bluuebunny/crossref_metadata_2025 huggingface dataset:
An overview of strategic alliances between universities and corporations
Authors: Elmuti Dean , Abebe Michael , Nicolosi Marco
Published: February 2005

Purpose

Strategic alliances generally represent inter‐firm cooperative agreements aimed at achieving competitive advantage for the partners. In recent years, there has a dramatic increase in strategic alliances by multinational firms.This paper aims to explore the essence of these alliances and why they have become such a growing area of research in business in recent years.

Design/methodology/approach

Discusses strategic alliances between corporations and institutions of higher education. The major underlying motives for creating these alliances and the critical success factors are also discussed. The paper also analyzes the success stories.

Findings

Highlights the major advantages for the academic community – research funding and practical learning opportunities for students – and for industry – lower research and development costs and technology transfer opportunities that affect competitiveness. The drawbacks may include the partners’ different working cultures and values. Finds that alliances must be supported by continuous learning and restructuring processes to overcome the differences.

Originality/value

Extracts the valuable lessons that might help others to effectively utilize strategic alliances between corporations and institutions of higher education.
Corporate universities: driving force of knowledge innovation
Authors: Rademakers Martijn
Published: February 2005

Purpose

This paper aims to explain the rapid emergence of corporate universities on the basis of fundamental developments presently shaping the economy and society on a world‐wide scale.

Design/methodology/approach

Four key forms of innovation are identified and combined with the corporate university concept. The paper explains why corporate universities are emerging world‐wide as strategic weapons in the competitive battle among companies, countries and international economic power blocs.

Findings

Companies endorsing the importance of knowledge innovation cannot get around the corporate university concept as part of their strategy. Three major corporate university types are identified and linked to their strategic role as the driving force of knowledge innovation.

Originality/value

Helps to explain why corporate universities have evolved as an answer to the challenge of competing in a knowledge‐driven economy.
Cross‐market dynamics in property stock markets
Authors: Hiang Liow Kim , Ooi Joseph , Gong Yantao
Published: February 2005

Purpose

Aims to investigate the long‐run and short‐term relationships among four Asian property stock markets of Japan, Hong Kong, Singapore and Malaysia; and four European property stock markets of UK, France, Germany and Italy. Additionally, aims to examine the relationships between equally‐weighted Asian and European regional property stock indices.

Design/methodology/approach

The long‐term analysis is undertaken using Johansen multivariate cointegration approach. The degree of short‐term dependence is investigated with an extended EGARCH model for evidence of mean and volatility spillovers across the property stock markets.

Findings

The combined findings of minimal cointegration, weak mean transmission and lack of significant evidence of cross‐volatility spillovers among the Asian and European property stock markets imply that investors would benefit from diversifying property stock portfolios internationally in Asia and Europe in the short‐ and long‐run.

Originality/value

This study contributes significantly to the empirical literature on capital asset pricing and on the risk‐return performance of international real estate. In particular, the findings from the study will be useful for European investors to understand better the potential portfolio implications of investing in Asian real estate.
Transparency in the German real estate market
Authors: Schulte Karl‐Werner , Rottke Nico , Pitschke Christoph
Published: February 2005

Purpose

German real estate markets used to show little transparency in the past. This has changed over the last 15 years. The purpose of this study therefore is to examine the current state of transparency.

Design/methodology/approach

The study investigates and discusses the concept of transparency in general, availability of private and public market data, major real estate investment products, performance measurement, changes in the regulatory environment and the emergence of organizations and publications. The findings of this study are obtained in a comparative manner: The transparency status of the 1990s in the different areas researched is compared to the current German and other international standards. The authors describe the relatively opaque German real estate market as it was at the beginning of the 1990s and show how it has improved to date.

Findings

The results show that transparency in the German real estate market has noticeably improved in all researched areas. But still, compared with the USA or the UK, the German real estate industry and real estate market still lack transparency and are characterized by information asymmetries and opaqueness.

Originality/value

The results indicate that the German real estate market and industry become more mature and bit by bit converge with their US and UK archetype.
Current Reproductive Technologies: Increased Access and Choice?
Authors: Beckman Linda J. , Harvey S. Marie
Published: February 2005

This article discusses key issues related to current reproductive technologies including contextual and personal barriers to use, complexity of decision making, limited access to technologies for poor women and women of color, and the politics and social controversy surrounding this area. New reproductive technologies have to be put to the same test as any other product—can and will women use them correctly? We need to not only know about the technology itself; we also need to know about the individuals who intend to use the technology and about contextual factors that influence use. Accordingly, the articles in this issue focus on the multiple determinants that influence acceptability of reproductive technologies and the policy, political, and legal implications associated with their use.
Navigating Rough Waters: An Overview of Psychological Aspects of Surrogacy
Authors: Ciccarelli Janice C. , Beckman Linda J.
Published: February 2005

This article provides an overview of the social and psychological aspects surrounding the surrogacy process including attitudes about surrogacy, perceptions and problems of surrogate mothers and intended/social parents, and questions concerning children resulting from contractual parenting. Review of the literature on contractual parenting reveals a wealth of discussion about the ethical, moral, legal, and psychological implications, but limited empirical data on the psychological and social aspects. Future research can provide empirical evidence as a foundation for counseling at all phases of the surrogacy process.
Context of Acceptability of Topical Microbicides: Sexual Relationships
Authors: Koo Helen P. , Woodsong Cynthia , Dalberth Barbara T. , Viswanathan Meera , Simons‐Rudolph Ashley
Published: February 2005

