bluuebunny/crossref_metadata_2025 huggingface dataset:
Diagnostic Accuracy of the Clock Drawing Test: The Relevance of ``Time Setting'' in Screening for Dementia
Authors: Berger Gabriele , Frölich Lutz , Weber Bernhard , Pantel Johannes
Published: January 2017

Objective: We aimed to evaluate the overall diagnostic accuracy of clock drawing test methods which require a defined time setting. In addition, diagnostic relevance of time setting was analyzed qualitatively. Methods: Clock drawing test performance of 462 consecutive memory clinic patients were analysed by 5 different clock drawing test methods. The sensitivity, specificity, positive and negative predictive value as well as the overall misclassification rate was calculated against a clinical diagnosis of dementia. Further, qualitative analysis of error types was done when subjects failed in the time setting task. Results: All clock drawing test methods that require time setting revealed higher sensitivities and superior negative predictive values as well as overall misclassification rates compared to methods which do not. Failure in the time setting task did not exclusively occur in dementia patients. However, error types which reflect a severely reduced capacity in abstract and conceptual thinking occurred exclusively in dementia patients. Discussion: Clock drawing test methods that require time setting should be favoured above methods which do not. An additional analysis of time setting errors may yield valuable diagnostic information.
The Importance of Alzheimer Disease Assessment Scale-cognitive Part in Predicting Progress for Amnestic Mild Cognitive Impairment to Alzheimer Disease
Authors: Rozzini Luca , Vicini Chilovi Barbara , Bertoletti Erik , Conti Marta , Delrio Ilenia , Trabucchi Marco , Padovani Alessandro
Published: January 2017

The aim of this study was to verify the usefulness of Alzheimer Disease Assessment Scale-cognitive subscale (ADAS-Cog), in screening participants at risk of developing Alzheimer disease (AD) among populations with amnestic mild cognitive impairment(aMCI). 98 outpatients with aMCI were recruited. Participants were revaluated after 1 year: 44 (44.9%) were progressed to AD (progressors), while 54 (55.1%) did not convert (nonprogressors MCI). At baseline, cognitive performances were more impaired in progressors assessed by MMSE and by a neuropsychological battery. When tested with the ADAS-Cog subscale, the 2 groups of participants at baseline, progressors, and nonprogressors MCI, were significantly different regarding total score, memory, and nonmemory subitems. Considering a cutoff of 9.5 total score, adjusted for education, ADAS-Cog subscale showed a good performance (area under the curve = 0.67; sensitivity = 0.62%; specificity = 0.73%) in predicting conversion from aMCI to AD. Progressors aMCI were characterized at baseline by a greater cognitive impairment. ADAS-Cog subscale is a useful and brief cognitive assessment tool to screen aMCI participants converting to AD within 1 year.
Considerations in Deciding Which Drugs Should Be in a Formulary
Authors: Kelly William N. , Rucker T. Donald
Published: January 2017

The formulary is a compendium of pharmaceuticals, along with important drug information, that reflects the current clinical judgment of the medical and pharmacy staffs of an organization. Sound formularies have been shown to have a positive effect on prescribing. Poor formularies, those with too many marginal, obsolete, or redundant drugs, may contribute to less than ideal therapy in some patients, and probably at more expense. At the core of a sound formulary is having sound criteria and procedures for adding drugs. Such criteria should be general and specific. Should there be separate criteria for adding new drugs? For antibiotics? For biotechnology drugs? Criteria for maintaining and deleting drugs should also be in place. This keeps the formulary up-to-date and viable. Even with sound criteria, the process of adding, maintaining, and deleting drugs can be flawed by pressures, outside and inside organizations. However, such barriers can be overcome. The process of evaluating drugs for formulary status has been changing. New techniques are being developed to make the process more objective, more scientific, and more patient-outcome-driven.
Changing Domains in the Management Process: Imaging Services Managers in the Post-1990 National Health Service
Authors: Forbes T. , Prime N.
Published: January 2017

Much of the current literature on healthcare professionals developing management roles has focused almost exclusively upon hopsital doctors. This paper seeks to redress this imbalance and explores the emergence of the professions allied to medicine (PAMs) as clinical managers. A comparative study of 25 English and Scottish radiographer managers were interviewed. From the interviews, a number of themes were developed associated with moving from a clinical professional to a clinical manager and were analysed using domain theory. These themes included management, professionalism, management style, conflicts between the role of both manager and professional, and role change. Radiographer managers are forming new ‘hybrid’ managerial roles, which have been developing within a changing NHS. A definite tension was seen in this role change, and the transition has not been easy for this group of PAMs. However, they have shown resilience in undertaking both operational and strategic management decisions, while using their clinical background in their decision-making and have much to offer the management process.
Community Care — The Costs and Quality
Authors: Davies Linda M.
Published: January 2017

