bluuebunny/crossref_metadata_2025 huggingface dataset:
Clinical Nephrology and Dialysis in the 1990s
Authors: Comstock Thomas J.
Published: January 2017

End-stage renal disease (ESRD) afflicts more than 200,000 patients in the United States today, and they undergo chronic dialysis or transplantation in order to sustain life. The primary causes of treated ESRD today are diabetes mellitus, hypertension, and glomerulonephritis. Hemodialysis remains the mainstay of therapy for patients, primarily due to the chronic shortage of organs available for transplantation. Technological advances have led to numerous improvements in hemodialysis therapy during the last 30 years. Dialysis is now provided in a variety of settings, including hospitals, outpatient dialysis units, and the home. Despite these advances, morbidity and mortality remain high for patients with ESRD. Patients with diabetes have the highest mortality rates primarily due to cardiac and infectious complications. Patients undergoing continuous ambulatory peritoneal dialysis (CAPD) are generally younger and healthier than their hemodialysis counterparts. Mortality is lower in the CAPD group for younger patients, whereas mortality is lower among older hemodialysis patients. Various methods have been described to assess adequacy of dialysis in order to develop the optimal dialysis prescription. Although these may ultimately prove beneficial, recent observations indicate an increased mortality in American hemodialysis patients compared with their European counterparts. These differences may be due in part to variances in reimbursement rates for dialysis therapy, and a reduction in dialysis time among U.S. centers. In light of the increasing number of patients and the complexity of their therapy, multiple opportunities exist for pharmacists to become actively involved in the comprehensive care of the ESRD patient.
Clinical Pharmacists' Involvement in Nephrology Research
Authors: Johnson Curtis A.
Published: January 2017

The provision of care to patients with renal disease provides pharmacists with many opportunities for research. Questions of drug use and toxicity arise frequently. Pharmacists should have little difficulty in identifying important unanswered questions regarding the clinical use of drugs in patients with renal disease. There are various ways in which pharmacists can contribute to the research process. In some cases, these contributions are informal such as suggestions regarding study design, blinding procedures, and study drug control. In other cases, the pharmacist may contribute more formally by serving as principal investigator or co-investigator. This latter role often leads to authorship of scientific literature. Eight medical and pharmacy journals were reviewed to assess the contributions of pharmacists to the clinical nephrology literature. This review covered articles published from 1980 (or the date of first publication of the journal, if more recent than 1980) through 1991. In these eight journals, pharmacists have been contributing as authors throughout this 12-year period. In the majority of cases, pharmacists have been the primary author. Most pharmacist-authored papers addressed drug-related issues, while articles on pharmacokinetics and therapeutics were most common. The primary source of funding for this research was the pharmaceutical industry. As more pharmacists begin to work with kidney disease patients, the contribution of pharmacists to the clinical nephrology literature will continue to grow. Pharmacists must be prepared to identify research opportunities whenever they may occur.
Formulary Management from a Health Maintenance Organization (HMO) Perspective
Authors: Zachary Rebecca
Published: January 2017

With the rise of managed care, formularies are being increasingly employed in the outpatient setting to manage use and control costs of prescription drugs. The formulary management policies of various managed care organizations are widely diverse and are largely dependent on the organizational structure of the managed care program. Although reasons for choosing certain types of formulary systems will be briefly explored, this article primarily focuses on formulary management tools used in the group model HMO setting. Various aspects of the formulary process that require ongoing management are described, including non-formulary drug usage, drug restrictions, drug use review, adverse drug reaction reporting, education of the professional staff, reporting of drug use data to physicians, and visitation by pharmaceutical sales representatives.
Measurement for Management: Report of a Pilot Project to Quantify Ambulance Misuse for Managers of a Fife Hospital
Authors: Coid Donald R.
Published: January 2017

Ambulance services appear to be under increasing pressure to provide a full range of services to the Community. It is important, therefore, that the service is appropriately utilised by patients. Health Service Managers, however, have little readily available information which identifies ‘appropriate’ utilisation. A simple technique is suggested to measure ‘appropriateness’ of utilisation of ambulances and a pilot survey of ambulance use by patients attending Dunfermline and West Fife Hospital Out-Patient clinics is described. In each case of ambulance use a panel of health professionals evaluated the ‘appropriateness’ of the patient having utilised this service. In the clinics surveyed, 91% of the sample of 328 patients did not use an ambulance to travel to clinics; in only two cases was use of the ambulance considered to be ‘probably inappropriate’. Misuse of the ambulance service was minimal during this study. Health Service Managers have been provided with some evidence to refute suggestions of substantial, inappropriate use of the ambulance service.
The Nature and Extent of Hospital Competition in a Government-Funded Health System
Authors: Fried Bruce J. , Leatt Peggy , Gelmon Sherril B.
Published: January 2017

