bluuebunny/crossref_metadata_2025 huggingface dataset:
An Epidemiologic Study of Psychotropic Medication and Obesity-Related Chronic Illnesses in Older Psychiatric Patients
Authors: Kisely Stephen , Cox Martha , Campbell Leslie Anne , Cooke Charmaine , Gardner David
Published: January 2017

Objective:

Adverse effects from medication vary with age. Weight gain with several psychotropics is well known in adults but less information is available related to extent and complications of psychotropic-induced weight gain in older psychiatric patients. We determined the relative incidence of 2 obesity-related conditions (diabetes and hypertension) in older psychiatric patients receiving antipsychotics, antidepressants, and mood stabilizers.

Method:

A population-based case–control study of all psychiatric patients aged 67 years or older in contact with either specialist services or primary care using administrative data from Nova Scotia.

Results:

We identified incident cases of diabetes ( n = 608) and of hypertension ( n = 1056), as well as an equal number of control subjects for each condition. Amitryptiline, selective serotonin reuptake inhibitors (SSRIs), and olanzapine were associated with an increased risk of presenting with hypertension 6 months after initial prescription. By contrast, conventional antipsychotics were associated with a reduced incidence of hypertension. Olanzapine was also significantly associated with diabetes after 6 months (ORadj = 2.58, 95% CI 1.12 to 5.92). The findings for SSRIs and olanzapine remained significant after adjusting for potential confounders such as sociodemographic characteristics, schizophrenia, beta blockers, thiazide diuretics, and corticosteroids.

Conclusions:

Our results suggest that the association of psychotropics and 2 obesity-related conditions, hypertension and diabetes, applies to older psychiatric patients as well as younger populations. Within drug classes, there are drugs that have a greater association than others, and this may be a factor when choosing a specific agent.
Personality Changes in Patients with Beginning Alzheimer Disease
Authors: Pocnet Cornelia , Rossier Jérôme , Antonietti Jean-Philippe , von Gunten Armin
Published: January 2017

Objective:

To investigate personality traits in patients with Alzheimer disease, compared with mentally healthy control subjects. We compared both current personality characteristics using structured interviews as well as current and previous personality traits as assessed by proxies.

Method:

Fifty-four patients with mild Alzheimer disease and 64 control subjects described their personality traits using the Structured Interview for the Five-Factor Model. Family members filled in the Revised NEO Personality Inventory, Form R, to evaluate their proxies' current personality traits, compared with 5 years before the estimated beginning of Alzheimer disease or 5 years before the control subjects.

Results:

After controlling for age, the Alzheimer disease group presented significantly higher scores than normal control subjects on current neuroticism, and significantly lower scores on current extraversion, openness, and conscientiousness, while no significant difference was observed on agreeableness. A similar profile, though less accentuated, was observed when considering personality traits as the patients' proxies remembered them. Diachronic personality assessment showed again significant differences between the 2 groups for the same 4 domains, with important personality changes only for the Alzheimer disease group.

Conclusions:

Group comparison and retrospective personality evaluation are convergent. Significant personality changes follow a specific trend in patients with Alzheimer disease and contrast with the stability generally observed in mentally healthy people in their personality profile throughout their lives. Whether or not the personality assessment 5 years before the current status corresponds to an early sign of Alzheimer disease or real premorbid personality differences in people who later develop Alzheimer disease requires longitudinal studies.
A Comparative Review of New Antipsychotics
Authors: Blin Olivier
Published: January 2017

Objective:

To review the preclinical and clinical properties of various established and putative antipsychotic medications, namely clozapine, risperidone, amisulpride, olanzapine, quetiapine, sertindole, and ziprasidone.

Methods:

This paper proposes a decision algorithm for comparing drugs used for psychotic disorders, based on biochemical profile, experimental pharmacology, postiron emission tomography (PET) scan results, and clinical efficacy on positive, negative, anxious, depressive, and cognitive symptoms. This “quotient” aims to compare the different available drugs, regardless of their development and registration status.

Results:

Antipsychotic drugs have been classified in many ways, mainly according to their chemical structure, clinical effects, receptor affinity, or side effects. Preclinical data have indicated that these drugs might be effective antipsychotic agents, causing fewer extrapyramidal side effects than most of the previously marketed drugs. However, the biological basis for the putative superiority of these drugs in treating psychosis has yet to be ascertained.

Conclusions:

Although most antipsychotics have been shown to be at least equivalent to haloperidol on positive symptoms, they must be studied further to establish their absolute and relative efficacy on positive symptoms, negative and primary negative symptoms, cognition, psychotic anxiety, psychotic depression, suicidality, and quality of life. These drugs should be valuable in treating schizophrenia, but their merit in the long-term management of patients with schizophrenia still needs to be confirmed.
Comment prévenir l'apparition d'un trouble de stress post-traumatique avant un traumatisme?
Authors: Melançon Geoffroy , Boyer Richard
Published: January 2017

Objectif:

Faire le point sur les moyens utilisés afin deprévenir l'apparition du trouble de stress post-traumatique (TSPT) avant un traumatisme.

Méthode:

Recension et analyse des écrits (principalement des articles) répertoriés à l'aide des bases de données Medline, Psycinfo et Pilot.

