bluuebunny/crossref_metadata_2025 huggingface dataset:
Exclusion from Resuscitation
Authors: Keatinge R M
Published: February 2018

Resuscitation was attempted for 156 (19.9%) of the 783 cases in St Thomas's Hospital, aged 16 or over, who suffered first cardiac or respiratory arrest of the current admission during the year to 13 April 1987. Seventeen (11%) of the 156 were discharged alive from hospital after resuscitation. All seventeen had been active outside the home before admission, and all except one remained so after discharge.

The factors which were associated with exclusion from resuscitation attempts are analysed. Most accorded with known prognostic factors, but resuscitation was attempted for some persons who seemed to have little chance of benefiting from resuscitation attempts. Routine collection, analysis, and dissemination of information on pre-arrest characteristics in relation to their outcome, on which clinicians can base their decision to with-hold resuscitation in the event of an arrest, is recommended.
Prevalence, Detection and Referral of Psychiatric Morbidity in General Medical Patients
Authors: Seltzer A
Published: February 2018

Twenty seven per cent of medical emergency admissions were found to have diagnosable psychiatric disorders, mostly mild. Although ward staff assessed 31.1% of admissions as having emotional or psychological problems, only a minority had diagnosable psychiatric disorders. Few patients were referred for specialist psychiatric help. This partly reflected the milder nature of problems identified by ward staff, and partly indifference to psychiatry.
Wind of Change. III. The Royal Colleges
Authors: Vickers M D
Published: February 2018

Preference is given to letters commenting on contributions published recently in the JRSM. They should not exceed 400 words and should be typed double-spaced.
Seizure Induction by Alcohol in Patients with Epilepsy Experience in two Hospital Clinics
Authors: Heckmatt J , Shaikh A A , Swash M , Scott D F
Published: February 2018

We surveyed 70 epileptic patients attending a general neurology clinic and 64 patients attending an epilepsy clinic to determine the incidence of alcohol-related seizures. Seven (10%) of the neurology clinic patients and 9 (15%) of the epilepsy clinic patients reported exacerbation of their seizures with alcohol. In the first group, two had been heavy drinkers when under-age, two had features of alcohol dependence, and three had experienced resolution of seizures following cessation of their drinking. In the second group, five drank 4 units/day or more, and one drank more heavily. The importance of alcohol in the causation of these patients’ seizures had not previously been appreciated.

The relationship of alcoholism to epilepsy has been recognized for many years, but the role of alcohol in the exacerbation of primary epilepsy, and in triggering seizures in epileptic patients is often not recognized. Control of alcohol ingestion is an important factor in the management of epilepsy.
Bier's Block Revisited: Intercuff Block
Authors: Hannington-Kiff J G
Published: February 2018

Bier introduced his intravenous technique of local anaesthesia to facilitate palliative surgery on the elbow or knee. He cannulated a suitably large vein in the vicinity of the joint to inject procaine after first isolating the operating site with a proximal and a distal tourniquet. This extra containment of the local anaesthetic solution made it feasible to flush out any unfixed drug with saline before release of the main tourniquet, an advantage which has been lost in the currently fashionable technique of intravenous regional anaesthesia (IVRA) involving a single tourniquet above the elbow or knee and a fine butterfly needle in a vein on the dorsum of the hand or foot. A modern version of Bier's original method is described, conveniently called an intercuff block (ICB), which reintroduces the possibility of effective flushing, offers better operating conditions and engenders new ideas for further study.
Delivery of Psychiatric Care
Authors: Strathdee G
Published: February 2018

This paper proposes criteria essential for the effective delivery of psychiatric care and briefly reviews the extent to which they are fulfilled by current services. An audit study is described where district general practitioners were asked to evaluate the extent to which their local psychiatric services met their needs and those of their patients. The implications for the development of community psychiatric services is discussed.
The General Practitioner'S Use and Expectations of An Accident and Emergency Department
Authors: Morrison W G , Pennycook A G , Makower R M , Swann I J
Published: February 2018

In an attempt to establish what the general practitioner expects from an accident and emergency department, and how closely the service provided correlates with that view, a 12-point questionnaire was sent to the general practitioners in the Glasgow Royal Infirmary catchment area.

Out of the 61.2% of general practitioners who replied, the majority wish to have responsibility for their own patients for conditions which are neither accidents nor emergencies. There is less agreement as to how much should be done within an accident and emergency department and on the appropriate modes of referral and communication between the general practitioner and the hospital service. Further consultation and cooperation are necessary to interpret and resolve these differences.
On Insight and Psychosis: Discussion Paper
Authors: David Anthony S
Published: February 2018

The concept of insight into psychosis has received scant attention in the psychiatric literature. Various types of insight are described after drawing on such sources as phenomenology, clinical observation and experimental psychology. It is proposed that insight is far from an all or none phenomenon but comprises three overlapping dimensions, namely, the recognition that one has a mental illness, compliance with treatment and the ability to re-label unusual mental events (delusions and hallucinations) as pathological.
Prolongation of the Antiemetic Action of P6 Acupuncture by Acupressure in Patients Having Cancer Chemotherapy
Authors: Dundee J W , Yang J
Published: February 2018

Previous work from our department has shown that P6 acupuncture is an effective adjuvant to conventional antiemetic therapy for patients having cytotoxic drugs. However, its efficacy is limited to about 8 h. The current studies show that the application of an elasticized wrist band with a stud placed over the acupuncture point, and pressed regularly every 2 h, will prolong the antiemetic action for 24 h. This proved more effective in hospitalized patients (20/20) than in outpatients (15/20), presumably due to the encouragement given to regularly press the stud.