A national study of Canadian hospitals assessed the perceived level and types of competition and the strategies pursued by these hospitals. Questionnaire data were obtained from chief executive officers in 715 hospitals, yielding a national response rate of 68%. Respondents indicated the perceived level of competition in the environment, the content of competition, and stated hospital strategies. Additional data were obtained on market share and hospital type. Close to half of the respondents indicated little or no competition in their environment, while 30% indicated substantial levels of competition. This represents a significant deviation from conventional wisdom about the Canadian health services environment. Respondents in hospitals with more than 75% of the market share were less likely to perceive competition than those with a smaller market share. CEOs in teaching hospitals and in hospitals located in larger communities reported higher levels of competition. Hospitals competed mostly for capital, programs, and staff; about a third of hospitals competed for patients and no differences were found by type of institution. Those hospitals in more competitive environments were more likely to indicate the use of diversification and horizontal integration as organizational strategies.
Occupational Stress in Health Service Employees
Authors: Rees David W. , Cooper Cary L.
Published: January 2017

Levels of occupational stress were examined in 383 employees of various occupations in one health district, as a preliminary to devising a strategy to reduce the negative effects of stress in the workplace. In comparison with white collar and professional workers in industry, health workers reported significantly greater pressure at work, higher ratings of physical and mental ill health, lower job satisfaction, less internal control over their working environment but used more coping strategies. Approximately one in eight of the subjects has stress symptoms of equal magnitude to patients attending clinical psychology outpatient clinics. It was also found that job satisfaction and psychosomatic ill health were related to sickness absence amongst health employees. The implications of these findings and the consequent challenges facing health service managers are discussed.
Factors Affecting the Supply of Private Hospital Beds in the UK: Priva te Insurance, NHS Pay Beds, or NHS Waiting List?
Authors: Yuen Peter P.
Published: January 2017

This study attempts to isolate the determinants of private hospital growth in the United Kingdom. Thirty-six variables, representing private medicine, the socio-economic environment, the political and government conditions, and the health care systems characteristics were selected for analysis. Multiple regression analysis shows that the number of independent hospital beds in the UK can be explained almost entirely by the number of persons with private health insurance, the number of NHS pay beds, and the overall bed level. Further analysis reveals that the number of persons with private health insurance can be explained to a large extent by the length of the NHS waiting list.
Community Participation and Involvement: Theoretical and Empirical Issues
Authors: Meleis Afaf I.
Published: January 2017

In 1978, the World Health Organization (WHO) and the United Nations International Children's Emergency Fund (UNICEF), in their Alma Ata Declaration, declared a war against ill health and lack of access to and use of health services by advocating a joint effort among countries to bring health for all for the year 2000. Although such wars have been waged many times before, this time the declaration had a slightly different message, one paying respect to the people who are the target of that declaration. The message was to help people achieve their health potential within their abilities, values, and technologies by helping them help themselves. Other significant parts to this message included dealing with the use of local technology, the involvement of intersectorial cooperation, and the view of health as integral to development (WHO, 1978).
Syphilis and Human Immunodeficiency Virus Seroconversion during a 6-Month Follow-Up of Female Prostitutes in Mogadishu, Somalia
Authors: Ahmed H Jama , Omar K , Adan S Yusuf , Guled A Mohamed , Grillner L , Bygdeman S
Published: January 2017

A total of 155 prostitutes inhabiting 4 different districts in Mogadishu, Somalia, were enrolled in a 6 month prospective study of syphilis and HIV infection. Blood samples were taken on entry, at 3 months and at 6 months. Differences were seen between the prostitutes in the 4 districts regarding possible risk factors for the acquisition of STDs. Initially 107 (69%) were found to have syphilis serum markers and 47% had active syphilis as judged by positivity in both Treponema Pallidum Haemagglutination (TPHA) test and non-treponemal (VDRL and RPR) tests. TPHA positivity was correlated to the number of sexual partners. Sixty-nine prostitutes were followed for 6 months. Two of the 16 initially TPHA negative women seroconverted for syphilis during the follow-up.

HIV antibodies were detected in one (0.6%) of the 155 prostitutes at the start of the study and one out of 68 seroconverted during the 6 months follow-up. To control the spread of HIV infection health education targeting the risk groups like prostitutes must be given a high priority.
Prior Sexual Assault Reported by Male Attenders at a Department of Genitourinary Medicine
Authors: Keane F E A , Young S M , Boyle H M , Curry K M
Published: January 2017

One-hundred-and-fifty male patients who attended the department of genitourinary medicine (GUM) completed a questionnaire which enquired into a past history of sexual assault and asked certain details about the assault and various sequelae of such an experience. Twenty-one men gave a history of sexual assault, 11 of whom had been abused before the age of 16, 7 afterwards and 3 in both age groups. Victims of such an assault were more likely to be homosexual or bisexual than heterosexual. The substantial majority i.e. 104 (81%) of the 129 patients who had not been assaulted in the past had been brought up by both natural parents. However, of the 21 males who reported a history of previous sexual abuse only 11 (52%) had been raised by both natural parents alone and 9 of the remaining 10 who divulged such information had been brought up in other circumstances. The association between not being raised entirely by both natural parents and a history of previous sexual assault was significant ( P<0.01). Overall, physical contact of a sexual nature was the most commonly reported type of abuse, followed by anal and then by oral penetration. All of the perpetrators of assault were male except in one instance. Only 3 cases of assault were reported to the police or other agencies. Those who had been abused as minors were more likely to acknowledge subsequent psychological difficulties and to have obtained professional counselling. This problem is a significant one which goes largely undetected in GUM departments and elsewhere. A high index of suspicion is required if we are to offer a sympathetic and appropriate service to these victims.
Decommodification and activation in social democratic policy: resolving the paradox
Authors: Jingjing Huo  , Nelson Moira , Stephens John D.
Published: January 2017