There has been much debate in recent years about the implementation of community care policies for people with learning difficulties. The debate has centred on the following points: what the real costs and benefits of community care are, and to whom; what a community care service should look like; who should provide the service and how should it best be funded. This paper presents the results of a study comparing the costs and outcomes to clients of a variety of residential services for people with learning difficulties. The services evaluated range from traditional hospital services to small community based homes, run on ‘ordinary life’ principles. The purpose of the study was to collect information to aid policy makers and service providers in deciding how best to implement the community care initiative.
Using Ratios to Measure Hospital Financial Performance: Can the Process be Simplified?
Authors: Counte Michael A. , Glandon Gerald L. , Holloman Karen , Kowalczyk James
Published: January 2017

Evaluation of a hospital's financial condition is often contingent upon the analysis of financial ratios. This study of 114 Illinois hospitals sought to simplify the financial assessment process by exploring the empirical dimensions that underlie 25 financial ratios. Results of a factor analytic solution suggest that there are five underlying factors which account for approximately 77% of the total variance. Uses of summative scaled measures in health services financial management and research are discussed.
Determining the Skills Training Needs of NHS Graduate General Management Trainees
Authors: Szczepura Ala K.
Published: January 2017

In 1986 a new graduate training program (GMTSI) was set up in the NHS for general management trainees. The completion of the two year program by the first intake of graduates in the summer of 1988 indicated that more thought needed to be given to identifying the skills and competence training needs in a program of this type. Accordingly, the NHS Training Authority commissioned Warwick Health Services Research Unit to carry out a study into the skills training needs of graduates entering the general management program. The methods adopted involved firstly group and individual semi-structured interviews with participants and managers to identify a wide range of possible skills and competences, and secondly a postal survey of all 230 trainees and mentors who had experience of the training program to help prioritize these skills. In this manner an extensive amount of information was collected on the preferred principal method of delivery for training in each of the 60 plus skills identified (district placement or management education centre), the optimal timing within the 22 month program for training in each of the skills identified and the relative importance of training for each skill. The present paper presents a selection of the study findings. Furthermore, it outlines the manner in which the project findings are being implemented in one education centre based regional consortium to provide graduate trainees with skills training geared to their immediate and short-term training needs.
The Evaluation of NIMROD, a Community-Based Service for People with Mental Handicap: Revenue Costs
Authors: Davies Linda , Felce David , Lowe Kathy , de Paiva Siobhan
Published: January 2017

The cost implications of moving from a system of services for people with mental handicaps centred on large institutions to a network of community-based services are not precisely known. The provision of the NIMROD service in a part of Cardiff, with its aim not only to meet the residential needs of adults comprehensively by providing a number of houses in the community but also to develop a support service to people living in their family home, gave an opportunity to investigate and report the revenue costs of a number of service elements with respect to a defined total population. The residential costs of intensively staffed houses in 1986–87, varying in size from two to six places, were found to range between £16,473 and £23,319 per person per year. With the addition of community support costs, such as the provision of day services, the total costs of care per resident averaged £21,708; range, £18,883-£26,009. These compared to the total costs in a minimally staffed house of £9,678 per resident. The costs of community support services for people living in their family homes averaged £5,614 inclusive of DSS benefits, of which £1,743 was accounted for by the NIMROD domiciliary support service, office base and administrative overheads. The residential costs reported were compared to other cost data in the literature. The study supports previous conclusions that there is little evidence of diseconomy attached to small scale per se but that the way staffing levels and therefore staff costs are determined is critical. No evidence was found in this study to link greater cost to better quality.
Process and Structure: Resource Management and the Development of Sub-Unit Organisational Structure
Authors: Packwood Tim , Keen Justin , Buxton Martin
Published: January 2017

Resource Management (RM) requires hospital units to manage their work in new ways, and the new management processes affect, and are affected by, organisation structure. This paper is concerned with these effects, reporting on the basis of a three-year evaluation of the national RM experiment that was commissioned by the DH. After briefly indicating some of the major characteristics of the RM process, the two main types of unit structures existing in the pilot sites at the beginning of the experiment, unit disciplinary structure and clinical directorates, are analysed. At the end of the experiment, while clinical directorates had become more popular, another variant, clinical grouping, had replaced the unit disciplinary structure. Both types of structure represent a movement towards sub-unit organisation, bringing the work and interests of the service providers and unit managers closer together. Their properties are likewise analysed and their implications, particularly in terms of training and organisational development (OD), ate then considered. The paper concludes by considering the causes for these structural changes, which, in the immediate time-scale, appear to owe as much to the NHS Review as to RM.
Analysing the Workload from HIV Inpatients: A 10-Month Retrospective Study
Authors: Lau R K W , Pinching A J
Published: January 2017