Nausea and vomiting remain problems with cancer chemotherapy1-4 despite the use of antiemetics5. Following encouraging results with P6 acupuncture (ACP) in postoperative sickness6 this has been shown to be effective in cancer chemotherapy in 105 patients who, despite the use of conventional antiemetics7 had been sick following the previous treatment. Electrical stimulation (10 Hz DC) of P6 point for 5 min before administration of the cytotoxic drugs was effective in preventing sickness in 66% and only 6% got no benefit. The ACP was given with the antiemetics which the patients had been receiving.

Although there were no side effects with the ACP, the benefit only lasted 6-8 h. This was not important in hospitalized patients where the treatment could be repeated, but was a problem with outpatients. It has been shown that pressure on the P6 point (acupressure) has an antiemetic action8,9. A commercially available elasticized band with a plastic stud (Sea Band) is an effective method of applying pressure to P6 point.

We report the findings of a study in which the band was applied over P6 point immediately after ACP and the patient told to press this for 5 min every 2 h.
Informational Stress: Discussion Paper
Authors: Restian A
Published: February 2018

Stress can be caused by a multitude of factors requiring the capacity for adaption by the organism. As well as physical, chemical and biological factors, information may also become a stressor in certain circumstances. Stress may be induced just as well by too little as by too much information, and by the quality of the information.
Are We Getting Informed Consent from Patients with Cancer?
Authors: Sutherland H J , Lockwood G A , Till J E
Published: February 2018

We developed a consent form for a hypothetical trial and asked patients to underline information that was pertinent to their decision to accept or refuse to participate in the proposed trial. We also investigated whether patients correctly interpreted statements describing the probability of certain events occurring. Of the 50 patients, 74% did not indicate that both risks and benefits were pertinent. Of the 20 patients who would not enter the trial, 70% focused on risks of therapy only. In contrast, of the 30 who agreed to enter, only 33% focused entirely on risks, while 10% did not note potential for either benefit or risk. For each of four probability statements, patients chose one of four possible interpretations, only one of which was correct. Depending on the statement, between 26 and 54% of the interpretations were incorrect. It appears that many decisions regarding trial entry may be based upon incomplete or incorrect information.
What are the Psychological Factors Influencing Attendance, Non-Attendance and Re-Attendance at a Breast Screening Centre?
Authors: Fallowfield L J , Rodway A , Baum M
Published: February 2018

We describe some preliminary findings from a pilot study using three recently developed questionnaires which assessed items such as the health beliefs, knowledge about cancer and attitudes to breast cancer screening in 242 women invited to attend for mammographic screening in South East London. We suggest that these questionnaires should be used in all regional centres both to monitor psychological variables and to identify local problems within the service which may be influencing the up-take of invitations to come for screening.
Comparison of a Dimethicone/Antacid (Asilone Gel) with an Alginate/Antacid (Gaviscon Liquid) in the Management of Reflux Oesophagitis
Authors: Smart H L , Atkinson M
Published: February 2018

Fifty-three patients with symptomatic reflux oesophagitis were entered into a single centre randomized study comparing the effects of a dimethicone/antacid (Asilone Gel) and an alginate/antacid (Gaviscon liquid) on symptoms and endoscopic changes over an 8-week period. Both treatments significantly improved heartburn, acid regurgitation and flatulence. Dimethicone/antacid but not alginate/antacid, produced a significant improvement in oesophagitis, oesophageal ulceration and histological grade of inflammation over the 8-week treatment period so that 14 patients treated with dimethicone/antacid and 10 with alginate/antacid had normal endoscopic oesophageal appearances at the end of the study. The difference in improvement between the two patient groups did not reach significance however, except for dimethicone/antacid improving histological changes (P<0.05). These findings suggest that dimethicone/antacid and alginate/antacid are equally effective in treating symptomatic reflux oesophagitis although dimethicone/antacid may have an advantage in improving oesophageal histological appearances.
The Electrocardiogram in General Practice: Its Use and Its Interpretation
Authors: Macallan D C , Bell J A , Braddick M , Endersby K , Rizzo-Naudi J
Published: February 2018