Domains central to the effects of sexual relationships on the acceptability of a vaginal protection method were explored in 14 focus groups and 38 in‐depth interviews with women and men recruited from a health department's sexually transmitted infections (STI) and family planning clinics. Findings indicate that acceptability depended on a couple's relationship type, classified as serious, casual, or “new.” Potential barriers to communication about product use may be overcome through direct or indirect covert use, depending on relationship type. More men than women thought women should always tell their partners if they use microbicides, regardless of relationship type. Results indicate the importance of the relationship context in understanding the likely acceptability of using microbicides, and perhaps any method of STI/HIV protection.
Conspiracy Beliefs About HIV/AIDS and Birth Control Among African Americans: Implications for the Prevention of HIV, Other STIs, and Unintended Pregnancy
Authors: Bird Sheryl Thorburn , Bogart Laura M.
Published: February 2005

In this article, we examine the potential role that conspiracy beliefs regarding HIV/AIDS (e.g., “HIV is a manmade virus”) and birth control (e.g., “The government is trying to limit the Black population by encouraging the use of condoms”) play in the prevention of HIV, other STIs, and unintended pregnancies among African Americans in the United States. First, we review prior research indicating that substantial percentages of African Americans endorse conspiracy beliefs about HIV/AIDS and birth control. Next, we present a theoretical framework that suggests how conspiracy beliefs influence sexual behavior and attitudes. We then offer several recommendations for future research. Finally, we discuss the policy and programmatic implications of conspiracy beliefs for the prevention of HIV, other STIs, and unintended pregnancy.
Emergency Contraception: The Politics of Post‐Coital Contraception
Authors: Sherman Christy A.
Published: February 2005

The literature and events related to the politicization of emergency contraceptive pills (ECPs) in the United States is reviewed. The basis of opposition to the regimen, rooted in the mode of action of ECPs, the confusion with mifepristone, and the challenges this presents for ECP advocates is also discussed. Legislative actions that impact the availability of ECPs are described, as well as efforts to increase access and availability through innovative programs, legislation, and changes in medical practice. Recommendations for future research, service delivery, and public policy are also presented.
Generation of Knowledge for Reproductive Health Technologies: Constraints on Social and Behavioral Research
Authors: Woodsong Cynthia , Severy Lawrence J.
Published: February 2005

Advances in new reproductive health technologies have surfaced an array of social and behavioral issues regarding decision‐making and use of these technologies, underscoring the need for research on such topics as reproductive health decision‐making, sexual practices, and norms and values for childbearing and family formation. Using topical microbicides as an example of a new method to prevent Sexually Transmitted infections (STIs), Human Immunodeficiency Virus (HIV) and/or pregnancy, we focus on gaps in information to inform reproductive health decision‐making, noting in particular the discrepancies between data on clinical efficacy and typical use‐effectiveness. Constraints on government and private sector support for research, particularly research on aspects of sexual behavior, contribute to problems with the availability of information for decision‐making about use of reproductive health technologies.
An open‐labelled study of granulocyte colony‐stimulating factor in the treatment of active Crohn's disease
Authors: Korzenik J. R. , Dieckgraefe B. K.
Published: February 2005

Background : Immunodeficiency syndromes associated with a Crohn's‐like illness suggest innate immune defects may lead to Crohn's disease. Anecdotal cases using haemopoietic colony‐stimulating factors report improvement in intestinal disease associated with these syndromes.

Aim : To test the safety and efficacy of recombinant human granulocyte colony‐stimulating factor in active Crohn's disease.

Methods : In an open‐labelled 12‐week trial, patients with a Crohn's Disease Activity Index between 220 and 450 were treated with recombinant human granulocyte colony‐stimulating factor (filgrastim, Neupogen). Concomitant immunosuppressants were prohibited except prednisone ≤20 mg/day. Patient's received recombinant human granulocyte colony‐stimulating factor 300 mcg daily subcutaneously adjusted to achieve an absolute neutrophil count between 25 and 35 × 109/L.

Results : Twenty patients were enrolled with a mean initial Crohn's Disease Activity Index of 307 (range: 234–428). Fifteen patients (75%) completed 8 weeks; 13 patients (65%) completed 12 weeks with the mean Crohn's Disease Activity Index for patients continuing through those times of 196 (range: 36–343) and 162 (range: 20–308), respectively. At week 12, 11 patients (55%) demonstrated a decrease of at least 70 points; five (25%) achieved a sustained remission. The mean decrease was statistically significant at each assessment time‐point. Three of four patients with fistulae had a positive response. Adverse effects included bone pain, mostly mild resolving with continued treatment. One patient was hospitalized with a viral‐like syndrome but it is uncertain if this was treatment related.

Conclusion : Recombinant human granulocyte colony‐stimulating factor is safe and potentially effective therapy for active Crohn's disease.
Failure of dietary oligofructose to prevent antibiotic‐associated diarrhoea
Authors: Lewis S. , Burmeister S. , Cohen S. , Brazier J. , Awasthi A.
Published: February 2005

Background : Oligofructose is metabolized by bifidobacteria, increasing their numbers in the colon. High bifidobacteria concentrations are important in providing ‘colonization resistance’ against pathogenic bacteria.