Résultats:

Les recherches font surtout ressortir l'identification des facteurs de risque et le renforcement de la résistance des individus comme moyen de prévention primaire du TSPT. La gravité du traumatisme demeure de loin le facteur de risque le plus important. Les approches psychoéducatives pour renforcer les défenses des individus et empêcher le développement d'un TSPT ont été privilégiées dans l'armée. Toutefois, aucun programme de préventionpré-trauma visant d'autres métiers à risque n'a été retrouvé dans l'analyse de la documentation.

Conclusion:

L'utilité des facteurs de risque identifiés dans la documentation pour la prévention primaire du TSPT est limitée puisque ceux-ci, saufle traumatisme lui-même, n'influencent que faiblement le développement du TSPT en cas de traumatisme grave. Les approches psychoéducatives de renforcement de la résistance des individus à risque d'exposition apparaissent prometteuses, mais leur potentiel doit être mieux exploré par la recherche auprès de groupes de métiers à risque. Enfin, l'identification de possibles facteurs de protection, l'effet de la génétique et des variables biologiques, l'effet additif d'exposition à des stresseurs et celui des stresseurs chroniques sont d'autres pistes de recherche suggérées par les auteurs dans la prévention primaire (pré-trauma) du TSPT.
Methodological and Clinical Challenges in Evaluating Treatment Outcome of Substance-Related Disorders and Comorbidity
Authors: el-Guebaly N , Hodgins DC , Armstrong S , Addington J
Published: January 2017

Objective:

To review the steps required to develop an outcome evaluation package and to report on the 12-month outcome of an integrated day program.

Method:

Based on the identification of salient outcome predictors, standardized instruments were selected. A cohort of 78 patients was assessed at the time of admission to the program, at discharge, and 3, 6, and 12 months afterward.

Results:

Improvements were sustained over 1 year in all areas including treatment needs, quality of life, and readiness to change.

Conclusions:

The gap between the “cultures” of treatment and research must be narrowed. Following evidence of a program's general effectiveness through outcome monitoring, a randomized control design is optimal for specific interventions. The optimal length of follow-up depends on the perceived confounds.
Hospital Outcome Measures following Assertive Community Treatment in Edmonton, Alberta
Authors: Tibbo Philip , Chue Pierre , Wright Evelyn
Published: January 2017

Objective:

To examine hospital outcome measures for individuals with chronic and severe mental illnesses before and after their registration in an assertive community treatment (ACT) program in Edmonton, Alberta.

Methods:

Data were collected from Alberta Health on individuals who were registered in ACT from April 1993 to April 1995. For each individual, hospital outcome measures were calculated for the 365 days prior to and 365 days after registration for ACT (thus covering April 1, 1992-March 31,1996).

Results:

Data were collected from 295 individuals. Compared with 1 year prior to beginning ACT, there was a 34% reduction in hospital separations for patients with psychiatric diagnoses. The average length of stay (LOS) for each separated patient decreased by 56%, and the hospitalization days for each patient separated also decreased by 39%. The number of emergency visits for psychiatric reasons was reduced by 32%, and the number of clients visiting emergency departments for psychiatric reasons declined by 30%.

Conclusions:

In the 1-year period after registration in an ACT program, hospital outcome measures were improved in this cohort of 295 individuals with severe and chronic mental illnesses.
Difficulties in Treating Patients with Eating Disorders: A Review of Patient and Clinician Variables
Authors: Kaplan Allan S , Garfinkel Paul E
Published: January 2017

Objective:

Patients with eating disorders (EDs) are often difficult to treat. Despite recent advances in treatment, a significant percentage of patients remain treatment refractory. This paper reviews variables that contribute to these difficulties and recent strategies that focus on increasing patient motivation for treatment.

Method:

The authors relate their clinical experience and synthesize the literature examining aspects of patients with EDs that may contribute to their treatment resistance and therapist variables that may contribute to negative nontherapeutic reactions.

Results:

Patient variables include the nature of the symptoms that patients experience, issues of trust, the not uncommon failure of ambulatory treatments, and issues related to comorbidity. Aspects of clinicians include lack of understanding of the biopsy chosocial pathophysiology of these conditions and lack of experience and appreciation for the countertransferential reactions that these patients evoke in caregivers.

Conclusions:

Improving understanding of the reasons for treatment refractoriness inpatients with EDs is critical to improving their care. New interventions aimed at enhancing motivation may facilitate this process.
Bilateral Anterior Cortical Atrophy and Subcortical Atrophy in Reduplicative Paramnesia: A Case-Control Study of Computed Tomography in 10 Patients
Authors: Joseph Anthony B , O'Leary Daniel H , Kurland Robert , Ellis Hadyn D
Published: January 2017

Objective:

Reduplicative paramnesia (RP) is thought to be related to other delusional misidentification syndromes (DMS) such as Capgras syndrome. DMS are thought to occur when brain lesions disrupt cortical functioning. This study tests this hypothesis and tries to understand whether focal lesions are as important in the etiology of RP as they are in other types of DMS.

Method:

The computed tomography (CT) scans of 10 consecutive psychiatric inpatients with RP and another principal psychiatric diagnosis were compared with those of control patients without RP matched for age, sex, and principal psychiatric diagnosis. The scans were assessed blindly by a neuroradiologist using a previously published rating scale for the presence of lesions in 11 discrete anatomic areas. The differences between the 2 groups were examined statistically using log-linear analysis.