General practitioners in one health district were surveyed by postal questionnaire (including 15 sample electrocardiogram tracings) to assess their usage and competence in interpretation of the electrocardiogram. A response rate of 60% was achieved, of whom 40% said they used the electrocardiogram at least monthly and 43% used it ‘always’ or ‘usually’ in patients with suspected myocardial infarction at home. Overall competence in recognizing a variety of abnormalities was felt to be good. Recent qualification, the possession of a higher qualification (MRCP/MRCGP) and frequency of usage were associated with better performance. Even so, unequivocal acute myocardial infarction was misdiagnosed by 20% of respondents. These findings have implications for the provision of electrocardiographic services in primary care and the management of patients in the home with suspected myocardial infarction, particularly with the advent of thrombolytic therapy.
Epidemiology of Shingles
Authors: Glynn C , Crockford G , Gavaghan D , Cardno P , Price D , Miller J
Published: February 2018

One thousand and nineteen patients with acute varicella zoster viral infection were referred to the physiotherapy department for treatment between 1978 and 1986. Sixty per cent were women and 40% were men with a mean age of 58 years (range 9–96 years). The prevalence varied between 1.3 and 1.6 per 1000 per annum. The left side was affected in 52% while the right was affected in 48%. The thoracic dermatomes were the most commonly affected (56%) followed by cervical (17%), lumbar (10%), sacral (5%), and the trigeminal nerve was infected in 12%. There was a significant seasonal (P < 0.001) variation in the prevalence of acute varicella zoster virus infection, most common in the summer and least common in the spring. There was no clustering in time and space so that it is unlikely that the varicella zoster virus is infective or that re-exposure to the virus causes reactivation of the latent virus.
Slip-Shod or Safely Shod: The Bighorn Sheep as a Natural Model for Research
Authors: Manning D P , Cooper J E , Jones C , Bruce M
Published: February 2018

Over a million injuries caused by slipping of footwear are believed to require treatment by doctors every year in the United Kingdom and many domestic animals are injured by slipping. Recent research has revealed that surface roughness of solings and floors is an important determinant of grip on lubricated surfaces and it is also known that soling friction is affected by hardness. The bighorn sheep (Ovis canadensis) an animal species which has adapted to a slippery environment, was studied to elucidate optimum roughness and hardness and other features which influence grip. Four adult ewes were examined in the London Zoo. The cloven hooves of this species are very mobile and the cranial tips of the hooves are the first parts to make contact with the ground. A very small contact area ensures penetration of a film of water. Mean roughness of the contact area was found to be 53 microns Rtm and the mean hardness 63 Shore A. These characteristics appear to facilitate an excellent grip on wet slippery rock but not on smooth ice. Further studies of the feet of wild species could contribute to an understanding of the factors which determine the safety of solings and floors.
Survival in Acute Non-Lymphocytic Leukaemia following Breast Cancer
Authors: Kaster S D , Holmes F F
Published: February 2018

Acute non-lymphocytic leukaemia (ANLL) occurs with increased frequency in women with previously diagnosed breast cancer. Adjuvant radiotherapy and chemotherapy are related to this increase. We studied the interrelationships among age at breast cancer diagnosis, interval to ANLL diagnosis, and survival in 54 women of whom 11 were from Kansas and 43 were from two other published series. Median age at breast cancer diagnosis was 50.5 years, median interval to ANLL diagnosis was 4.8 years, and median survival after ANLL diagnosis was 2.2 months. Increasing age was associated with a decrease of the interval to ANLL diagnosis just short of statistical significance (P=0.0591). There was no association of survival with either age or the interval to ANLL diagnosis. With an increase in the use of adjuvant therapy in breast cancer there is a need to identify women at greatest risk of subsequently developing ANLL, at present not possible.
Clinically and Mammographically Occult Breast Lesions Demonstrated by Ultrasound
Authors: Fung H M Y , Jackson F I
Published: February 2018

Histologic proof from 62 sites in 58 patients in whom an ultrasonic abnormality was detected in the absence of palpable or mammographic evidence revealed no malignancy. It is suggested that decision to biopsy be made on clinical grounds.
Continuing medical education at a university—evaluation of an MSc programme in general practice
Authors: Ridsdale L , Walker M
Published: February 2018

In 1986 London University launched a new MSc programme for GPs. This paper describes the problems met with, and the progress made by course members and tutors during the first part-time, 2-year course. We also describe some early measures of the outcome of this form of CME.
Diuretics and Electrolyte Disturbances in 1000 Consecutive Geriatric Admissions
Authors: Byatt C M , Millard P H , Levin G E
Published: February 2018

Old people are commonly receiving diuretics on admission to hospital. Diuretics are recognized as a risk factor for electrolyte disturbances; controversy exists about the relative risks of different combinations (in particular, co-amilozide [Moduretic]). We recorded the drug history and serum electrolytes in 1000 consecutive admissions to a geriatric hospital, and examined the relative prescribing rates of various diuretics in the community.

Full results were obtained in 929 patients. A history of diuretic prescription was present in 353 (38%) of the patients; the mean serum sodium in this group (95% CI 136.0–137.1 mmol/1) was lower than in the 586 not prescribed diuretics (137.1–137.9 mmol/1). The difference was small but statistically significant (95% CI difference=0.3–1.6 mmol/1; P<0.01).

Hyponatraemia (serum sodium < 130 mmol/l) was not significantly commoner in the 41 patients prescribed co-amilozide than in patients prescribed other diuretics. In general patients prescribed potassium-retaining diuretics had a lower serum sodium than the others.