Aim : To reduce the incidence of antibiotic‐associated diarrhoea in elderly patients.

Methods : Patients over the age of 65 taking broad‐spectrum antibiotics received either oligofructose or placebo. A baseline stool sample was cultured for Clostridium difficile and tested for C. difficile toxin. A further stool sample was analysed for C. difficile if diarrhoea developed.

Results : No difference was seen in the baseline characteristics, incidence of diarrhoea, C. difficile infection or hospital stay between the two groups (n = 435). Oligofructose increased bifidobacterial concentrations (P < 0.001, 95% CI: 0.69–1.72). A total of 116 (27%) patients developed diarrhoea of which 49 (11%) were C. difficile‐positive and were more likely to be taking a cephalosporin (P = 0.006), be female (P < 0.001), to have lost more weight (P < 0.001, 95% CI: 0.99–2.00) and stayed longer in hospital (P < 0.001, 95% CI: 0.10–1.40). Amoxicillin (amoxycillin) and clavulanic acid increased diarrhoea not caused by C. difficile (P = 0.006).

Conclusion : Oligofructose does not protect elderly patients receiving broad‐spectrum antibiotics from antibiotic‐associated diarrhoea whether caused by C. difficile or not. Oligofructose was well‐tolerated and increased faecal bifidobacterial concentrations.
A regional audit of iatrogenic perforation of tumours of the oesophagus and cardia
Authors: Jethwa P. , Lala A. , Powell J. , McConkey C. C. , Gillison E. W. , Spychal R. T.
Published: February 2005

Introduction : With the rising incidence of oesophageal cancer, palliative treatment has an increasingly important role. With median survival unlikely to exceed 6 months, in advanced disease the palliative therapy chosen must not hasten patient's demise.

Aim : To establish the outcome of both modern and historical palliative treatment in oesophageal tumours, with emphasis on the aetiology and outcome of iatrogenic perforation.

Methods : Patients with oesophageal or cardia carcinoma treated within the West Midlands between 1992 and 1996 were identified retrospectively. Information was gathered from hospital case notes and the regional cancer intelligence unit with hospitals visited to capture data. All episodes were entered into a dedicated database.

Results : Of the 3660 patients who were treated, 2529 received palliation as primary treatment, with 5259 palliative procedures performed; 164 iatrogenic perforations were recorded; 83 were due to diagnostic endoscopy (endoscopic perforation) with the reminder due to interventional palliative procedures. Median survival from all forms of palliation was 138 days. Following perforation survival was 95 days after interventional palliative procedure and 58 days after endoscopic perforation (P > 0.05). Thirty‐day mortality after emergency surgery was 11.8% with mean survival of 7.5 months.

Conclusion : Perforation at diagnostic endoscopy is associated with substantial mortality despite rapid intervention. Patients with suspected cancer must be investigated with extreme care to reduce iatrogenic complications.
Autoimmune cholestatic liver disease in people with coeliac disease: a population‐based study of their association
Authors: Lawson A. , West J. , Aithal G. P. , Logan R. F. A.
Published: February 2005

Background : Population data supporting an association between the autoimmune cholestatic liver diseases, primary biliary cirrhosis and primary sclerosing cholangitis and coeliac disease, is limited and at times contradictory.

Aim : To explore the relationship between coeliac disease and both primary biliary cirrhosis and primary sclerosing cholangitis within the General Practice Research Database, a UK‐based longitudinal primary care database.

Methods : We identified 4732 people with diagnosed coeliac disease and 23 620 age‐ and sex‐matched controls within the General Practice Research Database. We calculated the prevalence of primary biliary cirrhosis and primary sclerosing cholangitis for both the coeliac disease and control group.

Results : There was a higher prevalence of primary biliary cirrhosis in adults with coeliac disease, compared with controls [0.17% vs. 0.05%, odds ratio 3.63 (95% confidence interval: 1.46–9.04)]. Primary sclerosing cholangitis was also more common in the coeliac disease group [0.04% vs. 0%, fishers exact test (P = 0.03)].

Conclusions : There was a threefold or greater increase in risk of both primary biliary cirrhosis and primary sclerosing cholangitis in people with coeliac disease compared with the general population. The association with primary biliary cirrhosis was weaker than in some reports and it is difficult on the basis of this study to justify screening patients with coeliac disease for either primary biliary cirrhosis or primary sclerosing cholangitis.
Meta‐analysis: the influence of pre‐treatment with a proton pump inhibitor on Helicobacter pylori eradication
Authors: Janssen M. J. R. , Laheij R. J. F. , de Boer W. A. , Jansen J. B. M. J.
Published: February 2005

Background : There is much debate about the influence of pre‐treatment with a proton pump inhibitor on Helicobacter pylori eradication. The few studies investigating the influence of pre‐treatment on triple and quadruple therapies did not find differences in eradication rates. However, the high eradication rates make it difficult to study factors associated with therapy failure in small populations. In order to overcome this problem we performed a meta‐analysis.