To assess the clinical and laboratory workload arising from human immunodeficiency virus (HIV)-related inpatient admissions in a London teaching hospital, a 10-month retrospective audit was performed of the casenotes of all HIV-infected inpatients admitted under the care of one consultant physician. During this period, 84 inpatients were identified who generated 371 admissions, of whom 71 (84.5%) had acquired immunodeficiency syndrome (AIDS). Over two-thirds of admissions were essentially day cases, attributed to blood transfusions, antimicrobial and tumour chemotherapy, and minor surgery; with blood transfusions alone accounting for 43% of all admissions. Pulmonary infections (pyogenic and cell-mediated opportunist) accounted for 46 (12%) of admissions, with Pneumocystis carinii pneumonia second only to blood transfusions in caseload prevalence score (see below). Neurological complications of AIDS were associated with the longest admissions. Laboratory-based investigations were heavily utilized by AIDS inpatients, particularly bacteriological services. Choice of radiological investigation correlated with the anatomical site of disease presentation: plain radiology for chest symptoms, ultrasound for abdominal symptoms and computerized tomography (CT scanning) for neurological presentations. Drug-induced anaemia accounted for a substantial number of HIV-related admissions for red cell transfusions, which together with the disproportionate workload from daycase-type admissions, might be better handled in lower dependency day wards.
Anaerobic Vaginosis: Study of Male Sexual Partners
Authors: Arumainayagam J T , de Silva Y , Shahmanesh M
Published: January 2017

One hundred male sexual partners of women with anaerobic vaginosis (AV) were screened for the presence of sexually transmitted diseases (STD). Thirty male partners had evidence of non-gonococcal urethritis (NGU), compared to 5 in the control group ( P<0.05). Chlamydia trachomatis was isolated from 14 male partners, compared to 3 in the control group. Forty-five male partners required treatment for STDs, compared to 11 in the control group ( P<0.02). Nine (40%) male partners with chlamydia-negative NGU were successfully treated with metronidazole alone while 10 required Deteclo in addition. There was no significant association between Bacteroides ureolyticus and chlamydia-negative NGU. Screening of male partners resulted in the treatment of STDs in 62 additional patients who would have otherwise not received treatment. The results suggest that examination of male partners of women with AV results in an increased yield of STD diagnoses.
Erythropoietin and Granulocyte-Macrophage Colony-Stimulating Factor (GM-CSF) Levels in Sera of Patients with HIV Infection
Authors: Reddy M M , Grieco M H
Published: January 2017

Levels of erythropoietin and granulocyte-macrophage colony-stimulating factor (GM-CSF) were measured in sera of 28 HIV-seronegative heterosexual non-intravenous drug using controls, 57 HIV-seronegative and 42 HIV-seropositive asymptomatic intravenous drug users (IVDU) and 36 HIV-seronegative and 36 HIV-seropositive homosexuals, 79 patients with lymphadenopathy, 11 patients with AIDS-related complex (ARC) and 110 patients with AIDS. Serum erythropoietin levels were significantly elevated in HIV-seronegative and HIV-seropositive asymptomatic homosexuals and in patients with lymphadenopathy, ARC and AIDS when compared to controls. However, in asymptomatic HIV-seronegative and HIV-seropositive IVDU the erythropoietin levels were not significantly different from the control group.

GM-CSF mean levels in both HIV-seronegative and HIV-seropositive IVDU were elevated compared with the level in controls, whereas the mean levels in both the HIV-seronegative and HIV-seropositive homosexuals were decreased relative to the level in controls. GM-CSF levels in patients with lymphadenopathy, ARC and AIDS were not significantly different from the control value.

It appears that male homosexuals have mildly increased erythropoietin levels which rise substantially with the development of ARC and AIDS, which suggests that AIDS patients have intact capacity to produce erythropoietin. In contrast, GM-CSF levels are increased in association with IVDU but are not increased in association with HIV infection including ARC or AIDS. The difference in circulating levels of erythropoietin and GM-CSF may reflect the tissue sources of erythropoietin predominantly in the kidney and GM-CSF being a product of the immunological and inflammatory systems.
The Absence of Genital Human Papillomavirus DNA in Virginal Women
Authors: Fairley Christopher K , Chen Shujun , Tabrizi Sepehr N , Leeton Kay , Quinn Michael A , Garland Suzanne M
Published: January 2017

Our aim was to determine the prevalence of human papillomavirus (HPV) infection in virginal women and to establish if other forms of sexual activity not involving penetration may contribute to the transmission of this infection.

Female patients attending medical practitioners, and female high school students were recruited. Each participant answered an anonymous self answer questionnaire and collected a tampon specimen. Tampons were analysed for the presence of human papillomavirus by the polymerase chain reaction (L1 general primer and probe).

Fifty-five female participants who were of a mean age of 18 years (range 13–41) were recruited. Twenty-three reported non-penetrative sexual activity. None of the 55 women had evidence of HPV infection (0%, upper 95% confidence interval 5.4%). Twelve tampons from sexually active women with normal Papanicolaou smears and a mean age of 26 years (range 19–44) attending a hospital clinic were analysed at the same time and four were found to be positive (P=0.0006).