In Esping-Andersen's influential work decommodification appears as the central characteristic of the welfare state, and efforts to decommodify labour are posited to be the main goal of social democracy. Since decommodification is defined as exit from the labour market with little or no loss of income, social democrats' emphasis on decommodification clashes with another purported goal of social democracy, high labour force participation. Drawing on research demonstrating the divergent employment effects of various decommodifying social policies, we resolve the existing paradox by showing that social democratic parties are supportive of decommodifying social policies insofar as these policies do not reduce aggregate levels of employment. Pooled time series analysis of employment-impeding policies (long-term unemployment replacement rate, social security and payroll taxes, and employment protection) suggests that they are associated with Christian democracy rather than social democracy. Instead, we find that social democracy is a key determinant of employment-friendly policies, such as active labour market spending and short-term unemployment replacement rate. Given the radically divergent employment effects of different types of decommodifying social policies and the importance of employment-friendly policies for the viability of generous welfare states, our analysis further underlines the future viability of the social democratic model.
Thomas Morison Legge (1863–1932): The First Medical Factory Inspector
Authors: Waldron Tony
Published: January 2017

After a brief career in public health, Thomas Morison Legge was appointed to become the first medical factory inspector, in 1898, and remained in post until his resignation in 1927. During his tenure in office he became the leading authority on lead poisoning and anthrax; he resigned when the government refused to ratify the White Lead Convention. Subsequently he became the first medical adviser to the Trades Union Congress.
Joseph Landsberger (1848–1933): Medical Man in a Time of Change
Authors: Turk Theresa
Published: January 2017

Joseph Landsberger was a Jewish doctor in Germany in the second half of the 19th and much of the first half of the 20th century. He was involved in the scientific advances of his time, especially in the fields of antisepsis and asepsis, bacteriology, surgical technique, public health and therapeutics.
The Death of Buddha: A Medical Enquiry
Authors: Chen Thomas S N , Chen Peter S Y
Published: January 2017

The death of the Buddha (Siddhartha Gautama) has been depicted widely in Buddhist iconography. The Buddha is generally shown with a serene or smiling expression, lying on his right side and resting his head on his right hand. The dates of Buddha's life traditionally are given as 566–486 BC. Buddha died from an illness, the nature of which remains unsettled. The present paper examines a variety of sources and concludes that it was tainted pork that led to his demise. He succumbed to the disease pig-bel, a necrotizing enteritis caused by the toxins of Clostridium perfringens infection.
Carl Von Clausewitz (1780–1831) and Cholera: The Cause of World War II?
Authors: Spellberg Brad
Published: January 2017

Here it is proposed that, by killing Prussian Major General Carl von Clausewitz before he could complete the work on his military text On War, cholera strongly influenced the nature of World War I (1914–18) and, by direct extension, contributed to the cause of World War II (1939–45).
The Portraiture of William Harvey (1578–1657) Unveiled by the Detective Work of Geoffrey Keynes (1887–1983) and Alex Sakula (1917–2003)
Authors: James D Geraint
Published: January 2017

In November 1948, Sir Geoffrey Keynes exhibited the only known portrait of William Harvey in mid-life. The recovery of this rare portrait was due to Keynes's detective work at visits to Rolls Park in Essex. Dr Alex Sakula discovered the Betchworth portraits of the Harvey family by accident when he was invited to visit a patient, Major General Goulburn, at Betchworth in Surrey. After much research work Sakula was able to mount an informative exhibition at the Royal College of Physicians. Sakula also reminded us of Eliab Harvey (1758–1830), William's descendant, captain of the Téméraire at the Battle of Trafalgar; the year 2005 marks the bicentenary.
UK Breast Screening Programme: How Does it Reflect the Forrest Recommendations?
Authors: Gerard Karen , Brown Jackie , Johnston Kathy
Published: January 2017

Objective—

To compare the UK breast screening programme with the Forrest Report recommendations of 1986.

Setting—

The UK breast screening programme.

Methods—

A postal survey of 97 local breast screening programmes in the United Kingdom. The main outcome measures were the frequency of screening, the use of two view screening on incident screens, reading of screening mammograms, assessment procedures and visits, staffing levels, and the use of building and equipment.