Results:

Statistical analysis revealed that index patient cortical atrophy, cortical fissure enlargement, and deep brain atrophy distinguished the 2 groups significantly (P < 0.05).

Conclusions:

Bilateral anterior cortical, brain stem, and cerebellar vermis atrophy and dysfunction may be important in the pathogenesis of RP in particular and of DMS in general.
The Newly Disabled: Blind Nursing Home Residents
Authors: Retsinas Joan , Garrity Patricia
Published: January 2017

The sarse literature on blind nursing home residents describes them as isolated, withdrawn, and dependent. We introduce a model that links blindness to immobility, isolation, dependence, loss of affect, and disinterest in the outside world. Using data from one nursing home, we compared the functional status and mobility of residents who were blind before admission with that of residents who became blind after admission. The results suggest that preadmission blind residents' dependence, isolation, and immobility were attributed not solely to their blindness, but to their severe nonvisual disabilities, including hearing impairments. Postadmission blind residents, however, did suffer because of their blindness. To improve blind residents' quality of life, we offer practical suggestions for training nursing home staff.
Improving Quality of Care and Life in Nursing Homes
Authors: Glass Anne P.
Published: January 2017

For nursing home residents, quality of life is largely determined by the quality of the care they receive. Unfortunately, that quality is all too often inadequate. Current regulatory systems have failed in their efforts to assure high-quality care. Policy could vitally improve institutional quality of care in three ways: (1) increase efforts to derive a valid and reliable quality of care index that incorporates resident outcomes; (2) change the emphasis of resident care inspections; and (3) expand outside involvement. These elements are all essential and interdependent. They offer a myriad of creative opportunities for researchers, practitioners, and volunteers to make major contributions toward improving the quality of care, and, ultimately of life, for nursing home patients.
Thrombolytic Therapy: A Comprehensive Review of its Use in Clinical Medicine—Part I
Authors: Bell William R. , Streiff Michael B.
Published: January 2017

In the first part of this comprehensive review of thrombolytic therapy in clinical medicine, we begin with a brief history of fibrinolysis, followed by a review of the components of die endogenous fibrinolytic system and the currently available plasminogen activators. An in-depth examination of thrombolysis in treatment of acute myocardial infarction follows, Including recommendations for management based on available clinical trial data. New developments in thrombolytic therapy are also discussed.
The Influence of Health Literacy on Reach, Retention, and Success in a Worksite Weight Loss Program
Authors: Zoellner Jamie , You Wen , Almeida Fabio , Blackman Kacie C. A. , Harden Samantha , Glasgow Russell E. , Linnan Laura , Hill Jennie L. , Estabrooks Paul A.
Published: January 2017

Purpose:

To examine if employee health literacy (HL) status moderated reach, retention, and weight outcomes in a worksite weight loss program.

Design:

The study was a two-group cluster randomized controlled weight loss trial.

Setting:

The study was conducted in 28 worksites.

Subjects:

Subjects comprised 1460 employees with a body mass index >25 kg/m2.

Interventions:

Two 12-month weight loss interventions targeted diet and physical activity behaviors: incentaHEALTH (INCENT; incentivized individually targeted Internet-based intervention) and Livin’ My Weigh (LMW; less-intense quarterly newsletters).

Measures:

A validated three-item HL screening measure was self-completed at baseline. Weight was objectively assessed with the Health Spot scale at baseline and 12-month follow-up.

Analysis:

The impact of HL on program effectiveness was assessed through fixed-effect parametric models that controlled for individual (i.e., age, gender, race, ethnicity, income, education) and worksite random effects.

Results:

Enrolled employees had significantly higher HL status [13.54 (1.68)] as compared to unenrolled [13.04 (2.17)] ( p < .001). This finding was consistent in both interventions. Also, HL moderated weight loss effects ( beta = .66; SE = 027; p = .014) and losing >5% weight ( beta = −1.53; SE = .77; p < .047). For those with lower baseline HL, the INCENT intervention produced greater weight loss outcomes compared to LMW. The HL level of employees retained was not significantly different from those lost to follow-up.

Conclusion:

HL influences reach and moderates weight effects. These findings underscore the need to integrate recruitment strategies and further evaluate programmatic approaches that attend to the needs of low-HL audiences.
The Impact of Breastfeeding on Early Childhood Obesity
Authors: Hansstein Francesca V.
Published: January 2017

Purpose:

To investigate how breastfeeding initiation and duration affect the likelihood of being overweight and obese in children aged 2 to 5.

Design:

Cross-sectional data from the 2003 National Survey of Children’s Health.

Setting:

Rural and urban areas of the United States.

Subjects:

Households where at least one member was between the ages of 2 and 5 (sample size 8207).

Measures:

Parent-reported body mass index, breastfeeding initiation and duration, covariates (gender, family income and education, ethnicity, child care attendance, maternal health and physical activity, residential area).

Analysis:

Partial proportional odds models.