We conclude that HPV infection prior to sexual intercourse, as determined by tampons specimens, is rare, even in those participating in other forms of sexual activity.
Urethritis Due to Neisseria Meningitidis in a London Genitourinary Medicine Clinic Population
Authors: Maini M , French P , Prince M , Bingham J S
Published: January 2017

A retrospective study was performed in a department of genitourinary medicine to determine the prevalence and clinical features of urethral and cervical infection with Neisseria meningitidis among patients being screened for sexually transmitted diseases. During the 28 month period of the study 11 isolates (from 10 patients) of N. meningitidis were identified from 5571 urethral cultures from homosexual men (0.2%). This compares with an isolation rate of 4.7% for N. gonorrhoeae; 1.2% samples screened for chlamydial antigen were positive. There were no isolates from 8992 urethral cultures from heterosexual men or 15,976 cervical cultures. Eight of the cases identified had features of urethritis at diagnosis; 6 were diagnosed initially as non-specific urethritis (NSU) and 2 as gonorrhoea on the basis of microscopy of a urethral smear. Eight of the 10 patients were treated with amoxycillin and/or a tetracycline, and all but one had a clinical and microbiological cure. In the study population the prevalence of N. meningitidis infection was low and restricted to homosexual men; however, it may be associated with symptoms.
Prevalence of Urogenital Chlamydia Trachomatis Infection in El Salvador. II. Gynaecology Outpatients
Authors: Posada Ana Berta Cañas , Jonasson Jon , de Linares Leonor , Bygdeman Solgun
Published: January 2017

The prevalence of urogenital infection caused by Chlamydia trachomatis was examined in 100 non-pregnant women with cervicitis, and 100 healthy women, in San Salvador City, El Salvador. Pharmacia Chlamydia EIA test was used for the detection of chlamydial antigen in urethral and cervical specimens from all the women. Direct immunofluorescence was used for confirmative tests on the EIA positive and the negative gray zone samples. C. trachomatis antigen was detected in 28% of the women with cervicitis compared with 5% in the group of healthy women ( P < 0.001). The cervicitis group were also screened for Neisseria gonorrhoeae which was isolated from 12% of them. One strain out of 12 was beta-lactamase producing (PPNG). Five per cent of the women with cervicitis had simultaneous C. trachomatis and N. gonorrhoeae infections.
Treatment of Anogenital Warts in Genitourinary Clinics in England and Wales
Authors: Wardropper Alison , Woolley Paul
Published: January 2017

A questionnaire on the treatment of anogenital warts was sent to 150 consultants in genitourinary medicine, 78 (52%) were returned completed. A wide range of treatments were used; podophyllin was the commonest first line treatment of multiple penile (60.3%), perianal (57.7%) and vulval (61.5%) warts. Cryotherapy was a popular choice for intrameatal warts (65.3%), small numbers of vulval warts (33.3%) and as second line therapy for penile (35.9%) and perianal (33.3%) warts. Vaginal warts were treated with podophyllin (39.7%) or cryotherapy (29.5%). Various combinations of podophyllin, trichloroacetic acid and cryotherapy were used (2.6%–24.3%) although there is no evidence this offers benefit over single therapy. Podophyllin is frequently used despite side effects, a poor clearance rate and in vaginal warts, difficult access. Initial therapy with more time-consuming procedures such as cryotherapy or electrocautery may be of benefit to selected patients.
Epidemiological Characteristics of Human Immunodeficiency Virus Type-2 Infection in Africa
Authors: Miyazaki Motonobu
Published: January 2017

There are things yet to be clarified about African HIV-2 infection, compared to HIV-1 infection. However, the epidemiological characteristics have gradually been elucidated through various studies. HIV-2 infection is believed to have existed in the 1960s in Africa and is presently epidemic in West Africa. The HIV-2 seropositive rate for the general population is higher in urban regions than in rural areas. The peak age of persons infected with the HIV-2 tends to be higher than that of persons infected with the HIV-1, but no sex difference was recognized between the HIV-2 and HIV-1 seropositive rates. Sexual contact, mother-to-child transmission and blood transfusion have been confirmed as HIV-2 transmission modes. Prostitutes and patients with other STD are recognized as being high-risk groups for the HIV-2 infection. Patients who are infected with both HIV-1 and HIV-2 have also been identified, but it is suggested that the pathogenicity of HIV-2 is lower than that of HIV-1.
Sir William Newbigging (1772–1852) and Patrick Newbigging (1813–1864) — Father and Son Presidents of the Royal College of Surgeons of Edinburgh
Authors: Kaufman M H
Published: January 2017

Sir William Newbigging was a surgeon to the Edinburgh Royal Infirmary from 1802. While a dextrous operator, he was regarded principally as an excellent general practitioner. He was President of the Royal College of Surgeons of Edinburgh 1814–16 and was knighted by Queen Victoria in 1838. He had five sons, four of whom followed him into the medical profession. Four of his sons died young — only Patrick outlived him. When Patrick returned from a Continental tour in 1842 he joined his father's general practice and when Sir William died in 1852 he took it over. From 1861 to 1863 he was also President of the Royal College of Surgeons of Edinburgh. His last few years were plagued by ill health and he died in 1864, shortly after his fiftieth birthday.
Carl Liebermeister (1833–1901): A Pioneer of the Investigation and Treatment of Fever and the Developer of a Statistical Test
Authors: Seneta Eugene , Seif Fritz J , Liebermeister Hermann , Dietz Klaus
Published: January 2017