Methods : The literature was searched in order to identify randomized clinical trials comparing modern triple/quadruple therapies for H. pylori eradication without pre‐treatment with a proton pump inhibitor with exactly the same regimen with pre‐treatment. The overall risk difference (with − without pre‐treatment) was calculated by pooling the risk differences of the individual studies weighted by the inverse of their variances.

Results : Nine studies, investigating a total of 773 patients, were identified. There was considerable variation regarding therapy regimen and duration. Pooled eradication rates were 81.3% (312 of 384) for patients with pre‐treatment and 81.2% (316 of 389) for patients without pre‐treatment. The (weighted) overall risk difference was 0.1% (95% CI: −5%; 5%).

Conclusion : Pre‐treatment with a proton pump inhibitor does not influence H. pylori eradication.
Oral methotrexate in ulcerative colitis
Authors: Cummings J. R. F. , Herrlinger K. R. , Travis S. P. L. , Gorard D. A. , McIntyre A. S. , Jewell D. P.
Published: February 2005

Background : We performed an audit of methotrexate for ulcerative colitis, because efficacy is unclear.

Aim : To investigate the role of methotrexate in the management of ulcerative colitis.

Methods : Patients with ulcerative colitis treated with oral methotrexate at the inflammatory bowel disease clinics of Oxford and Wycombe General Hospital, UK, were evaluated. Efficacy was defined by remission (complete steroid withdrawal for >3 months) and response (good, partial or nil, proportionate reduction of steroids).

Results : There were 50 patients (42 ulcerative colitis alone; eight had rheumatoid arthritis associated with ulcerative colitis and were analysed separately). Indications for methotrexate in ulcerative colitis alone were azathioprine intolerance (31 of 42) and lack of benefit from azathioprine (11 of 42). The mean dose of methotrexate in ulcerative colitis alone was 19.9 mg/week for a median of 30 weeks (range: 7–395). Remission occurred in 42%. The response was good in 54% and partial in 18%. Side‐effects occurred in 23%; 10% stopped treatment because of side‐effects. Of those treated with methotrexate because of treatment failure with azathioprine, three of 11 achieved remission, but four came to colectomy within 90 days of starting methotrexate. The colitis remained in remission in seven of eight of those with RA treated with methotrexate and ulcerative colitis (mean dose 15.0 mg/week).

Conclusion : Oral methotrexate (approximately 20 mg/week) is well‐tolerated and moderately effective in steroid‐dependent or steroid‐refractory patients with ulcerative colitis.
Efficacy and tolerability of a new formulation of sodium phosphate tablets (INKP‐101), and a reduced sodium phosphate dose, in colon cleansing: a single‐center open‐label pilot trial
Authors: Khashab M. , Rex D. K.
Published: February 2005

Background : The tablet form of sodium phosphate for bowel preparation for colonoscopy contains microcrystalline cellulose. This inactive ingredient produces a residue that obscures mucosal visualization and is time‐consuming to remove during colonoscopy.

Aim : To perform an open‐label study of efficacy and tolerability of a modified formulation with microcrystalline cellulose reduced by 50% (code named INKP‐101) and a lower total dose of sodium phosphate.

Methods : Patients scheduled for colonoscopy self‐administered 28 INKP‐101 tablets (42 g sodium phosphate). Colon cleansing efficacy was evaluated using a standard 4‐point scoring system and the amount of microcrystalline cellulose present and time spent removing it using an 8‐point scale.

Results : A total of 31 patients were screened and enrolled. Thirty patients had a colonoscopy and were evaluated for colon cleansing efficacy. Overall colon cleansing was rated as excellent and good in 90% and 10% of patients respectively. About 77% of patients had microcrystalline cellulose scores of 2 or 3 (corresponding to <1 or 1–2 min spent removing microcrystalline cellulose, respectively). The drug was well‐tolerated and adverse events were generally benign.

Conclusion : A new formulation of sodium phosphate with reduced microcrystalline cellulose and a lower total dose of sodium phosphate was effective for colonoscopy and well‐tolerated.
Review article: oral ulcers and its relevance to systemic disorders
Authors: Porter S. R. , Leao J. C.
Published: February 2005

Oral ulceration is a common problem, and is sometimes a marker of gastroenterological disease. Patients with signs or symptoms of oral ulcers are sometimes referred to gastroenterology clinics, however, in most instances the ulcers does not reflect gastrointestinal disease. Indeed, a spectrum of disorders other than those of the gut can give rise to oral mucosal ulcers ranging from minor local trauma to significant local disease such as malignancy or systemic illness. This present article reviews aspects of the aetiology, diagnosis and management of common ulcerative disorders of the oral mucosa.
Histological progression of non‐alcoholic fatty liver disease in Chinese patients
Authors: Hui A. Y. , Wong V. W.‐S. , Chan H. L.‐Y. , Liew C.‐T. , Chan J. L.‐Y. , Chan F. K.‐L. , Sung J. J.‐Y.
Published: February 2005

Background : Non‐alcoholic fatty liver disease is an important cause of chronic hepatitis and cryptogenic cirrhosis. The natural history of non‐alcoholic fatty liver disease is not well understood especially in Asian populations.

Aim : To investigate the histological progression in Chinese patients with biopsy‐proven non‐alcoholic fatty liver disease.