Results:

In early childhood, breastfed children had 5.3% higher probability of being normal weight ( p = .002) and 8.9% ( p < .001) lower probability of being obese compared to children who had never been breastfed. Children who had been breastfed for less than 3 months had 3.1% lower probability of being normal weight ( p = .013) and 4.7% higher probability of being obese ( p = .013) with respect to children who had been breastfed for 3 months and above.

Conclusion:

Study findings suggest that length of breastfeeding, whether exclusive or not, may be associated with lower risk of obesity in early childhood. However, caution is needed in generalizing results because of the limitations of the analysis. Based on findings from this study and others, breastfeeding promotion policies can cite the potential protective effect that breastfeeding has on weight in early childhood.
Correlates of Reported Use and Perceived Helpfulness of Calorie Information in Restaurants Among U.S. Adults
Authors: Oh April , Nguyen Anh Bao , Patrick Heather
Published: January 2017

Purpose:

This study reports correlates in reported use and helpfulness of calorie information, when available, in restaurants on a national scale in the United States for demographic behavioral and health-related conditions.

Design:

This study is a secondary data analysis of the 2013 National Cancer Institute’s Health Information National Trends Survey data.

Setting:

United States.

Subjects:

Adults ( n = 3407).

Measures:

Menu labeling use and helpfulness; behavior change attempts; reported fruit, vegetable, and soda consumption; weight status; and chronic health conditions.

Analysis:

Trends were identified in weighted logistic and linear regression models.

Results:

U.S. adults who intended to lose weight (odds ratio [OR] = 5.01 [95% confidence interval 2.96, 8.46]), increase fruit (OR = 1.10 [.66, 1.84]) or vegetable consumption (OR = 2.25 [1.32, 3.83]), or reduce soda consumption (OR = 1.67 [1.11, 2.51]) were more likely to report using menu-labeling information when available. More women reported calorie information was helpful when ordering ( p < .05). Racial/ethnic and socioeconomic status disparities were identified in use (non-Hispanic [NH] blacks vs. NH whites OR = .43 [.25, .74]) and helpfulness (NH blacks vs. NH whites β = –.06 [–.44, .32]).

Conclusion:

Findings highlight potential subgroups to target for communication and education efforts regarding use of calorie information in restaurants. Following publication of final rules for federal menu-labeling legislation and implementation, further surveillance of public response to this information may inform message framing and educational interventions to promote use of calorie information on menu boards.
Effects of Exercise-Based Interventions on Neonatal Outcomes
Authors: Sanabria-Martínez Gema , García-Hermoso Antonio , Poyatos-León Raquel , González-García Alberto , Sánchez-López Mairena , Martínez-Vizcaíno Vicente
Published: January 2017

Objective:

The aim of this study was to conduct a systematic review and meta-analysis of randomized controlled clinical trials (RCTs) assessing the influence of physical exercise interventions during pregnancy on some neonatal outcomes.

Data Source:

Key words were used to conduct a computerized search in six databases: Cochrane Library Plus, Science Direct, EMBASE, PubMed, Web of Science, and ClinicalTrials.gov .

Study Inclusion and Exclusion Criteria:

RCTs that included an exercise program for healthy pregnant women who were sedentary or had low levels of physical activity were selected.

Data Extraction:

Two independent reviewers extracted data and assessed the quality of the studies included. Of 4296 articles retrieved, 14 RCTs (3044 pregnant women) met the inclusion criteria.

Data Synthesis:

Pooled effect sizes (ESs) were calculated using a fixed model.

Results:

Overall, physical exercise programs during pregnancy produced a small reduction in neonatal birth weight (ES = −.10; p = .04). The Apgar score at 1 minute was also weakly increased with combined exercise (aerobic, strength, and flexibility) (ES = .09; p = .048) and no differences between groups were observed in gestational age at delivery and Apgar score at 5 minutes.

Conclusion:

Structured physical exercise programs during pregnancy appear to be safe for the neonate, mainly favoring a lower birth weight within normal range. However, more studies are needed to establish recommendations.
Comparison of Self-report Measures for Identifying Late-life Generalized Anxiety in Primary Care
Authors: Webb Sarah A. , Diefenbach Gretchen , Wagener Paula , Novy Diane M. , Kunik Mark , Rhoades Howard M. , Stanley Melinda A.
Published: January 2017

This study evaluated the Penn State Worry Questionnaire, Penn State Worry Questionnaire—Abbreviated, and the Generalized Anxiety Disorder Questionnaire-IV for identifying generalized anxiety disorder in older medical patients. Participants were 191 of 281 patients screened for a clinical trial evaluating cognitive-behavior treatment, n = 110 with generalized anxiety disorder, 81 without. Participants completed the Penn State Worry Questionnaire and Generalized Anxiety Disorder Questionnaire-IV at pretreatment. Kappa coefficients estimated agreement with the Structured Clinical Interview for Diagnosis. Receiver operating characteristic curves compared sensitivity and specificity of self-report measures. The Penn State Worry Questionnaire (cutoff = 50) provided the strongest prediction of generalized anxiety disorder (sensitivity, 76%; specificity, 73%; 75% correctly classified; kappa = .49. Item 2 of the Generalized Anxiety Disorder Questionnaire-IV demonstrated comparable accuracy. The Penn State Worry Questionnaire, Generalized Anxiety Disorder Questionnaire-IV, and briefer versions of these measures may be useful in identifying late-life generalized anxiety disorder in medical settings.
The Emergence of Posttraumatic Distress in Later Life: A Review
Authors: Hiskey Syd , Luckie Michael , Davies Stephen , Brewin Chris R.
Published: January 2017