There was a significant positive correlation between the serum potassium and the log [serum urea) (r=0.26, P < 0.001) and a weak negative correlation existed between sodium and potassium (r= −0.14; P < 0.001). There was an association between the prescription of potassium-retaining diuretics and a higher serum potassium; also an association between the prescription of a loop or thiazide diuretic and a lower serum potassium. These interactions were shown by multiple regression analysis to be independent and additive.

Co-amilozide formed a significantly higher proportion of all diuretics prescribed in the community group than in the inpatient group (18% versus 12%; P < 0.05).

Hyponatraemia was mild and mainly associated with potassium-retaining diuretics in our patients. Our study was unable to confirm or refute any specific dangers of co-amilozide compared with other potassium-retaining diuretic combinations.
A Survey of the Practice of Regional Anaesthesia
Authors: Buist R J
Published: February 2018

A questionnaire designed to elucidate the popularity and practice of regional anaesthesia was circulated to all anaesthetists in the South East Thames Region. Two hundred and eleven completed questionnaires were received and subsequently analysed, a response rate of 65%. Regional anaesthesia was employed at least once per week by 83% of respondents usually in combination with general anaesthesia (77% of respondents). The provision of postoperative analgesia was cited as the main advantage by 86% of anaesthetists.
Epidemiology of Mouth Cancer in 1989: A Review
Authors: Boyle P , Macfarlane G J , Maisonneuve P , Zheng T , Scully C , Tedesco B
Published: February 2018

The oral cavity and pharynx combined is the sixth commonest site of cancer in both sexes. In many countries the mortality rate is increasing among younger men born since approximately 1910-1920. A causal role in the aetiology of mouth cancer has been established for tobacco use, both smoking and chewing, separately and in conjunction with betel-quid chewing; with alcohol consumption and, less certainly, with other factors such as poor oral hygiene, nutritional factors and certain occupational exposures. In Western countries, there is convincing evidence that a large attributable risk can be ascribed to the joint habits of cigarette smoking and alcohol consumption. In Asian societies, a high attributable risk can be ascribed to cigarette smoking and betel chewing. Mouth cancer is at the same time an important form of cancer, and one for which practical prospects for prevention already exist. Against this background of a continually increasing trend among younger persons, it seems essential to engage upon programmes of prevention, including increasing awareness for early detection, against mouth cancer at the present time.
Is Chronic Fatigue Syndrome Synonymous with Effort Syndrome?
Authors: Rosen S D , King J C , Wilkinson J B , Nixon P G F
Published: February 2018

Chronic fatigue syndrome (CFS), including myalgic encephalomyelitis (ME) and postviral syndrome (PVS), is a term used today to describe a condition of incapacity for making and sustaining effort, associated with a wide range of symptoms. None of the reviews of CFS has provided a proper consideration of the effort syndrome caused by chronic habitual hyperventilation. In 100 consecutive patients, whose CFS had been attributed to ME or PVS, the time course of their illness and the respiratory psychophysiological studies were characteristic of chronic habitual hyperventilation in 93. It is suggested that the labels ‘CFS’, ‘ME’ or TVS' should be withheld until chronic habitual hyperventilation - for which conventional rehabilitation is available - has been definitively excluded.
Gastrointestinal Complications of the Haemolytic Uraemic Syndrome
Authors: Crabbe D C G , Broklebank J T , Spicer R D
Published: February 2018

The haemolytic uraemic syndrome (HUS) is a well recognized cause of acute renal failure in children. Gastrointestinal involvement is common, and may result in rectal bleeding which can be an important presenting symptom. Previous publications have stressed the importance of correct diagnosis to avoid unnecessary surgery. Occasionally serious gastrointestinal complications do occur. We present five children with life-threatening gastrointestinal complications of the HUS and discuss the indications for laparotomy.
Night Sedation and Arthritic Pain
Authors: Hardo P G , Kennedy T D
Published: February 2018

This pilot study highlights the problems of benzodiazepine (BDP) usage in patients attending a rheumatology clinic. Of 127 consecutive patients attending the rheumatology clinic a total of 29% (37) had been taking night sedation for mean duration of 4.1 years. The majority of BDP users (92%) were women. In 78% night sedation was taken for insomnia associated with night pain. We recommend that if BDP is to be prescribed it should be only in selected cases for a short time.
The 1978 Italian Mental Health Law – a Personal Evaluation: A Review
Authors: Palermo G B
Published: February 2018

The author discusses the sociopsychiatric consequences of the 1978 Italian mental health law. He also reviews the international scientific ideas that led up to it. The sociopolitical psychiatric views of the late Franco Basaglia, pioneer of the change in the mental health system of the Italian Republic, are described. Statistical reports and critical analyses are reported. Objective data, based on the author's personal experience as a practising psychiatrist in Rome, Italy, from 1969 to 1987, are given.
Patterns of Referral to a Menopause Clinic
Authors: Garnett T , Mitchell A , Studd J
Published: February 2018

One hundred and fifty new patients attending the Menopause Clinic at Dulwich Hospital were questioned on their attitudes and fears about hormone replacement therapy and the perceived attitudes of their general practitioner. The majority of patients attending the clinic had initiated referral themselves and many had travelled from outside the health authority area in order to be seen. The waiting list for an appointment was often unacceptable.