Methods : Chinese patients who had liver biopsy at least 3 years ago and confirmed to have non‐alcoholic fatty liver disease were invited for a second liver biopsy. Clinical and laboratory parameters related to their liver function and metabolic syndrome were recorded and analysed. Liver biopsies were scored for the degree of steatosis, necroinflammation and fibrosis. Correlation coefficients were calculated to assess the association between changes in histological scores and metabolic parameters.

Results : Seventeen patients who had been followed up for a median period of 6.1 (range: 3.8–8.0) years underwent a second liver biopsy. Nine (53%) patients had progressive disease with worsening of fibrosis score. No statistically significant correlation was found between the changes in histological scores and metabolic parameters. Seven patients developed hypertension or diabetes mellitus during the period of follow‐up.

Conclusions : Non‐alcoholic fatty liver disease is a progressive disease in Chinese patients as in their Caucasian counterparts. Diagnosis of non‐alcoholic fatty liver disease may predate development of new components of metabolic syndrome.
A randomized, double‐blind, placebo‐controlled trial of CDP571, a humanized monoclonal antibody to tumour necrosis factor‐α, in patients with corticosteroid‐dependent Crohn's disease
Authors: Feagan B. G. , Sandborn W. J. , Baker J. P. , Cominelli F. , Sutherland L. R. , Elson C. O. , Salzberg B. A. , Archambault A. , Bernstein C. N. , Lichtenstein G. R. , Heath P. K. , Cameron S. , Hanauer S. B.
Published: February 2005

Aim : To evaluate CDP571, a humanized monoclonal antibody to tumour necrosis factor‐α, for the treatment of corticosteroid‐dependent Crohn's disease.

Methods : Patients with corticosteroid‐dependent Crohn's disease (use of prednisolone 15–40 mg/day or budesonide 9 mg/day for at least 8 weeks, a previous failed attempt to discontinue corticosteroids within 8 weeks, and Crohn's Disease Activity Index score 150 points or less) were enrolled in a 16‐week, randomized, double‐blind, placebo‐controlled trial. The patients received intravenous CDP571 (20 mg/kg at week 0 and 10 mg/kg at week 8) or placebo. Corticosteroid therapy was decreased following a predefined schedule. The primary efficacy end‐point was the percentage of patients with corticosteroid‐sparing [i.e. no disease flare (Crohn's Disease Activity Index score ≥220 points) and no longer requiring corticosteroid therapy] at week 10. The major secondary efficacy end‐point was corticosteroid‐sparing at week 16.

Results : Seventy‐one patients received treatment. Corticosteroid‐sparing was achieved by 19 of 39 (48.7%) CDP571 patients and 13 of 42 (40.6%) placebo patients (P = 0.452) at week 10, and by 18 of 39 (46.2%) CDP571 patients and seven of 32 (21.9%) placebo patients (P = 0.032) at week 16. CDP571 therapy was well‐tolerated and the incidence of serious adverse events was similar to placebo.

Conclusions : The CDP571 was effective for corticosteroid‐sparing at week 16 but not week 10, and was well‐tolerated in patients with corticosteroid‐dependent Crohn's disease.
Manometric evaluation of achalasia in the elderly
Authors: Hashemi N. , Banwait K. S. , Dimarino A. J. , Cohen S.
Published: February 2005

Background : The effect of ageing on oesophageal motility in patients with achalasia is not well described. Oesophageal contraction amplitude is decreased in otherwise healthy elderly subjects.

Aim : To evaluate whether ageing influences the motor function of the oesophagus in achalasia.

Methods : Initial manometry studies of patients with achalasia were reviewed and findings (lower oesophageal sphincter basal and residual pressures and oesophageal body contraction amplitudes) were compared between two groups of patients, those 65 years of age or older (49 patients) and those younger than 65 years (68 patients). The older group was further divided into those ≥70 years and those <70 years.

Results : Patients 65 years and older had significantly higher lower oesophageal sphincter basal pressures compared with younger patients (65.6 ± 4.9 vs. 52.3 ± 2.7, P = 0.02). At an age cut‐off of 70 years, older patients had significantly higher basal (70.7 ± 1.6 vs. 53.0 ± 2.4, P = 0.02) and residual (19.7 ± 1.6 vs. 15.9 ± 0.7, P = 0.03) lower oesophageal sphincter pressures compared with younger patients. Amplitude of oesophageal contractions was not different between the groups. Across all age groups, there was no linear correlation between age and basal or residual lower oesophageal sphincter pressures (r = 0.28 and 0.12, respectively).

Conclusions : Older patients with achalasia have higher lower oesophageal sphincter pressures, however there is no linear correlation between age and lower oesophageal sphincter pressures. Unlike healthy subjects, advanced age is not associated with a decrease in oesophageal contraction amplitude in patients with achalasia.
Budesonide as maintenance treatment in Crohn's disease: a placebo‐controlled trial
Authors: Hanauer S. , Sandborn W. J. , Persson A. , Persson T.
Published: February 2005

Aim : To assess the efficacy and safety of budesonide capsules 6 mg daily for prolongation of time to relapse and maintenance of remission in patients with Crohn's disease (CD) affecting the ileum and/or ascending colon.

Methods : In a double‐blind, placebo‐controlled, multicentre trial, 110 patients with CD, who had previously achieved remission in a placebo‐controlled trial of budesonide 9 mg daily, were randomly assigned to receive budesonide 6 mg once daily or placebo for 52 weeks. Primary outcome measure was time to relapse [CD activity index (CDAI) of >150 plus an increase of at least 60 points from study entry or withdrawal due to clinical deterioration].

