Peri Meir , Zelikovski Avigdor , Haddad Menashe , Reiss Raphael
Published: January 2017

Deep venous thrombosis of the upper limbs is rare and represents less than 2-3% of all cases of deep venous thrombosis. Reviewing our series of 25 patients we decided that follow-up and symptomatic treatment produce acceptable results, since the disease has a benign natural history. Fibrinolytic agents administered under strict limitations (The Consensus Conference 1980, Ann Int Med) are efficient in early cases, but its ability to change the natural course of the disease has not been proved. Surgical approach should be reserved for cases with secondary ischaemia and/or a resectable extraluminal mass.
Laser Doppler Flowmetric and Waveform Changes in Patients with Venous Reflux
Authors: Lancaster John , Lucarotti Michèle , Mitchell Alison , Leaper David
Published: January 2017

Laser Doppler velocimetry (LDV) is useful in measurement of relative tissue blood flow. We have found a change in both the variability of the LDV waveform and its absolute level, when measured in the supine and dependent lower limb, in patients with venous reflux. This change correlated well with simultaneous photo-plethysmographic (PPG) assessment of venous reflux and was more pronounced in patients with leg ulcers.
The Pharmacodynamic and Clinical Activities of Daflon 500 mg: Therapeutic Effect of Micronization
Authors: Nicolaides A. N. , Struckman J. R.
Published: January 2017

Objective:

To review the pharmacodynamic and clinical activities of Daflon 500 mg.

Data selection:

Choice of relevant publications in the literature.

Conclusion:

The pharmacological activities of Daflon 500 mg on capillary hyperpermeability, inflammatory mediators and lymphatic drainage can explain its therapeutic efficacy in the treatment of chronic venous insufficiency.
Chronobiology and Clinical Activity of Dation 500 mg in Chronic Venous Insufficiency
Authors: Menyhei G. , Acsady G. , Hetenyi A. , Dubeaux D. , Rado G.
Published: January 2017

Objective:

To assess the chronobiological effect on therapeutic activity of Daflon 500 mg and to determine the optimum method of administration.

Design:

Multicentre, randomized, double-blind, controlled trial.

Setting:

Hospital outpatient clinics for vascular diseases in Hungary.

Patients:

Three hundred and twenty ambulatory patients with symptoms of chronic venous insufficiency randomized to three groups.

Interventions:

Oral administration daily of 1000 mg of Daflon 500 mg for 2 months in three different ways (morning or evening or morning and evening).

Main outcome measures:

Symptoms and clinical signs of chronic venous insufficiency.

Results:

In each group, a statistically significant improve ment was observed between the first (DO) and the last visit (D60) concerning all symptoms. Oedema disappeared in a mean percentage of patients ranging between 26% and 43%, according to the group and the side affected ( p <0.001). For the most affected leg, a significant decrease ( p <0.001) of ankle and calf circumferences was observed in each group. The first significant improvement, in comparison to DO, occurred between D15 and D30 for all symptoms and ankle circumference. The comparison between the groups did not disclose any difference concerning the improvement of symptoms and signs.

Conclusion:

In this study, Daflon 500 mg demonstrated its therapeutic activity in chronic venous insufficiency, irrespective of the daily drug administration schedule.
Current Evaluation of Lymphoedema and Assessment by Lymphoscintigraphy of the Effect of a Micronized Flavonoid Fraction (Daflon 500 mg) in the Treatment of Upper Limb Lymphoedema
Authors: Pecking A. P. , Rambert P.
Published: January 2017

Objective:

To assess the effect of Daflon 500 mg on upper lymphoedema occurring after conventional treatment of breast cancer.

Design:

Open, pilot, single centre trial.

Setting:

Hospital outpatients attending a University Hospital.

Patients:

Ten female patients (aged 44–64 years) whose previous treatment for breast cancer was followed by upper limb lymphoedema (mean (SD) time delay = 17±7 months).

Interventions:

Oral administration of a daily dose of two tablets of Daflon 500 mg for 6 months.

Main outcome measures:

Symptoms, affected upper limb volume and parameters of radionuclide lymphoscintigraphy using technetium-99m.

Results:

All patients experienced improvement of symptoms and limb volume (mean volume decrease of the swollen limb: 6.80%). Functional parameters assessed with scintigraphy were significantly improved (half-life: 147.4 (14.9) to 144.1 (14.9) min, p < 0.01; clearance of the colloid: 25.9 (2.5) to 28.3 (2.8) <l/min, p < 0.05; lymphatic speed of the colloid: 7.7 (0.3) to 8.0 (0.2) cm/min, p < 0.05).

Conclusion:

These preliminary results suggest that this therapy is effective for the treatment of lymphoedema.
A Quantitative Study of Long Saphenous Vein Morphology in Patients Undergoing Arterial Surgery
Authors: Varty K. , Jones L. , Porter K. E. , Bell P. R. F. , London N. J. M. L.
Published: January 2017

Objective:

To quantify the incidence and extent of structural changes present in the long saphenous vein of patients with arterial disease.

Design:

Observational study of saphenous vein morphology.

Setting:

Departments of Surgery and Pathology, Leicester Royal Infirmary.

Patients:

Sixty vein biopsies from patients undergoing arterial surgery.

Main outcome measures:

Intimal and medial thickness and morphology.

Results:

Smooth muscle cell hyperplasia, elastosis and fibrosis contributed to intimal thickening (> 10 μm) in 87% of veins. This was frequently associated with medial longitudinal muscle hypertrophy. Intimal thickness had a skewed distribution with a median (range) of 33 (8–381) μm, The upper limit of the normal range was 200 μm. The median (range) medial thickness was 293 (131–468) μm.