We conclude that specialist menopause clinics in teaching hospitals are unable to cope with the demand for information about the menopause and hormone replacement from post-menopausal women and suggest alternative means for providing this service.
Inflammatory Bowel Disease: Patients' Expectations in the 1990s
Authors: Probert C S J , Mayberry J F
Published: February 2018

A group of 70 patients with inflammatory bowel disease were asked to complete a questionnaire about their disease counselling preferences, 59 replied. Seventy-five per cent wanted further advice about their disease. Of these, 60% wished to receive the advice by discussion with a trained advisor. Seventy-six per cent wanted this person to be a hospital specialist, but 50% would accept advice from a specialty trained nurse. Eighty-six per cent would like this in conjunction with ‘same day’ telephone advice from a hospital specialist and 85% of patients wish to be taught how to adjust their own therapy. There is an increasingly important role for nurse counsellors in the management of these diseases.
The Place of Arthrography in the Diagnosis and Management of Meniscal Injuries – a 6-year Review
Authors: Evans S E , Chandy J , Aldridge M J
Published: February 2018

Four hundred and eighty-seven consecutive knee arthrograms, performed over a 6-year period, are reviewed. Their accuracy is compared with arthroscopy and, where appropriate, with arthrotomy. The increasing accuracy of arthrography has resulted in the acceptance of this method of imaging as a useful and accurate means of examining meniscal injuries in the knee. This has led to far fewer surgical procedures and an overall saving of resources.
Non-Secretory Adenomas of the Pituitary Treated by Trans-Ethmoidal Sellotomy
Authors: Shone G R , Richards S H , Hourihan M D , Hall R , Thomas J P , Scanlon M F
Published: February 2018

A consecutive series of 35 clinically non-secretory pituitary adenomas treated surgically by the trans-ethmoidal approach is presented. Mean age at presentation was 60 years, with a male-to-female ratio of 2:1. These tumours present later than hormone secreting tumours: 90% were over 2 cm in diameter at operation. Seventy-one per cent of patients had impaired vision and 89% had hypopituitarism. Surgical treatment relieved or significantly improved visual fields in 79% of patients with impaired vision. Ninety-one per cent required permanent hormone replacement. Mean follow-up was for 4.4 years. Five tumours recurred, causing recurrent visual symptoms. No tumours recurred in those patients treated with postoperative radiotherapy, but follow-up in this group was only for a mean of 2.7 years.
Management Choices for Hypertension with Coexistent Hypercholesterolaemia
Authors: Feher M D , Lant A F
Published: February 2018

Guidelines for the management of either hypertension or hyperlipidaemia have been widely published. However, recent data have shown the high frequency of an abnormal lipid profile in hypertensive subjects. We have therefore surveyed 195 general practitioners throughout Britain to determine current community-based attitudes and management approaches to hypertension with coexistent hypercholesterolaemia. Routine screening for lipids in hypertensive subjects was recommended by 40% of respondents. First-line antihypertensive drug choices were influenced by the knowledge of a hypercholesterolaemia, with preference for drugs known to have no adverse effects on the lipid profile. When first-choice drug failed to effectively lower blood pressure, the additional drug or the substitute choices were not influenced by the metabolic profiles of the alternative selected. The current wide choice of antihypertensive drugs and the complexity of metabolic complications of treatment plus the relationship of risk factor clustering has made the formulation of management strategies very difficult. This was supported by the finding that 88% of respondents in our survey felt that there was a clear need for consensus management guidelines for the treatment of hypertension with coexistent hypercholesterolaemia.
Non-invasive Stimulation of the P6 (Neiguan) Antiemetic Acupuncture Point in Cancer Chemotherapy
Authors: Dundee J W , Yang J , McMillan C
Published: February 2018

The beneficial effects of transcutaneous electrical stimulation of the P6 antiemetic point (Neiguan) as an adjuvant to standard antiemetics was studied in over 100 patients in whom chemotherapy-induced sickness was not adequately controlled by antiemetics alone. Although the results were not quite as good as with invasive acupuncture, more than 75% patients achieved considerable benefit from what was a nontoxic procedure.

The use of large diffuse low impedence electrodes simplifies the technique. The 2 hourly application of Sea Bands prolongs the antiemetic action. Best results were obtained from the 2 hourly self-administration of 5 min of transcutaneous electrical stimulation of P6 using a simple battery-operated TENS machine (15 Hz) to activate a large, easy-to-place surface electrode and increasing current until Qi is elicited.
Mortality in a University Surgical Unit: What is an Avoidable Death?
Authors: McDonald P J , Royle G T , Taylor I , Karran S J
Published: February 2018

Between January 1978 and December 1987 there were 23 557 surgical admissions to the University Surgical Unit in Southampton. During this period there were 543 deaths, an overall death per admission rate of 2.3%. During the 10-year period the number of admissions per year had risen from 1884 in 1978 (death per admission=3.6%) to 3467 in 1987 (death per admission rate=1.7%).