Results—

Eighty two (85%) of the questionnaires were completed and returned. All programmes screen every three years, as Forrest intended, with the exception of one health region which screens more often. The national policy is to use two views on incident screens where there is a clinical indication. None the less, 14% of programmes are using, or intending to use, two views on all women. Double reading of mammograms is not recommended in the United Kingdom outside Scotland, but is used by 88% of programmes. All programmes have access to the equipment required for the assessment techniques recommended by Forrest. Variation exists between programmes in the procedures women can expect to receive at their initial assessment visit and in the total number of assessment visits. Sixty eight per cent of programmes' breast screening budgets cover the staff required for a multidisciplinary team as denned by the Forrest Report. Ninety three per cent of screening programmes are organised around static sites, with 86% of these also using mobile vans.

Conclusions—

The national programme is following recommendations about the frequency of screening, but there seems to be some divergence from policy as regards the use of double reading, two views at incident screening, and the multidisciplinary team covered by the programmes' breast screening budget. Further research is needed on the effectiveness and cost effectiveness of two view incidence screening, double reading, and non-radiologists as readers. Investigation is also needed of the costs and effects of the variation between programmes in the number of assessment visits a woman may have.
Breast Cancer Screening: The Effect of Self Selection for Screening on Comparisons of Randomised Controlled Trials
Authors: Richardson Ann , Wells J Elisabeth
Published: January 2017

In randomised controlled trials of breast cancer screening women are randomly allocated to an intervention group that is offered screening, or a control group that receives the usual medical care. Not all women in the intervention group accept screening; the women who do so may differ from other women in their underlying risk of breast cancer. This self selection for screening can result in either women at high risk or at low risk being overrepresented in the screened group. When comparisons between trials are made it is important to take self selection for screening into account, as a trial with self selection of women at high risk has the potential to have greater efficacy than a trial with self selection of women at low risk. A method of adjusting for self selection when comparing randomised controlled trials of breast cancer screening is described.
Impact of Follow up Letters on Non-Attenders for Breast Screening: A General Practice Based Study
Authors: Majeed Azeem , Given-Wilson Rosalind , Smith Eve
Published: January 2017

Objective—

To determine the effectiveness of follow up letters to non-attenders for screening on the breast screening uptake in practices with a low preliminary uptake of screening.

Design—

Observational study of two groups of general practices. In 40 of these practices, the preliminary uptake of screening was less than 60%These 40 practices were offered help from a clerical officer to check names and addresses of non-attenders, and to send non-attenders a reminder letter.

Setting—

93 general practices in South West London in 1995–96.

Main outcome measures—

Preliminary and final uptake of breast screening.

Results—

Breast screening uptake increased by an average of 4.6% in the 40 intervention practices compared with 1.6% in the 53 control practices (difference 3.0%, P < 0.0001). However, the absolute increase in the uptake of screening in the intervention group was small (from 53.8% to 58.5%). The marginal cost for each additional women screened was £7 (compared with an average cost for each women screened of £27).

Conclusions—

Reminder letters can help increase the uptake of screening in practices with a low preliminary uptake of breast screening. However, they have a limited role in improving the uptake of breast screening in inner city areas, and other methods of increasing uptake therefore need to be developed and evaluated.
Neonatal Screening for Cystic Fibrosis in the Trent Region (UK): Two-Stage Immunoreactive Trypsin Screening Compared with a Three-Stage Protocol with DNA Analysis as an Intermediate Step
Authors: Pollitt R J , Dalton A , Evans S , Hughes H N , Curtis D
Published: January 2017

Objectives—

To assess neonatal screening for cystic fibrosis using immunoreactive trypsin, either alone or in conjunction with DNA analysis for the AF508 mutation. A novel three-stage screening protocol was compared with the previously introduced two-stage immunoreactive trypsin-DNA protocol.

Design—

(a) Collection of data from a 41/2 year period (phase 1) of two-stage immunoreactive trypsin screening. The initial dried blood samples were obtained at 6 days of age and repeat samples at 27 days of age from babies with results above the 99.5th centile. Babies with persistent hypertrypsinaemia were referred for a diagnostic sweat test. (b) Retrospective DNA analysis: Patients with cystic fibrosis diagnosed in phase 1 were genotyped and most samples from babies with increased initial immunoreactive trypsin but normal results in the second sample were analysed for the δF508 mutation, (c) Phase 2, a prospective study of a three-stage neonatal screening protocol, in which only babies heterozygous for the δF508 cystic fibrosis mutation progressed to the second immunoreactive trypsin test.

Setting—

The Trent neonatal screening programme.

Subjects—

437 859 babies born between August 1989 and March 1996.

Main outcome measures—

Proportions of unaffected babies requiring a second blood sample or a sweat test. Overall sensitivity for the detection of cystic fibrosis.

Results—

The two-stage screen failed to identify six out of 94 cases of cystic fibrosis (without meconium ileus). The introduction of the DNA analysis step would have resulted in one additional case being missed. With the three-stage screen there was a 92% reduction in babies requiring a second blood sample and an 80% reduction in negative sweat tests, results close to the predictions of the retrospective study.