Results : Median time to relapse was 360 days for budesonide patients; 169 days for placebo patients (P = 0.132). No significant differences were seen between groups in relapse rates at 1 year. Budesonide was safe and well tolerated, with a similar adverse events profile to placebo.

Conclusion : Patients treated with budesonide 6 mg once daily had a trend towards a prolonged time to relapse and lower CDAI scores compared with patients treated with placebo, but relapse rates were not significantly different at the 1‐year end point.
Efficacy of esomeprazole 40 mg vs. lansoprazole 30 mg for healing moderate to severe erosive oesophagitis
Authors: Fennerty M. B. , Johanson J. F. , Hwang C. , Sostek M.
Published: February 2005

Background : Secondary analyses from previous studies indicated that esomeprazole was more effective than lansoprazole and omeprazole in healing moderate or severe (Los Angeles grades C or D) erosive oesophagitis (EE).

Aim : To compare prospectively healing rates with esomeprazole vs. lansoprazole in patients with moderate to severe EE.

Methods : In this multicentre, randomized, double‐blind, parallel‐group trial, adult patients with endoscopically confirmed moderate or severe EE received esomeprazole 40 mg (n = 498) or lansoprazole 30 mg (n = 501) once daily for up to 8 weeks. The primary end point was EE healing through week 8. Secondary assessments included investigator‐assessed resolution of symptoms and safety and tolerability.

Results : Time to healing was significantly different (P = 0.007), favouring esomeprazole. Estimated healing rates at week 8 were 82.4% with esomeprazole 40 mg and 77.5% with lansoprazole 30 mg. Heartburn resolved at week 4 in 72% and 64% of patients who received esomeprazole and lansoprazole, respectively (P = 0.005). Control of other GERD symptoms was similar between treatments. Both treatments were well tolerated.

Conclusions : With 8 weeks’ treatment, esomeprazole 40 mg once daily heals moderate to severe EE faster and in more patients, and resolves heartburn in more patients after 4 weeks of treatment, than lansoprazole 30 mg once daily.
Review article: monitoring of immunomodulators in inflammatory bowel disease
Authors: Aberra F. N. , Lichtenstein G. R.
Published: February 2005

The armamentarium of medications for the treatment of inflammatory bowel disease is growing and becoming more complicated to use. Immunomodulators are a class of medications that have found a niche for the treatment of Crohn's disease and ulcerative colitis. Because of the mounting supporting evidence for efficacy, the most commonly‐used immunomodulators are azathioprine, mercaptopurine, methotrexate and ciclosporin. These medications are being used more often due to their steroid‐sparing and potentially surgery‐sparing effects. Immunomodulators are also known for a significant side‐effect profile and require careful monitoring. This review provides the latest information for clinicians on efficacy, side‐effects, dosing and monitoring of these medications for treatment of inflammatory bowel disease.
Meta‐analysis: endoscopic variceal ligation for primary prophylaxis of oesophageal variceal bleeding
Authors: Khuroo M. S. , Khuroo N. S. , Farahat K. L. C. , Khuroo Y. S. , Sofi A. A. , Dahab S. T.
Published: February 2005

Background : The treatment effects of primary prophylactic endoscopic variceal ligation are unclear.

Aim : To compare the treatment effects of endoscopic variceal ligation and β‐blockers for primary prophylaxis of oesophageal variceal bleeding. In addition, a subgroup analysis was done with the purpose to delineate differences in the effects of intervention that were biologically based.

Methods : We performed a literature search for randomized controlled trials, which compared the treatment effects of endoscopic variceal ligation with β‐blockers for primary prophylaxis of oesophageal variceal bleeding. Of the 955 articles screened, eight randomized‐controlled trials including 596 subjects (285 with endoscopic variceal ligation and 311 with β‐blockers) were analysed. Outcomes measures evaluated were first gastrointestinal bleed, first variceal bleed, all‐cause deaths, bleed‐related deaths and severe adverse events. The measure of association employed was relative risk; with heterogeneity and sensitivity analyses.

Results : Variceal obliteration was obtained in 261 (91.6%) patients and target β‐blockers therapy was achieved in 294 (94.5%) patients (P = 0.19). Endoscopic variceal ligation compared with β‐blockers significantly reduced rates of first gastrointestinal bleed by 31% (RR, 0.69; 95% CI: 0.49–0.96; P = 0.03; NNTB = 15) and first variceal bleed by 43% (RR, 0.57; 95% CI: 0.38–0.85; P = 0.0067; NNTB = 11). All‐cause deaths and bleed‐related deaths were unaffected (RR, 1.03; 95% CI: 0.79–1.36; P = 0.81 and RR, 0.84; 95% CI: 0.44–1.61; P = 0.60 respectively). Severe adverse events were significantly less in endoscopic variceal ligation compared with β‐blockers (RR, 0.34; 95% CI: 0.17–0.69; P = 0.0024; NNTB = 28). Sensitivity analysis of five trials published in peer review journals and four trials with high quality showed results similar to those seen in the primary analysis of all the eight trials, confirming stability of conclusions. Following variceal obliteration with endoscopic variceal ligation, oesophageal varices recurred in 83 (29.1%) patients. Seven (28.1%) patients bled with one fatal outcome. In subgroup analyses, endoscopic variceal ligation had significant advantage compared wtih β‐blockers in trials including ≤30% patients with alcoholic cirrhosis, >30% patients with Child Class C cirrhosis and >50% patients with large varices.