We review the literature for evidence of posttraumatic stress disorder that emerges in older adulthood yet is related to earlier life events. Minimum standards necessary to establish the phenomenon are proposed and applied to existing group and case studies. Our findings suggest that the best evidence for this rests with a handful of group studies featuring male war veterans (n = 4) and a variety of case studies (n = 12) that have appeared over the last two decades. We summarize what is known regarding prevalence, symptoms, course, and triggers, and conclude that the phenomenon does exist but has rarely been investigated systematically. There are therefore no grounds at present for thinking of reemergent posttraumatic stress disorder as a unique subtype of the disorder among elderly people. We suggest that future research focuses in more detail on participants' history of posttraumatic difficulties and considers the phenomenon across groups other than male veterans.
Going to School
Authors: Fieldhouse Jenni
Published: January 2017

Gentle transition rather than sudden change should be the aim of first schools
Facing Transitions: The Primary School Experience
Authors: Molony Simon
Published: January 2017

Whole-school policies and a structured transition at 11 will support children's innate adaptability
Clinical Pharmacy Care in Continuous Ambulatory Peritoneal Dialysis Patients
Authors: Bailie George R.
Published: January 2017

Continuous ambulatory peritoneal dialysis (CAPD) continues to grow as a treatment modality for end-stage renal disease (ESRD). The high cost of care, multiplicity of drugs used by each patient, high cost of individual drugs, and high incidence of complications, make this patient population a challenging area for clinical pharmacy input. This article discusses the mechanics of CAPD, together with patient selection criteria, monitoring of the dialysis prescription, and infectious complications. The potential for research involving clinical pharmacists is discussed. Apart from studies on the pharmacokinetic disposition of drugs administered to CAPD patients, there remains a relative lack of information on many aspects of drug therapy. Recommendations for areas of continued study include the optimization of antibiotic therapy for peritonitis and exit-site infections, use of the intraperitoneal route for systemic effects of drugs, quality-of-life investigations, and stability studies of drugs in dialysate.
Clinical Pharmacy Nephrology Consultation and Documentation: A Comprehensive Approach
Authors: St. Peter Wendy L.
Published: January 2017

End-stage renal disease patients represent a complex medical population with multiple comorbid conditions and, therefore, complex medication regimens that may lead to noncompliance, and drug-drug and drug-food interactions. Acutely ill dialysis patients' cases are even more complicated and are prone to iatrogenically induced problems. For these reasons, this patient population should be targeted to receive clinical pharmacy services. This article outlines the evolution of clinical pharmacy nephrology consultative services at a large county teaching hospital over the past decade. Consultative activities for ambulatory and hospitalized patients include therapeutic drug monitoring, medication reviews, dosage modifications, patient counseling, and suggestions for alternative therapeutic selections. Documentation of clinical services is essential to track both written and non-written recommendations and to quantitate clinical activity levels. Documentation procedures are described, and examples of the documentation form and coding list are supplied. Reimbursement procedures for clinical nephrology consultative services which may be applicable in other outpatient clinical settings are discussed.
A Clinical Syndrome-Based Antibiotic Drug Use Evaluation: Impact on Antibiotic Use in a Large Teaching Hospital
Authors: Krueger Kristine A. , Postelnick Michael
Published: January 2017

The traditional drug use evaluation (DUE) process fails to integrate well with the way patients are treated by physicians. In order to address the shortcomings of the traditional DUE process, a clinical syndrome-based antibiotic drug use evaluation was developed. The steps involved in the development and implementation of this process are described, with an emphasis on physician involvement in each step of the development process. Feedback loops to Medical Staff Quality Management Committees are an integral part of this program. Results of this program have been encouraging, with final physician compliance with the established guidelines occurring for 91% to 96% of the antibiotic orders written. This program has also resulted in a 10% decline in per day antibiotic expenditures, and has been instrumental in enabling the institution to tightly restrict antibiotic usage in response to outbreaks of multidrug-resistant organisms.
Drug Usage Evaluation
Authors: Sass Cathleen M.
Published: January 2017

Drug usage evaluation (DUE) is a component of the Joint Commission on Accreditation of Healthcare Organizations guidelines for hospitals. If DUE is viewed with a positive focus rather than as simply a mandatory function, it can readily be exploited to benefit the institution. Study selection should be of practical use to the institution and study design should be as uncomplicated as possible. DUE may then be used to identify adverse drug reactions (ADRs), increase pharmacy staff, contain costs, and implement pharmaceutical care.
Determining the Training Needs of Planners
Authors: Mullen Penelope M.
Published: January 2017