Conclusions—

The three-stage screening protocol is a marked improvement on the two-stage immunoreactive trypsin strategy and on the two-stage immunoreactive trypsin-DNA strategy recently introduced in some other screening programmes.
A Survey of Screening Compliance among First Degree Relatives of People with Colon Cancer in New South Wales
Authors: Harris Margaret A , Byles Julie E
Published: January 2017

Objective—

To survey screening practices, knowledge, and attitudes towards screening among first degree relatives of people with colon cancer.

Setting—

A random sample of people with colon cancer listed on the New South Wales (NSW) Cancer Registry were mailed a questionnaire to be passed on to an appropriate first degree relative.

Methods—

Two hundred and twenty five first degree relatives completed a self administered questionnaire.

Results—

Although there were high levels of awareness about colorectal cancer, and attitudes towards colorectal cancer were generally positive, screening rates were low, and only three relatives had been screened in accordance with current Australian recommendations. Factors associated with previous participation in any type of screening test (usually once) included receiving a medical recommendation to screen, having more than one relative with colorectal cancer, being a sibling of the relative with colon cancer, the relative with cancer being female, and perceiving screening as messy, but not painful.

Conclusions—

Strategies to enhance screening awareness and participation among relatives need to be considered. This study provides some insight into factors to be considered in developing awareness programmes. Further research is required to explore these factors, and to identify ways to overcome barriers.
Raddi Infrastructure: Collecting Film Memorabilia in Pakistan: An Interview with Guddu Khan of Guddu’s Film Archive
Authors: Cooper Timothy P.A.
Published: January 2017

This interview with Guddu Khan of Guddu’s Film Archive was conducted in October 2015, concurrent with the first major public exhibition of Guddu Khan’s memorabilia collection in Karachi, and was translated from Urdu by Abeera Arif-Bashir. An introductory essay prefaces this interview and explores some of the methodological implications of the ways in which Guddu re-contextualizes both the objects he collects and the audience-consumer for which they were initially produced. Despite a rich and vibrant “golden-age” of film production that flourished from the 1960s to the early 1980s, the circulation and dissemination of cinema in contemporary Pakistan is defined by a socio-cultural climate that is hostile to filmmaking as a system of production and film as an object of mass consumption. In spite of this, Guddu Khan shares his small apartment in Karachi with an unparalleled collection of artifacts relating to the Pakistani film industry, a collection he has amassed in parallel with the deterioration of the industry that has become interwoven with his own personal biography.
Flexible Specialization and the Garment Industry
Authors: Collins Jane L.
Published: January 2017

This paper takes issue with accounts that argue that flexible specialization is the appropriate industrial paradigm for the high-end, fashion segment of the apparel industry. Many accounts have argued that apparel factories using mass-production face three obstacles in this segment of the industry: they cannot produce goods quickly enough, they cannot change styles fast enough, and they cannot meet quality standards. Evidence from two case studies and a review of the industry press reveals that large firms in the 1990s have been able to meet these challenges using mass production methods. Quality challenges have been met by the implementation of hyper-Taylorist labor practices such as “statistical process control.”
Corporate Coalitions and Industrial Restructuring: Explaining Regional Trade Agreements
Authors: Cox Ronald W.
Published: January 2017

This paper locates business support for the North American Free Trade Agreement (NAFTA) and the Caribbean Basin Initiative (CBI) in the context of the internationalization of capital markets and the competitive pressures of the world economy. Multinational corporations which are internationally competitive and trade dependent across various regions of the world economy, tended to support NAFTA and CBI for the trade liberalization provisions. On the other hand. MNCs which are less competitive and trade dependent within regions tended to support NAFTA and CBI for the discriminatory investment provisions. Other firms which are less competitive and tied to the U.S. market tended to oppose NAFTA and CBI.

The corporate coalitions that battled over the terms of the NAFTA and CBI agreements reflect the uneven character of globalization in the world economy. Some firms are reacting to globalization by expanding their international operations and supporting free trade in a variety of contexts. Other firms are regionalizing their operations and lobbying governments to implement discriminatory regional trade agreements to protect them from foreign competition. The future direction of global trade could well depend on the battles amongst these diverse corporate interests.
Globalisation in Telecommunications: The Dynamics of Firms, Governments and Technologies
Authors: Loveridge Ray , Mueller Frank
Published: January 2017

The focus of this paper is to be upon the differential effect of national institutional frameworks on actors in a pivotal sector in the growth of global markets-telecommunications. We emphasise the varying modalities in which corporate and sectoral agendas inform public policy making and vice versa in a manner which modifies the institutional framework. We seek to illustrate the multi-layered nature of this interaction between structures and actors.