At the monthly audit meeting an attempt was made to classify each death as ‘avoidable’ or ‘unavoidable’. During this 10-year period it was considered that there were 89 ‘avoidable’ deaths. This represents an avoidable mortality rate (AMR) of 0.38%.

These ‘avoidable’ deaths were due to a wide variety of causes and this paper discusses the lessons learnt from a review of surgical mortality and outlines how units might compare results.
Epilepsy after Craniotomy and the Place of Prophylactic Anticonvulsant Drugs: Discussion Paper
Authors: Shaw M D M , Foy P M
Published: February 2018

A retrospective study of 1000 patients who had undergone supratentorial neurosurgery and with prolonged follow-up revealed an overall postoperative incidence of epilepsy of 17%. The incidence varied with different pathologies but anticonvulsants given prophylactically in a randomized trial did not significantly alter the incidence. Routine anticonvulsant prophylaxis cannot be recommended.
Acceptability of Binaural Hearing Aids: A Cross-Over Study
Authors: Stephens S D G , Callaghan D E , Hogan S , Meredith R , Rayment A , Davis A
Published: February 2018

Using screening questionnaires we were able to detect individuals aged 50–65 years with hearing disability in a general practice population. Those who had better ear hearing levels of 30 dB or worse were invited to take place in a cross-over study comparing the acceptability of a monaural or binaural hearing-aid fitting. Fifty-five per cent ultimately opted for a binaural fitting and had greater hearing disability and worse mean hearing levels than those who opted for a monaural fitting. They made their choice for acoustical reasons, particularly on the basis of improved localization ability.
Results of Buck Screw Fusion in Grade I Spondylolisthesis
Authors: Bonnici A V , Koka S R , Richards D J
Published: February 2018

The results of posterolateral screw fixation using the Buck technique performed on 24 patients with painful isthmic spondylolysis and up to grade I spondylolisthesis in the lumbar spine are reported. The average age at operation was 29 years and average follow-up was 5 years with a range of 13 months to 12 years. Operations were performed for persistent disabling low back pain. At review 21 patients were either free of pain or complained of only occasional backache and discomfort. All but two patients were satisfied with the operation and rated the result as excellent or good. It is concluded that Buck screw fixation is a safe and reliable method of treatment for painful Grade I spondylolisthesis due to isthmic spondylolysis in the young active adult with a low complication rate.
Gastric Emptying Procedures in the Self-Poisoned Patient: Are we Forcing Gastric Content beyond the Pylorus?
Authors: Saetta J P , March S , Gaunt M E , Quinton D N
Published: February 2018

A prospective, randomized, single-blind study was carried out to determine whether gastric content is forced into the small bowel when gastric-emptying procedures are employed in self-poisoned patients. They were asked to swallow barium-impregnated polythene pellets, immediately prior to either gastric lavage or ipecacuanha-induced emesis. A second group of patients, who did not require treatment, were used as controls. Sixty patients were recruited to the study. The data show a significant difference in the number of residual pellets in the small bowel of the treated group (n=40), when compared with the control group (P < 0.0001). There was no statistical difference in the number of pellets in the small bowel when the treated groups were compared with each other. In addition, the inefficiency of gastric-emptying procedures is highlighted; 58.5% of the total number of pellets ingested were retained in the gastrointestinal tract of the ipecacuanha-treated group, while 51.8% of total pellets ingested were retained in the gastric lavage-treated group.
Are Patients in Favour of General Health Screening?
Authors: Levine J A
Published: February 2018

In order to determine whether patients are in favour of general health screening, two sex-matched groups of patients of similar age from a general practice were studied; a group of 315 consecutive patients who attended the practice and 93 individuals who had not attended the practice for at least 12 months were studied. Individuals in both groups were provided with a short, anonymous questionnaire about their desire for general health screening. Although roughly equal proportions of the attenders (93%) and non-attenders (88%) indicated that general health screening was a ‘good idea’, a significantly greater proportion of the attenders (83%) indicated that they would make an appointment and attend the practice for health screening compared to the non-attenders (66%) (P < 0.002). Similarly, a significantly greater proportion of the attenders (33%) indicated that they would seek general health screening, even if not contacted by their doctor, when compared with the non-attenders (16%) (P < 0.001). Thus patients in this study were greatly in favour of general health screening. However, patients who attended the general practice infrequently may represent a population who are relatively resistant to health screening.
Consultants' and Patients' Views about Patient Access to their General Practice Records
Authors: Britten N , Bartholomew J , Morris R , Zander L
Published: February 2018

Semi-structured interviews were conducted with 24 hospital consultants and 47 general practice patients, asking for their opinions about a proposed policy of partial access to records in one general practice. Eleven consultants were opposed to the policy, 10 were in favour and three were classified as ambivalent. Arguments against access were couched largely in terms of consultants' own interests whereas arguments in favour of access were couched in terms of patients' interests. Although 81% of patients interviewed said that they should in principle be allowed to see their own records, only 51% wanted access to their own records. Fears expressed by consultants on patients' behalf are not necessarily well founded.
A Comparison of Human and Animal Botulism: A Review
Authors: Critchley E M R
Published: February 2018