Since the NHS Planning System was formally introduced in 1976 both it and the NHS itself have undergone a succession of changes and reorganisations. To facilitate the introduction of the Planning System an integrated programme in training for planning was established by the DHSS. Over the years since then, training in planning has developed in a less integrated manner and by the late 1980s it was felt that the situation should be reviewed to meet the challenges of the forthcoming round of strategic planning. Accordingly, the Health Services Management Centre was commissioned to carry out a study into the training needs of planners. Because of the restricted timescale a workshop approach was adopted and leading planners and managers from all tiers and all professions from different parts of England and Wales were invited to participate. The project had two main foci which are discussed here. Firstly, current and future changes in the NHS and its environment which might or will impact on health care planning and, secondly, the identification of the groups which require training in planning, the skills and competencies they require and possible methods of acquisition.
Resource Management or Managing Resources?
Authors: Bagust A.
Published: January 2017

Claims made by Stilwell and Hamlyn to have recorded reductions of 25% in average cost per patient in an out-patient clinic where detailed patient costing data was collected and employed are examined critically. Their failure to allow for case-mix differences is shown to nullify the apparent gain in resource efficiency. This raises issues concerning the value of providing managers with detailed patient costings, and throws doubt on the wisdom of current initiatives in Clinical Budgeting and Resource Management.
Accounting Based Risk Measures for Not-for-Profit Hospitals
Authors: Smith Dean G. , Wheeler John R. C.
Published: January 2017

This paper discusses the issues involved with determining an appropriate discount rate for not-for-profit hospitals and develops a method for computing measures of systematic risk based on a hospital's own accounting data. Data on four hospital management companies are used to demonstrate the method. Results indicate the need for sensitivity analysis in the selection of estimation methods and in the final determination of a discount rate.
The Effects of For-Profit Multihospital System Ownership on Hospital Financial and Operating Performance
Authors: Lynch Janet R. , McCue Michael J.
Published: January 2017

The financial and operating performance of independent not-for-profit hospitals acquired by US for-profit multi-hospital systems in 10 Southern states between the years 1978 and 1982 was explored. The impact of system ownership on acquired hospitals was investigated by comparing the average financial performance of hospitals in the two years immediately prior to acquisition to the average for 1984 and 1985 and by comparing changes in the performance of acquired hospitals with changes in matched independent facilities.

Findings suggest that for-profit multi-hospital systems were able to improve many of the financial and operating problems of acquired facilities. In comparison to independent not-for-profit hospitals, acquired hospitals were found to increase access to long-term debt, make improvements to plant and equipment, improve profitability, and increase efficiency to a greater extent. Prices in acquired hospitals rose more than those in independents and liquidity decreased to a greater extent.
Health Care Markets as Interorganizational Fields: A Conceptual Perspective
Authors: Gamm Larry D.
Published: January 2017

This paper examines the interorganizational (IO) field approach to the study of local health care markets. Art IO field conceptualization focuses attention on organizational behavior and interorganizational relations among providers and purchasers and other health care organizations relevant to the field. This perspective is suitable for guiding evaluations of the multiple effects of pro-competition or regulative interventions on health care markets.
Contact Tracing in the Control of Genital Chlamydia Trachomatis Infection
Authors: Ramstedt Kristina , Forssman Lars , Johannisson Gunnar
Published: January 2017

Four different types of contact tracing for partners of Chlamydia trachomatis infected patients were compared with respect to reinfections during two 15-month periods in 1979/80 and in 1983/84. Between the two study periods a gradual improvement in contact tracing occurred. No reduction in overall reinfections was observed in the second period, reinfections occurring within 12 weeks were similar in the two periods. Treatment of the regular partner (by giving the woman a prescription for her partner) without examination or further partner follow-up resulted in few reinfections. A system of partner referral without verification that partners actually appeared for examination resulted in significantly more reinfections by the regular partner than a system with non-mandatory verification: 60 of 997 women (6%) compared with 6 of 645 (1%). The addition of C. trachomatis infection to the existing STD legislation resulted in fewer identified partners refusing examination than previously, one of 254 men (0.4%) compared with 40 of 223 (18%) before legal inclusion.
Contrasting Psychosexual Problems of Patients Attending a Genitourinary Medicine Clinic and a Community-Based Clinic
Authors: Jones A J , Thin R N
Published: January 2017

The presenting complaint in 100 consecutive patients attending the psychosexual session (PSS) attached to the Department of Genitourinary Medicine (GUM) in St Thomas's Hospital was compared with 100 consecutive patients seen at a community PSS attached to a family planning clinic in an outer London district. Patients attending the GUM PSS had a greater fear of infection and more relationship problems, but less erectile failure and loss of libido; there was also a higher proportion of men referred and more patients with no regular partner than in the community PSS. It is concluded that many patients with psychosexual problems sought help from the GUM clinic.
Markers of Past Syphilis in HIV Infection Comparing Captia Syphilis G Anti-Treponemal IgG Enzyme Immunoassay with other Treponemal Antigen Tests
Authors: Young H , Moyes A , Ross J D
Published: January 2017