The paper will describe the manner in which the telecommunications sector emerged historically within different national business systems (NBSs) and has become a global arena for contest between multi-national corporations (MNCs) serviced by regional supply chains. The life cycle effects of emergent boundaries to sectoral relationships and to technological “best-practice” are seen to be shaped both by national ideologies and institutional frameworks and by a range of competitive and what are sometimes loosely described as isomorphic pressures. In this process the MNC is seen to acquire an increasing degree of detachment from any single NBS and an ability to leverage its capabilities across national markets.
The Governance of International Telecommunications Competition: Cross-International Study of International Policy Regimes
Authors: Levi-Faur David
Published: January 2017

One of the most outstanding features of making politics in a shrinking world and interdependent economies is the creation of “International Policy Regimes” (IPR) for the governance of “micro” arenas of International politics. This is a stimulating development for comparative public policy analysts as it enables (and requires) us to extend our traditional cross-national, cross-sectorial and cross-issue analyses so as to include also a cross-international analysis. This paper compares two international policy regimes for the regulation of international competition in the sector of telecommunications. The first regime deals with the regulation of terminal equipment (type-approval processes) and the second with network interconnection (the integration of different and competing networks into one system). While the terminal type-approval regime involves deregulation, and was found to be narrow in scope and fairly effective, the network interconnection regime involves reregulation and was found to be broad in scope and relatively weak. These variations are particularly interesting because they refer to “most similar cases”. They were shaped by the same actors, at around the same time, and with respect to same policy problem and the same sector. The paper suggests that these variations in the regulation of international competition are best explained by juxtaposing the “policy determine politics” approach to the “politics determines policy” approach.
E-health responses to common mental disorders in primary care: experiences with Ębeyondblue‘ and ĘSPHERE’
Authors: Hickie Ian , Davenport Tracey , Scott Elizabeth , Morgan Hugh
Published: January 2017

Objective:

To highlight opportunities for enhancing mental health services in primary care through utilisation of e-health systems. Specifically, an information-based website (provided by ‘beyondblue: the national depression initiative’) and a web-based support system for general practitioners (provided by ‘SPHERE: a national depression project’) are described.

Conclusions:

Recommendations regarding potential roles for e-health systems in association with Australian primary care are outlined.
The Efficacy of Ergogenic Agents in Athletic Competition Part I: Androgenic-Anabolic Steroids
Authors: Smith Daniel A. , Perry Paul J.
Published: January 2017

OBJECTIVE:

To summarize the literature describing the epidemiology, pharmacology, efficacy, and adverse effects associated with androgenic-anabolic steroid (AAS) use among athletes.

DATA SOURCES:

Relevant articles were identified from a MEDLINE search using the search terms “Doping in Sports,” “Anabolic Steroids (exploded),” and “Androgens (exploded).” Additional references were found in the bibliographies of these articles.

STUDY SELECTION/DATA EXTRACTION:

We reviewed studies of AAS use among professional athletes. Interpretation of these studies is difficult because of poor research design. The efficacy studies lacked adequate placebo control. Much of the literature describing adverse effects consists of anecdotal reports. All of this literature was considered for review.

DATA SYNTHESIS:

Of all ergogenic drugs, AASs are the most widely abused. Abuse of AASs among high school students is estimated at five to ten percent. AASs are hypothesized to produce ergogenic effects during periods of concomitant positive nitrogen balance via antagonism of the catabolic effect of glucocorticoids released during intense exercise. Despite years of study, the extent of the ergogenic effects associated with AASs remains unclear. This may be because most studies have failed to approximate athletes' AAS usage patterns. The primary toxic effects of AASs are divided into four areas: hepatic, reproductive, cardiovascular, and psychiatric. Athletes do not consider these effects severe enough to refrain from using these drugs.

CONCLUSIONS:

Athletes view AASs as an essential component for success. Without adequate intervention measures, AAS abuse is likely to continue unchecked.
Polypharmacy in Psychiatry: Three Case Studies and Methods for Prevention
Authors: Stewart Ronald B. , Yedinak Kimberly C. , Ware Michael R.
Published: January 2017

OBJECTIVE:

To illustrate problems of overprescribing in the elderly and to make practical suggestions for prevention of polypharmacy.

DESIGN:

Three cases of polypharmacy in psychiatric patients admitted to the hospital between January and March 1990 are described. Intervention to correct drug-related problems in these patients is described and methods of preventing polypharmacy are discussed.

SETTING:

Inpatient psychiatry service in a tertiary-care center.

PATIENTS:

Elderly psychiatry patients (n=3) taking an excessive number of medications. This polypharmacy was believed to contribute to decreased cognitive and/or physical function.

INTERVENTIONS:

Medication regimens were reviewed by the physician and pharmacist. Those considered unnecessary or believed to be adversely affecting the patient were discontinued.

RESULTS:

All patients were discharged on a reduced number of medications, with improvement in cognitive and/or physical function.

CONCLUSIONS:

Polypharmacy contributes to an increased incidence of adverse reactions in the elderly. Implementation of practical methods for reducing polypharmacy can lead to a reduction in the number of drug-related adverse effects and improved care of the elderly patient.
Status of Child Health Worldwide
Authors: Nahata Milap C.
Published: January 2017

OBJECTIVE:

The objective of this article is to summarize some of the facts about child health and goals of international health organizations.