In the second half of the nineteenth century, when the typical course of various febrile clinical phenomena was found to be specific to particular infectious diseases, Carl Liebermeister successfully pioneered the investigation of the pathophysiology of fever and the regulation of body temperature. He applied biophysical and pharmacological antipyresis, especially for the treatment of typhoid fever, and developed new statistical tools for the evaluation of therapeutic results.
A Portrait of Fielding H Garrison (1870–1935): America's Pioneering Medical Historian
Authors: Colman Eric G
Published: January 2017

Fielding Hudson Garrison once remarked that because his birthday fell on 5 November, Guy Fawkes Day, he was “fated to suffer from in-ward hell-fire and brimstone all [his] life”. Though said in jest, Garrison was a vulnerable, melancholic and self-confessed lonely man who found solace in the papers, periodicals and books of the Army Medical Library — today's National Library of Medicine. Over the course of approximately 25 years, and often while working in his spare time, Garrison went from a clerk in the world's largest medical library to America's pioneering and, arguably, most prolific medical historian, past or present.
Population Screening for Neonatal Liver Disease: Potential for a Community-Based Programme
Authors: Powell J E , Keffler S , Kelly D A , Green A
Published: January 2017

Objectives:

To evaluate a community-based screening programme for detecting neonata/liver disease by the quantitation of conjugated bilirubin in blood.

Setting and Methods:

Prospective cohort/observational study using spare plasma from routinely collected liquid neonatal screening specimens from babies born in Birmingham over a two-year period. Babies with a conjugated bilirubin above 18 umol/l and comprising more than 20% of the total bilirubin were followed up. A total of 27,654 neonates were tested in the community, with a further 2425 samples from babies hospitalised at the time of the test.

Results:

In the community-based series, 84.7% of the specimens received were analysed, the remainder being unusable mainly because of gross hoemolysis (8.6%) or insufficient sample (5.8%). In 107 neonates the results were above the cut-off limits (0.46% of the number analysed). Of these, 12 had persistently abnormal results, 11 of whom hod confirmed liver disease. The liver diseases detected included neonatal hepatitis (n=6), extra-hepatic biliary atresia (n=2), hypopituitarism In= 1), a-1antitrypsin deficiency (n=1) and Alagille syndrome (n= 1). The sensitivity and specificity of the test for babies in the community were 100% and 99.6%, respectively.

Conclusions:

Conjugated bilirubin in plasma measured at 6–10 days is a reliable marker for neonatal liver disease, and a population screening programme based on this method has the potential to improve the survival and quality of life of infants born with liver disease. However, testing as part of the neonatal screening programme will prove practical only iF the method can be adapted to use dried blood spots
Changing Incidence of Invasive Adenocarcinoma of the Uterine Cervix in East Anglia
Authors: Stockton Diane , Cooper Pauline , Lonsdale R N
Published: January 2017

Objective—

To determine trends in incidence of invasive adenocarcinoma of the uterine cervix in East Anglia.

Methods—

Cervical cancer incidence data for both squamous cell carcinomas and adenocarcinomas were obtained from the East Anglian Cancer Registry for the period 1971–94. Similar data were obtained for England and Wales. European age standardised rates (ASRs) were used for comparisons.

Results—

The mean incidence (ASR) of cervical adenocarcinoma was 0.85 per 10s in 1971–76, rising to 2.54 per 105 in 1989–94. There has been a marked age shift, with the main increase in incidence occurring in younger women aged 30–39. The mean incidence (ASR) of squamous cell carcinoma of the cervix has decreased from 9.78 to 8.74 per 10s over the periods 1971–76 and 1989–94. Again there has been an age shift, moving from a single incidence peak in the 4S-S9 age band in earlier years to incidence peaks in both the 30–39 and 55–69 age bands in more recent years. Similar trends were noted when data for England and Wales were analysed. Birth cohort analyses show that both tumours are occurring progressively earlier (about five years earlier in each five year birth cohort).

Conclusion—

Although the overall incidence of cervical carcinoma is declining, this study has shown an increased incidence of cervical adenocarcinoma, particularly in the younger age groups. In future it would seem advisable to publish separate incidence and mortality data for squamous cell carcinoma and adenocarcinoma of the uterine cervix. All practitioners involved in the cervical cancer screening programme would then be aware of the very real significance of this tumour.
The Bad-Shahs of Small Budget: The Small-budget Hindi Film of the B Circuit
Authors: Subba Vibhushan
Published: January 2017

Since the early 1990s Kanti Shah has made over a hundred and forty films which cut across genres—from badland bandit films to raging action features, from horror to erotica. He has been called the “badshah” of B grade, the “sultan” of C grade, “a man forever associated with India’s adult film industry” but remains an interesting figure because he has slipped in and out of strict categorizations, having dabbled with films that fall under all the grades—A, B, and C—if those categories apply. However, most of Shah’s films have always been cast aside as degraded cultural artifacts hidden from public view, derided, and excluded from film histories.