Conclusions : In patients with cirrhosis with moderate to large varices and who have not bled, endoscopic varices ligation compared with β‐blockers significantly reduced bleeding episodes and severe adverse events, but had no effect on mortality.
Concomitant dosing of famotidine with a triple therapy increases the cure rates of Helicobacter pylori infections in patients with the homozygous extensive metabolizer genotype of CYP2C19
Authors: Okudaira K. , Furuta T. , Shirai N. , Sugimoto M. , Miura S.
Published: February 2005

Background : Proton‐pump inhibitors, such as lansoprazole, are metabolized in the liver by CYP2C19 and cannot inhibit acid sufficiently in homozygous extensive metabolizers of CYP2C19.

Aim : To examine whether famotidine would increase the cure rates of Helicobacter pylori infection by a standard triple therapy.

Methods : A total of 177 H. pylori‐positive patients were randomly assigned to either lansoprazole 30 mg b.d., clarithromycin 200 mg b.d. and amoxicillin 750 mg b.d. for 1 week (LCA group; n = 89) or famotidine 20 mg b.d., lansoprazole 30 mg b.d., clarithromycin 200 mg b.d. and amoxicillin 750 mg b.d. for 1 week (FLCA group; n = 88). Famotidine was administered after lunch and before sleep, and the others were after breakfast and dinner. CYP2C19 genotypes were determined by a polymerase chain reaction restriction fragment length polymorphism (PCR–RFLP) method.

Results : In the LCA group, the eradication rates for homozygous extensive metabolizers, heterozygous extensive metabolizers, and poor metabolizers were 63%, 87%, and 100%, respectively (P = 0.014). Those in the FLCA group were 85%, 85%, and 100%, respectively (N.S.). The cure rate for homozygous extensive metabolizers in the FLCA group was significantly higher than that in the LCA group (P = 0.035).

Conclusion : Famotidine improves the cure rate of H. pylori infection by a triple therapy in CYP2C19 homozygous extensive metabolizers patients.
Efficacy and safety of an olive oil‐based intravenous fat emulsion in adult patients on home parenteral nutrition
Authors: Reimund J.‐M. , Rahmi G. , Escalin G. , Pinna G. , Finck G. , Muller C. D. , Duclos B. , Baumann R.
Published: February 2005

Background : The most frequently used intravenous lipid emulsions are composed of 100% long chain triacylglycerols from soybean oil or of 50% long chain triacylglycerols–50% medium chain triacylglycerols. A newer emulsion, ClinOleic 20% containing 80% olive oil and 20% soybean oil, was suggested to reduce lipid peroxidation and immune function impairment.

Aim : To assess ClinOleic 20%'s efficacy, safety and effect upon systemic inflammatory parameters in adults on home parenteral nutrition.

Methods : In stable home parenteral nutrition patients, the initial intravenous lipid emulsion was changed for ClinOleic 20%. Nutritional status, clinical and biological tolerance, and systemic inflammatory markers were analysed before and after 1 and 3 months of home parenteral nutrition, with ClinOleic 20% as intravenous lipid emulsion.

Results : Clinical and biological nutritional markers and inflammatory parameters did not differ between day 0 and month +3. There was no essential fatty acids deficiency. No side‐effects were reported. Three of five patients presenting with migraine during home parenteral nutrition infusion at day 0 felt consistently better at month +3.

Conclusions : ClinOleic 20% is safe and efficient in adult home parenteral nutrition. It maintains normal essential fatty acids status and did not influence inflammatory parameters. In contrast to studies in preterm infants or paediatric patients, no effect on vitamin E concentration or lipid peroxidation was observed.
Evaluation of a new rapid immunoassay for the detection of Helicobacter pylori in faeces: a prospective pilot study
Authors: Trevisani L. , Sartori S. , Rossi M. R. , Ruina M. , Matarese V. , Gullini S. , Abbasciano V.
Published: February 2005

Background : Detection of Helicobacter pylori antigen in faeces is a valid method to diagnose H. pylori infection. Presently available stool tests are performed in the laboratory, and diagnostic report is delayed.

Aim : To evaluate a new rapid stool test in a pre‐treatment setting and to compare it with a validated laboratory stool test.

Methods : A total of 105 patients underwent gastroscopy with brush cytology, and biopsies for histology and rapid urease test, to assess H. pylori presence. Helicobacter pylori‐status was considered positive if at least two tests were positive; negative if all tests were negative; indeterminate if one test was positive and two negative. Stool specimens were tested using either a rapid immunoassay kit (ImmunoCard STAT) or a laboratory enzyme immunoassay kit (Hp StAR).

Results : Sixty patients were infected with H. pylori, 44 non‐infected, one indeterminate. The sensitivity and specificity of ImmunoCard STAT were 85 and 93%; those of Hp StAR were 88 and 100% (not significant).