The sensitivity of the Captia Syphilis G anti-treponemal IgG enzyme immunoassay (EIA-IgG) was compared with the Treponema pallidum haemagglutination assay (TPHA) and the Fluorescent Treponemal Antibody Absorbed (FTA-Abs) test as a marker for past syphilis in 28 HIV-infected and 31 HIV-negative patients with a past history of syphilis. The specificity of EIA-IgG was compared in 89 patients without a history of syphilis who were known to be HIV antibody positive with a control group of 89 patients who had tested HIV negative. In patients with a past history of syphilis each treponemal test (EIA-IgG, TPHA and FTA-Abs) gave a lower sensitivity (82%, 86%, 79%) in the HIV-positive group than in the HIV-negative group (97%) but the difference was significant only in the case of the FTA-Abs test ( P < 0.05). In the HIV-positive patients 11% (3/28) were negative in all 3 treponemal tests while 25% (7/28) were negative in at least one treponemal test. In patients without a past history of syphilis the EIA-IgG antibody index in the HIV-positive group (0.436) was significantly higher than in the MV-negative group (0.378): the specificity, however, was similar in the HW-positive (100%) and HW-negative groups (99%). We conclude that the Captia Syphilis G anti-treponemal IgG enzyme immunoassay is of similar specificity in HIV-positive and HIV-negative patients and is of similar sensitivity to the TPHA and FTA-Abs as a marker of past syphilis in HIV-infected patients. Because HIV-infected patients may lose markers to one or more treponemal antibody tests the exclusion of past treponemal infection is more reliable if sera from such patients are tested using several different tests.
Impact of Counselling on Safer Sex and STD Occurrence among STD Patients in Malawi
Authors: Wynendaele B , Bomba W , M'Manga W , Bhart S , Fransen L
Published: January 2017

In developing countries where professional manpower and basic supplies are lacking for STD control, low-cost prevention strategies must be explored. This study assesses the impact of counselling on STD treatment and prevention in Malawi. Increases in safer sex practices are used as indicators of prevention behaviour.

A pre-test post-test control group design over a 4-month interval was conducted in 1991 in 2 comparable hospitals approximately 100 km apart. STD was diagnosed symptomatically and Knowledge Attitude Practice and Behaviour (KAPB) data collected using a structured questionnaire.

In one group, trained counsellors discussed modes of transmisison and prevention of STD/AIDS including a condom demonstration; symptoms and treatment of STDs; partner notification; risk taking and reasons for doing so; and motivations for behaviour change.

The results show that counselling reduces the occurrence of STDs; increases concern for sexual partners; increases knowledge about and use of condoms; reduces mean number of partners; and reduces health costs due to fewer hospital visits.

Although the observed behaviour change was short term, these outcomes argue in favour of counselling as a low-cost effective strategy for STD control.
Response to Podophyllotoxin Treatment of Genital Warts in Relation to HIV-1 Infection among Patients in Dar Es Salaam, Tanzania
Authors: Kilewo C D S , Urassa W K , Pallangyo K , Mhalu F , Biberfeld G , Wigzell H
Published: January 2017

Forty-two Tanzanian patients with genital warts were treated with 0.5% podophyllotoxin solution (Wartec) for 3 days. Thirteen patients (30.9%) were cured and a further 7 patients (16.7%) had more than 50% of lesions cleared at 6 weeks, while 19 patients were resistant to treatment. Three patients had a recurrence of lesions after an initial response. Thirty-three patients were tested for serological evidence of infection with human immunodeficiency virus (HIV) and 15 (45.5%) patients were shown to be HIV-1 antibody positive. The response to treatment was analysed in relation to HIV antibody status. The cure rate was significantly higher in HIV seronegative patients (8/18=44.4%) compared to HIV seropositive patients (1/15=6.7%) (P=0.018). We conclude that podophyllotoxin treatment provides a useful non-hospital based treatment for genital warts, but HIV infection appears to contribute to the failure of treatment for genital warts.
HIV-1 Variants in South and South-East Asia
Authors: Tsuchie H , Saraswathy T S , Sinniah M , Vijayamalar B , Maniar J K , Monzon O T , Santana R T , Paladin F J E , Wasi C , Thongcharoen P , Hossain M M , Yamada O , Kageyama S , Kitamura T , Kurimura T
Published: January 2017

HIV spread in South and South-East Asia is most alarming, and genetic variability of HIV-1 is an important consideration in vaccine development. In this study, we examined the third variable (V3) region of env gene of HIV-1 variants prevalent in Thailand, Malaysia, India, and the Philippines. By phylogenetic tree analyses, an HIV-1 variant from an injecting drug user (IDU) in Thailand belonged to subtype B, and HIV-1 variants from 2 IDUs in Malaysia were classified into 2 subtypes, B and E. One HIV-1 variant from a male homosexual in the Philippines belonged to subtype B. Out of 8 HIV-1 variants from sexually transmitted disease patients in India, 7 belonged to subtype C, and one to subtype A. Although the total number of individuals examined in this study was limited, 4 HIV-1 subtypes were found in South and South-East Asia and large international movements of HIV-1-infected individuals in this region could induce global dissemination of these HIV-1 variants.
“It is Wisest here, as Always, to Maintain a Balance”: The Medical Dissertations of Friedrich Schiller
Authors: Albury W R , Weisz G M
Published: January 2017

Johann Christoph Friedrich Schiller (1759–1805) is remembered today for his contributions to literature and aesthetic theory — it is less well known that his first career was in medicine (an army appointment). Scholars have generally held that his primary interest lay in psychology and the psychological aspects of medicine, and that his commitment to other aspects of medicine was perfunctory at best. The present paper argues that a study of Schiller's three medical dissertations — two on psychological aspects of medicine and one on fevers — reveals his attempt “to maintain a balance” between the mind and the body in his approach to medicine.
Lack of Association between Breast Artery Calcification Seen on Mammography and Coronary Artery Disease on Angiography
Authors: Henkin Y , Abu-Ful A , Shai I , Crystal P
Published: January 2017

Objectives:

Some studies have found correlations between the presence of breast artery calcium (BAC) observed on routine mammograms and risk factors for coronary artery disease (CAD). The aim of this study was to investigate whether such calcifications could predict the presence of coronary atherosclerosis.