Using first hand interviews with filmmakers Kanti Shah and his brother Kishan Shah, ethnographic material, reading through journals and archival material, this article as a narrative tracks Kanti Shah’s filmmaking journey through the informal networks of the small-budget film industry (alternatively called B grade, C grade, exploitation films, paracinema) from the late 1980s to present times.
From a Developmental State to a Competition State? Conceptualising the Mexican Political Economy within Global Financial Orthodoxy
Authors: Soederberg Susanne
Published: January 2017

This paper sets out to explore the changing political and economic landscape of the Mexican state against the backdrop of the growing disciplinary power of the globalised financial markets (e.g., capital flight and investment strikes). Specifically it asks if the general defining characteristics of a neoliberal “competition state” found in the advanced industrialised countries (AICs) can be applied to the Mexican case. The paper sustains that although the Mexican state conforms to the basic features of a neoliberal competition state, this transformation has brought about neither sustained economic growth nor less dependence on external sources of capital. A fundamental reason for this failure lies in the highly contradictory nature of the stale's neoliberal policy formulation that is marked by domestic objectives such as subduing class conflict and international exigencies such as signalling creditworthiness.
Testing the Utility of Person—Environment Correspondence Theory with Instructional Technology Students in Turkey
Authors: Perkmen Serkan
Published: January 2017

The main objective of this study was to examine the validity and usefulness of the person—environment correspondence theory with instructional technology students in Turkey. The participants included 211 students and three teachers. Results revealed that instructional technology students value achievement most and that they believe that entering a career in computer teaching will probably not enable them to make use of their abilities and give a sense of accomplishment. This lack of correspondence was found to be related to their predicted vocational satisfaction. Based on these findings, it appears that person—environment correspondence theory offers a useful framework for understanding instructional technology students' satisfaction.
Assessment in basic training: what is the matrix?
Authors: Burke David
Published: January 2017

Objectives:

The aim of this paper is to foster discussion about how best to design a new assessment system for the first three years of RANZCP Fellowship training, under the new regulations for training and assessment to be implemented in 2004.

Conclusions:

An integrated, flexible, reliable and valid system of formative and summative assessment is required. It should include a variety of assessment tools, measuring a range of domains on a number of occasions during basic training, and it should actively involve trainees, supervisors, patients and other consumers.
Is the satisfied customer one who also Ędoes wellę? The relationship between outcome and parent satisfaction in a child and adolescent mental health service
Authors: Rey Joseph M. , O'brien Margot , Walter Garry
Published: January 2017

Objective:

Research has found little association between parent satisfaction with treatment and outcome. This report aimed to examine correlates of parental satisfaction with treatment of their child, in a child and adolescent mental health service.

Method:

The study was conducted in the Rivendell Unit, Sydney. Fifty-eight satisfied and 53 dissatisfied parents were identified using the Patient Satisfaction Questionnaire. Two outcome measure were used, a rating by an independent researcher and another from the patient's treating clinician.

Results:

After controlling for potential confounders, satisfied parents were eight times (95% CI = 2.0--34.5) more likely to have a child rated as having had a satisfactory outcome by the treating clinician. Conversely, children of satisfied parents were six times more likely to have been rated as improved (95% CI = 1.4--22.5).

Conclusions:

Contrary to previous reports, this study suggests that parental satisfaction is associated with outcome of treatment.
Factors contributing to difficulty with psychiatric disorder among junior medical staff
Authors: Solar Ann
Published: January 2017

Objective:

This study examines the attitudes and difficulties that junior medical staff, working in the emergency department of a teaching hospital, have in relation to psychiatric disorders.

Method:

Systematic textual analysis of nine in-depth interviews.

Results:

Three major categories identified were emotional difficulty with patient interaction, uncertainty and pessimism.

Conclusion:

Those doctors able to self reflect and adjust their level of emotional distance appropriately had less emotional difficulty interacting with psychiatric patients. They were also more comfortable in dealing with the issue of uncertainty associated with psychiatric disorder. There was a worrying level of pessimism regarding prognosis in psychiatric disorder.
Looking after our future colleagues: an experience from a provincial hospital in New Zealand
Authors: Kumar Shailesh , Aitken Denise
Published: January 2017

Obective:

To describe a support group developed in New Zealand for junior resident medical officers.

Conclusions:

Fresh medical graduates starting as junior doctors are faced with numerous stresses. Abusive relationships with supervisor, the need to balance personal and professional lives, limited ability to deal with all of the factual knowledge or with patients adequately, long, unsocial hours, financial pressures, the need to rapidly acquire the organisational skills to manage a job with multiple tasks and multiple interruptions, and being the lowest in the hierarchy are just some of the stresses junior doctors face. We, in our roles as intern supervisors, have found that running weekly support groups along with some structured sessions on how to maintain personal well being have been helpful in providing support to the junior doctors working in our hospital. Our experience is described and the implications are discussed.
Of mice and men: a curious tale of disappearing plaques and tumbling stocks
Authors: Boman Bruce
Published: January 2017

Objective:

To describe the events surrounding the recent termination of Elan Pharmaceutical's phase 2a trial of beta amyloid immunisation for Alzheimer's disease.