Conclusions : ImmunoCard STAT seems a reliable method for detecting H. pylori in untreated patients. It could replace laboratory stool tests, as it is easy and can be performed quickly. These characteristics might be a breakthrough for diagnosing H. pylori in the doctor's office.
Capacity to make financial decisions among people with mild intellectual disabilities
Authors: Suto W. M. I. , Clare I. C. H. , Holland A. J. , Watson P. C.
Published: February 2005

Background Although there has been growing recognition of the importance of enabling people with intellectual disabilities (ID) to be more directly involved in managing their own financial affairs, so far, little is known about this aspect of their decision‐ making.

Method Using vignettes and semi‐structured interviews, the financial decision‐making abilities of men and women with mild ID (n = 30; mean FSIQ = 61.80; SD = 10.59) were compared with those of their counterparts in the ‘general population’ (n = 16; mean FSIQ = 101.56; SD = 7.62) and ‘very able’ individuals (n = 14; mean FSIQ = 123.93; SD = 7.60).

Results Whilst the financial decision‐making abilities of participants with ID were generally weaker than those of other participants, the differences were not discrete, and many individuals were judged to be able to make at least some personal financial decisions. For all three groups, understanding information relevant to the decision, and reasoning with it, were the hardest parts of the process.

Conclusions The findings support a functional approach to the assessment of financial decision‐making for both legal and clinical purposes, but raise concerns about mental incapacity legislation and assessment.
Social outcomes in adulthood of children with intellectual impairment: evidence from a birth cohort
Authors: Hall I. , Strydom A. , Richards M. , Hardy R. , Bernal J. , Wadsworth M.
Published: February 2005

Background  Social Policy for people with intellectual disabilities (ID) continues to evolve, but little is known about the lives to which such policies are applied. We aimed to use a prospective follow‐up of a British birth cohort to identify children with mild and more severe intellectual impairment, and compare a range of social outcomes in adulthood with people in the rest of the cohort.

Method  We used data from the MRC National Survey for Health and Development. Intellectual impairment was identified by intelligence tests and educational history. Adult outcome measures included employment and social class, education, marriage and children, home ownership, social networks and community use.

Results  We identified 111 people with mild intellectual impairment (2.7%) and 23 with severe intellectual impairment (0.6%) at age 15/16. By the age of 43, there were 52 people remaining in the mild impairment group and 14 in the severe impairment group. In adulthood those with intellectual impairment enjoyed contact with friends and family, and joined in informal social activities. Although the mild intellectual impairment group were less likely to attain the following social outcomes than people with normal intellectual functioning, 67% had jobs, 73% were married, 62% had children and 54% owned their own homes. 12% participated in adult education. People with more severe intellectual impairment were less likely to attain these outcomes.

Conclusions  These outcomes highlight issues in current social policy and suggest efforts should be directed particularly towards promoting educational opportunities and developing social inclusion for people with ID.
Wolf–Hirschhorn syndrome – two case‐study reports focusing particularly on long‐term survival
Authors: Lopes O. , Barton G. , Morgan J.
Published: February 2005

Background  The clinical features of this rare chromosomal syndrome are described in two individuals. Our limited knowledge of the natural history of this disorder has made it difficult to counsel parents as well as outline specific treatment and management plans.

Method  Interviews were undertaken with subjects, carers and next of kin, and the literature was searched.

Results  Pertinent features of the syndrome are reported.

Main Conclusions  These two cases highlight that long‐term survival may occur and that accurate diagnosis is paramount so that healthcare professionals are able to provide accurate information.
Enhancing primary health care services for adults with intellectual disabilities
Authors: Melville C. A. , Finlayson J. , Cooper S.‐A. , Allan L. , Robinson N. , Burns E. , Martin G. , Morrison J.
Published: February 2005

Background  Primary health care teams have an important part to play in addressing the health inequalities and high levels of unmet health needs experienced by people with intellectual disabilities (ID). Practice nurses have an expanding role within primary health care teams. However, no previous studies have measured their attitudes, knowledge, training needs, and self‐efficacy in their work with people with ID.

Methods  All practice nurses working in a defined area were identified. A purpose‐designed questionnaire to measure nurse attitudes, knowledge, training needs and self‐efficacy was developed and piloted. All practice nurses were then invited to participate. Data from completed questionnaires were entered onto PC and analysed.

Results  Of a total of 292 practice nurses 201 (69%) participated. Whilst 89% (n = 179) of participants reported having infrequent contact, 25% (n = 50) reported a growing workload with people with ID. Only 8% (n = 16) had ever received any training in communicating with people with ID. A knowledge gap regarding the health needs of people with ID was identified. Eighty‐six per cent reported having experienced specific difficulties during previous appointments, and only 23% thought they had sufficient case note information at appointments, but 68% did not modify the duration of their appointments with people with ID. Conversely, responses demonstrated that practice nurses have a high level of experience and qualification in general nursing, have positive attitudes to working with people with ID, and high self‐efficacy scores were identified for work with people with ID. The practice nurses viewed ID to be a high priority area for future training.

Conclusions  Primary health care teams have a key role in tackling the unmet health needs of people with ID. Whilst this project has identified factors that may impact on the accessibility of services, it has also identified practice nurses as having positive attitudes and high self‐efficacy scores in their work with people with ID. This indicates that they should be targeted for specific training in this area, which may make an important contribution in enhancing future accessibility of primary health care services for people with ID.