DATA SOURCES:

The sources included the publications of World Health Organization's (WHO), United Nations Children Fund, and United Nations Educational, Scientific, and Cultural Organizations; and journal articles.

DATA EXTRACTION:

Data on areas related to child health were obtained from various publications.

DATA SYNTHESIS:

Although childhood mortality continues to fall worldwide, nearly 14 million children under five years of age still die annually in developing countries. Diarrhea, measles, tetanus, pertussis, pneumonia, and malnutrition are preventable and treatable and yet account for the majority of deaths. AIDS has begun to substantially affect the pediatric population. It is encouraging that the WHO's goal to immunize 80 percent of all children in the developing world has been met. The World Summit for Children, in consultation with governments of 159 countries, and the agencies of the United Nations, has adopted new goals to be attained by the year 2000.

CONCLUSIONS:

It is hoped that governmental and nongovernmental agencies will embrace these goals and formulate plans to markedly reduce childhood morbidity and mortality.
Didanosine Therapy in Patients Intolerant of or Failing Zidovudine Therapy
Authors: Rathbun R. Chris , Martin Emory S.
Published: January 2017

OBJECTIVE:

To examine the effect of didanosine (2′,3′-dideoxyinosine, ddI) on surrogate markers of HIV infection (CD4+ lymphocyte count, p24 antigen) and to evaluate the incidence of adverse effects from ddI.

DESIGN:

This study was performed as a retrospective chart review of patients who were enrolled in Bristol-Myers Squibb's expanded-access program for ddI.

SETTING:

Patient records were obtained from primary care physicians' offices.

PATIENTS:

Twenty-five HIV-infected patients diagnosed with AIDS or AIDS-related complex (ARC) who were intolerant of zidovudine (ZDV) therapy or deteriorating clinically despite ZDV therapy and were eligible for inclusion in the ddI expanded-access program.

INTERVENTION:

ddI was administered orally in a citrate-phosphate buffer every 12 hours. Patients were followed by their private physician on a monthly basis.

MAIN OUTCOME MEASURES:

Laboratory analysis at each month included CD4+ lymphocyte count, hemoglobin, hematocrit, serum amylase, uric acid, serum triglycerides, and p24 antigen. Mean CD4+ cell count, serum amylase, hemoglobin, and uric acid at each month during ddI therapy were compared with baseline concentrations for nine months.

RESULTS:

Patients had received prior ZDV therapy for an average of 15.5 months before starting ddI. Mean CD4+ cell counts increased from 53.9/mm3 at baseline to 72.4/mm3 after 4 months of therapy (p=0.04) but returned to concentrations comparable with those at baseline after 5 months. One case of documented pancreatitis, two cases of suspected pancreatitis, and nine cases of peripheral neuropathy occurred during ddI therapy. The estimated mean cumulative dose for the development of neuropathy was 1.16 g/kg, which is lower than previously reported.

CONCLUSIONS:

Patients who have received prolonged therapy with ZDV or who have low initial CD4+ counts may not have sustained increases in CD4+ counts from ddI therapy. Also, development of peripheral neuropathy may occur at lower cumulative doses in these patient populations.
Prolonged Recurrence of Pentamidine-Induced Torsades de Pointes
Authors: Cortese Linda M. , Gasser Robert A. , Bjornson Darrel C. , Dacey Michael J. , Oster Charles N.
Published: January 2017

OBJECTIVE:

To report a case of recurrent pentamidine-induced torsades de pointes (TdP) and to review previously reported cases in the literature.

DATA SOURCES:

Medical records of the subject patient, case reports, and relevant studies identified by MEDLINE.

DATA EXTRACTION:

Data were abstracted from pertinent published sources by one author and reviewed by the remaining authors.

DATA SYNTHESIS:

A 43-year-old woman with AIDS experienced pentamidine-induced TdP. TdP and other cardiac arrhythmias recurred repeatedly for 13 days after pentamidine therapy was discontinued and in the presence of normal magnesium and potassium serum concentrations. Infusions of magnesium, lidocaine, and isoproterenol were used to treat the arrhythmias. The exact mechanism of pentamidine-induced TdP has not been clearly established. It is postulated, however, that the similarity of pentamidine's structure to procainamide may contribute to its proarrhythmic effects. The tissue-binding capacity of pentamidine may result in a prolongation of its effects. No distinctive characteristic appears to predispose people to the development of cardiac arrhythmias. Laboratory values that should be monitored include serum magnesium, potassium, and creatinine. The corrected QT interval also should be monitored.

CONCLUSIONS:

Recurrent arrhythmias may be seen for many days after intravenous administration of pentamidine has been discontinued. Clinicians should consider this phenomenon as they decide how to monitor patients who have received this drug.
Verapamil Overdose: Case Report and Review of the Literature
Authors: Watling Sharon M. , Crain Judy L. , Edwards Todd D. , Stiller Ronald A.
Published: January 2017

OBJECTIVE:

To report the presentation and controversies regarding therapy of an 18-year-old man following a life-threatening ingestion of verapamil.