Botulism can arise from preformed toxin, wound infection or intestinal toxico-infection. All three forms can occur in humans as well as in animals. The examination of botulism in veterinary practice can alert the medical profession to the hazards which can occur with the introduction of dietary alterations and hermetic sealing of foodstuffs. There is also the possibility that the development of pica through lack of essential nutrients could lead to the ingestion of contaminated substances rendering the child (or even adult) susceptible to botulinum intoxication. A positive gain has been that research leading to the elimination of shaker foal disease has provided a comprehensive analysis of factors which may underline the risk of toxico-infection in infants12.
Frontal Lobe Dysfunction in Schizophrenia and Parkinson's Disease-a Meeting Point for Neurology, Psychology and Psychiatry: Discussion Paper
Authors: Reading P J
Published: February 2018

The psychotic features of schizophrenia and the motor problems of Parkinson's disease, respectively, allow striking contrasts to be made between the two disorders. However, it has recently become apparent that the two groups of patients share problems of mentation that are best explained by some dysfunction of the prefrontal cortical areas of the brain. These commonalities are addressed in terms of neurobiological fact and psychological theory, providing possible insight into the neuropsychology of schizophrenia and its dichotomous nature. In particular, the putative role of abnormal frontostriatal interactions in the two disease states is emphasized.
Anal Cancer: The Case for Earlier Diagnosis
Authors: Edwards A T , Morus L C , Foster M E , Griffith G H
Published: February 2018

The results of treatment in 22 patients with anal carcinoma are reviewed. The overall results are disappointing with only five (28%) surviving more than 5 years. The commonest form of treatment during the study period was an abdomino-perineal excision of rectum (APER). For patients with tumours less than 2 cm in diameter local excision is an acceptable alternative.

The majority (76%) of tumours were diagnosed as common benign conditions by the referring practitioners leading to a delay in initiating definitive treatment. Most tumours (81%) were greater than 2 cm in diameter and therefore unsuitable for local excision.

There was a high recurrence rate (76%) amongst the group treated by APER. This along with the poor overall survival is probably due to late presentation.
Should General Practitioners Refer More Patients to Hospital?
Authors: Roland M O , Green C A , Roberts S O B
Published: February 2018

Twenty-two patients with skin problems were identified on the basis that their general practitioner was satisfied with their management and had no intention of referring them to hospital. These patients were reviewed by one of two dermatologists who made treatment recommendations in 14 cases, and these suggestions were taken up by 11 patients. Six patients reported definite subjective improvement in their skin condition six weeks later. The general practitioners found the consultation valuable in 17 cases.

Although these patients might have improved without the dermatologists' intervention, a group of patients may exist who would benefit from specialist advice, even though that advice has not been sought. Restriction on hospital referrals could therefore be detrimental to patient care. Controlled trials could be conducted to determine the benefit of specialist advice on patients not currently seen in hospital.
Anoxic Asphyxia – a Cause of Industrial Fatalities: A Review
Authors: James P B , Calder I M
Published: February 2018

The investigation of commercial diving accidents has indicated that the danger of anoxia, from the inhalation of gases not containing oxygen, is not fully recognized. The problem is more common in a variety of general industrial situations and is an occasional cause of death in anaesthesia. It is a particular hazard with inert gases, which, because they are recognized to be non-toxic, give a false sense of security. The pathological findings consist of pulmonary oedema and petechial haemorrhages, mainly in the brain, lungs and myocardium. Whenever possible, a minimum oxygen content should be included in all gases liable to be respired, but where this is not possible, oxygen analysers and alarms should be provided. Where a general hazard exists, personnel must be warned of the danger.
Pregnancy and Drug Addiction – Long-Term Consequences
Authors: Fraser Alasdair C , Cavanagh Sharon
Published: February 2018

With the prevalence of drug addiction amongst young women rising in the United Kingdom the problems associated with pregnancy in this group are increasingly being reported. An attempt has been made to determine whether the birth of a baby is a sufficient stimulus for the mother to cease her drug of addiction. Between the years 1966 and 1988, 86 such mothers gave birth at St Mary's Hospital, London, whom we were able to trace for at least one year after their last delivery.

The results show that the majority of mothers continued with their drug use and where this is so the chances of the child remaining with her are markedly reduced.