Conclusions:

Excessive and uncritical enthusiasm for new treatments can lead to negative clinical and financial outcomes.
Evaluation of Two Over-the-Counter Natural Thyroid Hormone Preparations in Human Volunteers
Authors: Csako Gyorgy , Corso Diane M. , Kestner Jane , Bokser Allan D. , Kennedy Paul E. , Pucino Frank
Published: January 2017

OBJECTIVE:

To determine the pharmacologic activity of over-the-counter (OTC) thyroid preparations.

DESIGN:

In vitro analysis and a prospective, crossover study in vivo.

SETTING:

Tertiary care center.

PARTICIPANTS:

Two healthy adult volunteers

INTERVENTION:

Three OTC preparations (Thytrophin PMG [bovine thyroid PMG extract], Thyro Forte [thyroid lyphogland concentrate with synergistic complex], and Thyro Complex [thyroid lyophilized gland concentrate with synergistic complex]) were analyzed in vitro. Volunteers were administered two times the manufacturer's maximum recommended daily dose of either Thytrophin PMG or Thyro Forte for one week, washed out for four to five weeks, and crossed over to receive the opposite tablet preparation for an additional week.

MAIN OUTCOME MEASURES:

The triiodothyronine (T3) and thyroxine (T4) contents of OTC preparations were measured by HPLC. Vital signs, serum total and free T4, total T3, thyroid stimulating hormone, thyroxine binding globulin, thyroglobulin, and general chemistry tests (including glucose and cholesterol) were monitored before, during, and between administration of the products.

RESULTS:

HPLC analysis of the three OTC preparations showed no T4 but did show possible T3 in two of these products. We found no definite clinical or laboratory evidence of thyroid hormone excess with either product.

CONCLUSIONS:

Healthcare professionals should advise against the use of these scientifically unsound and relatively expensive OTC thyroid preparations, of which the therapeutic efficacy is unknown.
Cyanide Toxicity from Sodium Nitroprusside: Risks and Management
Authors: Rindone Joseph P. , Sloane Edward P.
Published: January 2017

OBJECTIVE:

To review the risks, manifestations, and treatment of cyanide toxicity from nitroprusside therapy.

DATA SOURCES:

All English case reports identified in Index Medicus (MEDLINE) of cyanide intoxication related to nitroprusside from 1970 to the present were reviewed. In addition, literature regarding the incidence, risks, and treatment of cyanide toxicity from nitroprusside is presented.

CONCLUSIONS:

Numerous cases of cyanide toxicity associated with nitroprusside have been reported. The overall incidence appears to be infrequent; however, certain patients may be at high risk. Risk factors may include hypoalbuminemia, cardiopulmonary bypass procedures, or the administration of moderate to high doses of nitroprusside. Treatment of cyanide toxicity requires the cessation of nitroprusside and, for severe toxicity, use of the cyanide antidote kit. Cyanide toxicity from nitroprusside may be prevented by concomitant administration of sodium thiosulfate infusions.
Effectiveness of a Gentamicin Dosing Protocol Based on Postconceptional Age: Comparison to Published Neonatal Guidelines
Authors: Reed Michael D. , Lopez-Samblas Ana M. , Torres Carmen L. , Wang Helena , Feuer William J. , Goldberg Ronald N.
Published: January 2017

OBJECTIVE:

To evaluate the effectiveness of a gentamicin dosing protocol based on postconceptional age in producing therapeutic serum concentrations and to compare the protocol with commonly used gentamicin dosing guidelines.

DESIGN:

During the initial three months of this study infants were dosed according to physician discretion (group I). In the subsequent three-month period patients were dosed according to a postconceptional age dosing schedule (group II).

SETTING:

Infants were enrolled after being admitted to the Newborn Intensive Care Unit at the University of Miami/Jackson Memorial Medical Center.

PATIENTS:

Infants less than 37 weeks gestational age with normal renal function, not receiving indomethacin, and requiring gentamicin treatment were enrolled. Fifty-nine infants were enrolled into group I (median weight 1300 g [range 720–3300]), postconceptional age 29 weeks [26–37]); and 68 infants were enrolled into group II (weight 970 g [530–3000], postconceptional age 29 weeks [24–36]).

INTERVENTION:

Patients in group II were dosed according to the following protocol: postconceptional age <30 weeks, 3.0 mg/kg q24h, and postconceptional age 30–37 weeks, 2.5 mg/kg q18h. Peak and trough serum gentamicin concentrations were obtained in all study patients. Pharmacokinetic parameters were calculated from measured serum concentrations. Using the calculated pharmacokinetic data, peak and trough serum concentrations were simulated for five published neonatal dosing guidelines and the proposed postconceptional age protocol.