Methods:

A total of 319 female patients between 50 and 70 years of age, 187 with significant CAD and 132 with angiographically normal coronary arteries, were randomly selected from a computerised database of our central catheterisation laboratory. The patients' mammograms were evaluated independently for the presence of BAC in a blinded fashion by an experienced breast radiologist, and additional clinical data were extracted from clinical charts.

Results:

The women in the CAD group were older (62.5 vs 60.7 years, p=0.05) and had a higher prevalence of hypertension, diabetes mellitus and dyslipidaemia. Although the prevalence of BAC was marginally higher in the CAD group (43.9% vs 37.1 %, p=0.138), this tendency was eliminated after controlling for confounders. Multiple regression analyses indicated that only age above 63 years (odds ratio [OR]=3.0, 95% confidence interval [CI]= 1.8–4.9) and hypertension (OR=2.2, 95% CI= 1.2–4.1), but not angiographic evidence of CAD (OR=1.0,95% CI=0.6–1.6), predict with BAC on mammography.

Conclusions:

Despite correlation with some risk factors For CAD, the presence of BAC does not differentiate between patients with angiographic evidence of CAD and those with angiographically normal coronary arteries.
Colposcopy Information Leaflets: What Women Want to Know and When They Want to Receive This Information
Authors: Byrom J , Dunn P D J , Hughes G M , Lockett J , Johnson A , Neale J , Redman C W E
Published: January 2017

Objectives:

To evoluate whether the information leoflets produced by UK colposcopy clinics provide women with the information they desire and to determine when they would like to receive this information.

Design:

Questionnaire study and structured evaluation.

Setting:

The colposcopy clinic of a UK cancer centre.

Participants:

Forty-two women attending a pre-colposcopy counselling session and 100 consecutive women attending the colposcopy clinic.

Methods:

Thirty-eight standards derived from the concerns/questions asked by women attending a pre-colposcopy counselling session were used to assess locally produced colposcopy clinic leaflets from UK colposcopy clinics, the leaflets produced by the Royal College of Obstetricians and Gynaecologists and the National Health Service Cervical Screening Programme (NHSCSP), and two “leaflets” obtained from internet sites. The Gunning fog test was used to assess the leaflets' readability. A questionnaire survey of 100 women attending the colposcopy clinic was used to determine when women wanted to receive information about colposcopy. Main outcome measures: Percentage of questions answered by a given leaflet and Gunning fog scores for readability.

Results:

The information leaflets of 128 colposcopy clinics were received and assessed. Thirty-two clinics only sent women the NHSCSP leaflet. No leaflet answered all 38 questions. Less than half (36/100) of the leaflets answered more than 50% of the questions. In addition to the lack of advice given, different leaflets frequently gave conflicting advice. The average Gunning fog score was 9.7 (range 5.5–15.5). The majority of women (70%) wanted to receive information about colposcopy at or prior to the time of receiving their abnormal smear test result, although only 42% of women actually received information at this time.

Conclusions:

Many UK colposcopy clinics do not appear to be providing women with the information they require to understand their condition and the procedure that they are about to undergo. Furthermore, this information is often not provided at the appropriate time in the screening process.
Usefulness of Routine Urine Analysis in Medical Outpatients
Authors: Rüttimann Sigmund , Clémençon Désirée
Published: January 2017

Objective—

To investigate prospectively the value of routine urine analysis in a university based, medical outpatient clinic providing primary (> 90%) and referral care (< 10%) in general internal medicine, as determined by whether it led to a new diagnosis requiring a change in medical management (new treatment; advice to patient; further follow up appointment).

Methods—

A dipstick urine analysis was performed in 610 consecutive patients (mean (SD) age 41 (16) years) making their first clinic visit. A urinary sediment of the same specimen was examined in those patients with abnormal results for haemoglobin, leucocytes, or protein. A urine analysis was defined as routine when it was not considered indicated for diagnostic or management purposes by the resident in charge at the patients' initial clinic visit. The main outcome measures were the number and nature of new diagnoses leading to a change in patient management.

Results—

In 183 patients (30%, 95% confidence interval (CI) 27% to 34%) the urine analysis was performed as an indicated test and in 427 (70%; 95% CI 64% to 73%) as a routine test. Urine analysis was abnormal in 71 of the 427 patients (17%) in whom it had been performed as a routine test. Abnormal findings led to a change in management in three patients only (0·7%; 95% CI 0·2% to 2·2%). Critical assessment makes the value of routine urine analysis debatable even in these three patients.

Conclusions—

In a middle aged medical outpatient group of a university based, teaching clinic providing predominantly primary care, urine analysis can be restricted to patients in whom it is clinically indicated.