Conclusions:

Intimal thickening is common in the long saphenous vein of patients undergoing arterial surgery but is extensive in only a small proportion. The upper limit of the normal range was 200 μm.
Recurrent Varicose Veins and Primary Deep Venous Insufficiency: Relationship and Therapeutic Implications
Authors: Guarnera G. , Furgiuele S. , Di Paola F. M. , Camilli S.
Published: January 2017

Objective:

Evaluation of the relationship between deep venous insufficiency and recurrent varicose veins (RVV).

Design:

Retrospective analysis of patients affected by RVV submitted to clinical examination, continuous-wave (CW) Doppler, duplex scanning and descending phlebography in cases of incompetence at groin level.

Setting:

Department of Vascular Surgery, Istituto Dermopatico dell'Immacolata (IRCCS), Rome.

Patients:

Two hundred and thirty-nine patients affected by RVV.

Main outcome measures:

CW Doppler ultrasound, duplex ultrasound imaging and descending phlebography to assess venous incompetence.

Results:

Doppler examination revealed no reflux at the groin level in 80 limbs. In the remaining 166 limbs, descending phlebography showed a superficial venous reflux in 95 limbs (related to a sapheno-femoral junction recanalization or to an inadequate previous operation) while in 69 (28% of the 246 limbs examined) deep venous reflux was present (superficial femoral vein in 38 cases, profunda femoris vein in seven cases and both veins in 24 cases); in two cases reflux came from the pelvic veins.

Conclusions:

Our data suggest a possible role of primary deep venous insufficiency in the development of RVV and the value of descending phlebography in the planning of further surgery.
Day Case Varicose Vein Operations: Patient Suitability and Satisfaction
Authors: Ramesh S. , Umeh H. N. , Galland R. B.
Published: January 2017

Objectives:

To define how many patients with varicose veins are suitable to have the operation carried out as a day case. To define how well the procedure is tolerated.

Design:

A prospective 6-month study.

Setting:

District General Hospital.

Patients:

One hundred and sixty-eight new patients and a separate group of 100 patients having a day case varicose vein operation.

Interventions:

New patients were assessed according to RCS guidelines. Postoperatively, patients completed a one-page questionnaire.

Results:

Of the 168 patients, 141 (84%) were suitable for a day case operation. The main indications for an overnight stay were associated medical conditions and social problems. Of the 100 patients having an operation, 90 stated they would have a similar procedure carried out as a day case again. In the first 2 postoperative weeks, 12 patients saw their GP and three a district nurse. No patients contacted their GP before the fifth postoperative day. Twenty-eight patients took no analgesia following discharge from hospital; 81 felt that their postoperative pain was less than or as they expected.

Conclusion:

Most patients with varicose veins are suitable to have a day case procedure, which is well tolerated and provides no additional workload for the GP.
Liquid Crystal Thermography and Duplex in the Preoperative Marking of Varicose Veins
Authors: Kalodiki E. , Calahoras L. , Geroulakos G. , Nicolaides A. N.
Published: January 2017

Objective:

To determine the role of liquid crystal thermography (LCT) in preoperative marking of varicose veins and incompetent perforating veins.

Design:

Single patient group study comparing techniques.

Setting:

Teaching hospital vascular laboratory.

Patients:

Two hundred patients (265 legs) referred to St Mary's Hospital Vascular Laboratory for preoperative varicose vein marking.

Methods:

Patients were studied using LCT and duplex ultrasonography to identify calf perforating veins.

Results:

In part I of the study LCT identified 47 ‘areas at risk’, 42 of which were demonstrated to contain incompetent perforating veins on duplex examination (positive predictive value 89%). Thirty-eight of these 42 patients were explored at operation and 36 (95%) were confirmed as incompetent. The remaining two perforating veins could not be located. In part II of the study LCT identified 327 ‘areas at risk’, 299 of which were demonstrated to contain incompetent perforating veins on duplex examination (positive predictive value 91%).

Conclusion:

LCT is useful in the identification of incompetent perforating veins, it is easy to perform, less time consuming, cheaper and can replace duplex scanning.
Effect of Long-Distance Flights on Oedema of the Lower Extremities
Authors: Loew D. , Gerlach H. E. , Altenkämper K. H. , Schneider B.
Published: January 2017

Objective:

During long-distance flights, passengers complain of leg heaviness and oedema in the feet, ankles and distal parts of the lower extremities. Among the rarer complications are thrombophlebitis, thrombosis and pulmonary embolism. The aim of this study was to compare the efficacy of class II elastic stockings with no stockings and a venoactive compound (dried extract of vine leaves) and with a diuretic combination for preventing venous oedema during a long-distance flight.

Design:

Open, randomized study on outward-bound and return flights, volunteers having been administered the venoactive compound Antistax ( n = 13) or no medication ( n = 13); nine subjects received the fixed diuretic combination only on the outward-bound flight. Each subject ( n = 35) wore a class II compression stocking (Sigvaris 902/A-D) on one leg.

Main outcome measures:

Water displacement volume measurements of the lower limb; secondary end-points: clinical oedema, subjective symptoms, phlebological status, clinical and Doppler findings.

Results:

The most effective measure in preventing lower limb oedema was the individually fitted elastic support stockings. The venoactive drug Antistax was ineffective. The diuretic combination did have an effect in combination with the compression stocking.

Conclusion:

During long-distance flights, compression stockings are more effective in preventing oedema in the lower limbs than the venoactive dried extract of vine leaves. The diuretic combination had a marked effect in combination with compression.