Discussion centres around possible ways of identifying those likely to succeed in drug withdrawal during pregnancy and the need for increasing and continued support for these mothers and their babies after they have left hospital.
The European Academy of Anesthesiology – 1992 and Beyond
Authors: Zorab John S M , Vickers M D
Published: February 2018

The European Academy of Anaesthesiology was founded in 1978 as a means of meeting the challenges resulting from the introduction of the Medical Directives permitting the free movement of doctors within the European Community. The Academy is a scientific forum for anaesthetists throughout Europe -not just the EC countries - and has established its own English-language journal and multi-lingual Diploma examination. It is now embarking on a system of hospital recognition linked to intraining examinations. With the help of industry and a professional communications organization, it is also exploring the production of multi-lingual educational packages. It is believed that for effective evolution of hospital practice in Europe, medical specialties need to have their own academic organizations which will develop specialist training and which are in a position to provide appropriate advice to relevant national and European bodies.
Anterior Pelvic Reconstruction with Ileum after Cancer Treatment
Authors: Hendry W F , Christmas T J , Shepherd J H
Published: February 2018

Ileum has been used to reconstruct the lower urinary tract in 15 patients (10 women, five men) after treatment for bladder or gynaecological cancer. Seven patients had previously received radical pelvic irradiation. Four methods were used: group 1 (five patients): bladder patch after partial cystectomy or bladder augmentation after clam cystotomy for bladder contracture; group 2 (four patients): bladder replacement after subtotal (supratrigonal) cystectomy; group 3 (two patients): ureteric replacement for lower ureteric obstruction or fistula, and group 4 (four patients): complete replacement of bladder and lower ureters after anterior pelvic exenteration, with creation of neovagina from caecum in the two female patients.

Review of the results indicates that ileum provides a versatile and safe material for anterior pelvic reconstruction in cancer patients, even after previous pelvic irradiation.
Beneficial Effects of Pet Ownership on Some Aspects of Human Health and Behaviour
Authors: Serpell James
Published: February 2018

A 10-month prospective study was carried out which examined changes in behaviour and health status in 71 adult subjects following the acquisition of a new pet (either dogs or cats). A group of 26 subjects without pets served as a comparison over the same period. Both pet-owning groups reported a highly significant reduction in minor health problems during the first month following pet acquisition, and this effect was sustained in dog owners through to 10 months. The pet-acquiring groups also showed improvements in their scores on the 30-item General Health Questionnaire over the first 6 months and, in dog owners, this improvement was maintained until 10 months. In addition, dog owners took considerably more physical exercise while walking their dogs than the other two groups, and this effect continued throughout the period of study. The group without pets exhibited no statistically significant changes in health or behaviour, apart from a small increase in recreational walking. The results provide evidence that pet acquisition may have positive effects on human health and behaviour, and that in some cases these effects are relatively long term.
An Outbreak of Chickenpox in a Military Field Hospital-the Implications for Biological Warfare
Authors: Hepburn N C , Brooks T J G
Published: February 2018

An outbreak of chickenpox with spread to patients and staff on the isolation ward of a British field hospital during the Gulf war is described. The implications for the design and operation of field hospital isolation units should transmissible biological warfare agents be encountered in any future conflict are discussed.
Use of the Emergency Ambulance Service to an Inner City Accident and Emergency Department – a Comparison of General Practitioner and ‘999’ Calls
Authors: Pennycook A G , Makower R M , Morrison W G
Published: February 2018

Over a 2-week period a prospective study was undertaken of patients brought to an inner city accident and emergency department by the emergency ambulance service. Criteria for assessing the appropriateness of use of the emergency ambulance service are not well defined and at worst entirely subjective. The author's finding that, of patients attending after a ‘999’ call, 49.8% were discharged with no follow-up suggests that many of these journeys represented inappropriate use of the emergency ambulance service. Close liaison between senior medical staff and the emergency ambulance service may allow more appropriate and effective use of the service, improving patient care in the pre-hospital setting.
Hydrocarbon accumulation and formation of composite reservoirs in KL16-1 of Laizhou Bay Sag, Bohai Sea, China
Authors: Xu Yunlong , Luo Xiaoping , Wei Ajuan , Hou Mingcai , Wu Haoming , Li Yong
Published: February 2018

The Laizhou Bay Sag, one of the oil-bearing sags with large exploration potential in the South Bohai Sea of China, contains two sets of high-quality hydrocarbon source rocks, i.e. Member 3 and Member 4 of Shahejie Fm (E2s3 and E2s4). As an important hydrocarbon accumulation zone in the sag, the KL16-1 low bulge is found to have oil reservoirs in the Neogene Guantao Fm (N1g), the Paleogene Dongying Fm (E3d), the Paleogene Shahejie Fm (E2s), and the Mesozoic buried hill formation. It is characterized by distinct features of composite reservoirs. Nonetheless, its hydrocarbon accumulation process and mechanism are unknown yet. In this paper, the hydrocarbon generation modelling of source rocks, combined with the characteristics of oil-source rock biomarker compounds and fluid inclusions, is used to restore the hydrocarbon accumulation process in the KL16-1 low bulge. Crude oil in all three KL16-1 plays is characterized by low Pr/Ph, low gammacerane, high 4-methyl sterane and high dinosterane. In other words, it is oil of low maturity to maturity. As the biomarker index of the oil is very similar to that of the E2s3 source rocks, it is thought that E2s3 is the primary source rock layer, while E2s4 is the secondary source rock layer. In addition, episodic oil and gas charging happened in two phases under high pressure in the late period (from 5.0 Ma till now).