CASE SUMMARY:

An 18-year-old man ingested large quantities of dipyridamole, trimethoprim/sulfamethoxazole, amoxicillin, and verapamil. He presented to an outlying hospital and was initially conscious. Soon thereafter, the patient had a seizure; he required intubation, developed cardiac conduction abnormalities, and became hypotensive. The patient required pharmacologic pressors and a pacemaker for transfer to our institution. At our institution, vigorous fluid resuscitation, cardiac pacing, and careful attention to acid/base and electrolyte management provided the basis of therapy. The patient recovered without deficit and was discharged from the intensive care unit five days later.

DISCUSSION:

Current controversies regarding the management of verapamil overdose are reviewed. Removal of the drug by gastric lavage is a mainstay of therapy. Administration of syrup of ipecac is contraindicated. Although specific recommendations for calcium dosing in the overdose situation have not been rigorously studied, maintenance of a normal serum ionized calcium concentration is suggested. An exogenous catecholamine, rather than dopamine, may be the drug of choice for treating hypotension. Cardiopulmonary bypass provides a method for drug removal in cases of severe toxicity; however, this invasive method requires further study. Management of fluid/electrolyte, acid/base, and ventilation abnormalities is required to treat large ingestions of verapamil. Treatment guidelines for critical care clinicians are provided.
Lisinopril-Induced “Scalded Mouth Syndrome”
Authors: Savino Lee B. , Haushalter Nikki M.
Published: January 2017

OBJECTIVE:

To report a case of “scalded mouth syndrome” (SMS) caused by lisinopril.

PATIENT:

A woman being treated with lisinopril for hypertension developed a burning sensation of her lips and buccal mucosa. The condition persisted with continued use of lisinopril and subsided when the medication was discontinued.

CONCLUSIONS:

The symptoms described by our patient were similar to those reported in previous cases of SMS associated with the use of enalapril and captopril, two other angiotensin-converting enzyme (ACE) inhibitors. This reaction to ACE inhibitors appears to be dose related, and subsides with a decreased dosage or discontinuation of the medication.
Haemophilus Influenzae Type B Conjugate Vaccines
Authors: Force Rex W. , Lugo Ralph A. , Nahata Milap C.
Published: January 2017

OBJECTIVE:

To review the epidemiology of Haemophilus influenzae type b (Hib) disease, the first Hib vaccine and its limitations, the characteristics and clinical efficacy of the newer conjugate vaccines, and the current recommendations for administration of Hib vaccines.

DATA SOURCES:

Pertinent literature was identified via a MEDLINE search. Additionally, references cited in published articles were used as data sources.

STUDY SELECTION:

Studies describing the epidemiology of Hib disease and the efficacy and/or immunogenicity of the Hib vaccines are reviewed.

DATA SYNTHESIS:

Serious invasive disease secondary to Hib infection causes significant morbidity and mortality in children between the ages of three months and five years. The original Hib vaccine was found to be ineffective in stimulating an adequate immune response in children younger than two years of age. The new Hib conjugate vaccines provide superior efficacy and immunogenicity compared with the original unconjugated vaccine. They stimulate an immune response that is distinctly different from that elicited by the original vaccine. Two vaccine products are currently licensed for use in children as young as two months of age, thus conferring immunity to those children at highest risk for Hib disease.

CONCLUSIONS:

The new Hib conjugate vaccines provide excellent efficacy and, when used as recommended, may significantly reduce the incidence of invasive Hib disease and its sequelae.
Current Treatment Recommendations for Leishmaniasis
Authors: Moss Jeffrey T. , Wilson James P.
Published: January 2017

OBJECTIVE:

To review the epidemiology, clinical presentation, risk factors for transmission, and pathogenesis of leishmaniasis, as well as current treatment options for this disease.

DATA SOURCES/DATA SELECTION:

We reviewed unclassified medical-threat briefing material, subject-matter reviews, and case reports from the world's infectious disease literature. We concentrated on literature pertaining to the pathogenesis and management of leishmaniasis indigenous to Southwest Asia.

DATA EXTRACTION:

Data from subject reviews published in the English language were evaluated. Case reports and clinical trials provided supplemental data on evolving theories and management options.

DATA SYNTHESIS:

The clinical presentation of leishmaniasis is highly variable. Management relies heavily upon the use of parenteral antimonial drugs. Although these agents are effective in most cases, toxicity and the emergence of resistance limit the usefulness of standard therapies. Alternative treatment modalities include heat, surgical curettage, ketoconazole, metronidazole, pentamidine, rifampin, amphotericin B, aminoglycosides, allopurinol, and immunotherapy.

CONCLUSIONS:

Although the number of reported cases of leishmaniasis in the US has generally been low, there is a possibility that more cases may be reported in the future because of the large number of military personnel returning to this country from endemic areas. Medical personnel, particularly those working in governmental institutions, should be familiar with the pathogenesis of this unusual infection as well as potential treatment options.