MAIN OUTCOME MEASURES:

The number of therapeutic serum gentamicin concentrations resulting from the dosing guidelines studied were compared.

RESULTS:

Measured trough concentrations differed significantly between the two groups with 35 percent of patients in group I and 90 percent of patients in group II having trough values <2 mg/L (p<0.001). There was no significant difference in measured peak concentrations between groups. Simulated trough concentrations were significantly different when postconceptional age dosing was compared with commonly used protocols (p<0.0001) with the highest percentage of concentrations <2 mg/L (89 percent) resulting from the proposed postconceptional age guidelines.

CONCLUSIONS:

These data suggest that the proposed postconceptional age protocol is reproducible and reliable in achieving therapeutic gentamicin serum concentrations in neonates.
Thallium-201 Myocardial Imaging in Patients with Coronary Artery Disease: Comparison of Intravenous Adenosine and Oral Dipyridamole
Authors: Mohiuddin Syed M. , Gupta Naresh C. , Esterbrooks Dennis J. , Siffring Patricia A. , Frick Mathis P. , Hilleman Daniel E. , Sketch Michael H.
Published: January 2017

OBJECTIVE:

To compare thallium-201 (201Tl) myocardial perfusion imaging following intravenous adenosine and oral dipyridamole.

DESIGN:

Open-label, randomized, comparison.

SETTING:

Outpatient, university-affiliated clinic.

PATIENTS:

Fifteen patients with angiographically documented coronary artery disease.

INTERVENTIONS:

Planar 201Tl myocardial perfusion imaging following both intravenous adenosine 140 μg/kg/min for six minutes and oral dipyridamole suspension 300 mg.

MAIN OUTCOME MEASURES:

A comparison between adenosine and dipyridamole was made in the following areas: concordance in interpretation of 201Tl scintigrams, cardiac and noncardiac 201Tl uptake and clearance, hemodynamic and electrocardiographic changes, and adverse effects.

RESULTS:

The scintigraphic studies showed perfusion defects in 13 patients (87 percent) after dipyridamole and in 15 patients (100 percent) after adenosine. 201Tl uptake and clearance were quantitated in nine myocardial segments and in four extracardiac segments in each patient. 201Tl uptake was not significantly different between adenosine and dipyridamole studies in most cardiac regions. Extracardiac 201Tl uptake was significantly less in the liver and splanchnic regions following adenosine compared with dipyridamole. 201Tl clearance was not significantly different following adenosine and dipyridamole except in the anterolateral region in the anterior view. Hemodynamic changes following administration of intravenous adenosine and oral dipyridamole were not significantly different. Adverse effects were more common with adenosine than with dipyridamole. Adverse effects with adenosine were transient; however, adverse effects with dipyridamole were prolonged and required reversal with aminophylline in 2 patients. No patients required termination of the adenosine infusion or administration of aminophylline.

CONCLUSIONS:

These preliminary data suggest that adenosine 201Tl imaging may be a useful alternative to dipyridamole 201Tl imaging. Although adenosine produces more frequent adverse effects, they are generally better tolerated than those associated with dipyridamole.
Nonneuroleptic Treatment of Disruptive Behavior in Organic Mental Syndromes
Authors: Smith Daniel A. , Perry Paul J.
Published: January 2017

OBJECTIVE:

To summarize the literature describing nonneuroleptic treatments of unacceptably disruptive behavior in chronically institutionalized psychiatric patients with mental retardation, autism, organic brain syndrome, and dementia.

DATA SOURCES:

Relevant articles were identified from a MEDLINE search of the above diagnoses linked with “aggression” and “psychomotor agitation.” Additional references were found in the bibliographies of these articles.

STUDY SELECTION/DATA EXTRACTION:

The studies reviewed were limited to prospective evaluations of nonneuroleptic drug therapy of these behavior disturbances. Case reports, case series, and retrospective studies were excluded. Studies of patients with schizophrenia, affective disorders, and personality disorders were also excluded.

DATA SYNTHESIS:

Studies of lithium, beta-blockers, carbamazepine, benzodiazepines, and buspirone were adequate for review. As a rule, these studies are hampered by poor design. The lithium studies suggest that mentally retarded patients with behavior disturbances may respond to lithium treatment. The beta-blocker studies suggest improvement in patients with mental retardation, autism, organic brain syndrome, and dementia. Neuroleptic discontinuation or a decrease in dose was possible in some patients. The carbamazepine studies were inconclusive. Carbamazepine should be reserved for patients with concomitant seizure disorders. Benzodiazepines were helpful in treating elderly demented patients. Thus far, buspirone has been evaluated in only a few, poorly designed studies and is not yet recommended for treatment of behavior disturbances.

CONCLUSIONS:

Legislation has restricted the use of neuroleptics in many patients receiving long-term healthcare. Despite the questionable validity of the studies reviewed, lithium, beta-blockers, carbamazepine, and benzodiazepines may be considered as alternatives to neuroleptics in selected cases.