bluuebunny/crossref_metadata_2025 huggingface dataset:
Signal-averaged P wave analysis for delineation of interatrial conduction – Further validation of the method
Authors: Holmqvist Fredrik , Platonov Pyotr G , Havmöller Rasmus , Carlson Jonas
Published: October 2007

Background

The study was designed to investigate the effect of different measuring methodologies on the estimation of P wave duration. The recording length required to ensure reproducibility in unfiltered, signal-averaged P wave analysis was also investigated. An algorithm for automated classification was designed and its reproducibility of manual P wave morphology classification investigated.

Methods

Twelve-lead ECG recordings (1 kHz sampling frequency, 0.625 μV resolution) from 131 healthy subjects were used. Orthogonal leads were derived using the inverse Dower transform. Magnification (100 times), baseline filtering (0.5 Hz high-pass and 50 Hz bandstop filters), signal averaging (10 seconds) and bandpass filtering (40–250 Hz) were used to investigate the effect of methodology on the estimated P wave duration. Unfiltered, signal averaged P wave analysis was performed to determine the required recording length (6 minutes to 10 s) and the reproducibility of the P wave morphology classification procedure. Manual classification was carried out by two experts on two separate occasions each. The performance of the automated classification algorithm was evaluated using the joint decision of the two experts (i.e., the consensus of the two experts).

Results

The estimate of the P wave duration increased in each step as a result of magnification, baseline filtering and averaging (100 ± 18 vs. 131 ± 12 ms; P < 0.0001). The estimate of the duration of the bandpass-filtered P wave was dependent on the noise cut-off value: 119 ± 15 ms (0.2 μV), 138 ± 13 ms (0.1 μV) and 143 ± 18 ms (0.05 μV). (P = 0.01 for all comparisons).

The mean errors associated with the P wave morphology parameters were comparable in all segments analysed regardless of recording length (95% limits of agreement within 0 ± 20% (mean ± SD)). The results of the 6-min analyses were comparable to those obtained at the other recording lengths (6 min to 10 s).

The intra-rater classification reproducibility was 96%, while the interrater reproducibility was 94%. The automated classification algorithm agreed with the manual classification in 90% of the cases.

Conclusion

The methodology used has profound effects on the estimation of P wave duration, and the method used must therefore be validated before any inferences can be made about P wave duration. This has implications in the interpretation of multiple studies where P wave duration is assessed, and conclusions with respect to normal values are drawn.

P wave morphology and duration assessed using unfiltered, signal-averaged P wave analysis have high reproducibility, which is unaffected by the length of the recording. In the present study, the performance of the proposed automated classification algorithm, providing total reproducibility, showed excellent agreement with manually defined P wave morphologies.
Induction of multi-antigen multi-stage immune responses against Plasmodium falciparum in rhesus monkeys, in the absence of antigen interference, with heterologous DNA prime/poxvirus boost immunization
Authors: Jiang George , Charoenvit Yupin , Moreno Alberto , Baraceros Maria F , Banania Glenna , Richie Nancy , Abot Steve , Ganeshan Harini , Fallarme Victoria , Patterson Noelle B , Geall Andrew , Weiss Walter R , Strobert Elizabeth , Caro-Aquilar Ivette , Lanar David E , Saul Allan , Martin Laura B , Gowda Kalpana , Morrissette Craig R , Kaslow David C , Carucci Daniel J , Galinski Mary R , Doolan Denise L
Published: October 2007

The present study has evaluated the immunogenicity of single or multiplePlasmodium falciparum (Pf)antigens administered in a DNA prime/poxvirus boost regimen with or without the poloxamer CRL1005 in rhesus monkeys. Animals were primed withPfCSP plasmid DNA or a mixture ofPfCSP,PfSSP2/TRAP,PfLSA1,PfAMA1 andPfMSP1-42 (CSLAM) DNA vaccines in PBS or formulated with CRL1005, and subsequently boosted with ALVAC-Pf7, a canarypox virus expressing the CSLAM antigens. Cell-mediated immune responses were evaluated by IFN-γ ELIspot and intracellular cytokine staining, using recombinant proteins and overlapping synthetic peptides. Antigen-specific and parasite-specific antibody responses were evaluated by ELISA and IFAT, respectively. Immune responses to all components of the multi-antigen mixture were demonstrated following immunization with either DNA/PBS or DNA/CRL1005, and no antigen interference was observed in animals receiving CSLAM as compared toPfCSP alone. These data support the down-selection of the CSLAM antigen combination. CRL1005 formulation had no apparent effect on vaccine-induced T cell or antibody responses, either before or after viral boost. In high responder monkeys, CD4+IL-2+ responses were more predominant than CD8+ T cell responses. Furthermore, CD8+ IFN-γ responses were detected only in the presence of detectable CD4+ T cell responses. Overall, this study demonstrates the potential for multivalentPfvaccines based on rational antigen selection and combination, and suggests that further formulation development to increase the immunogenicity of DNA encoded antigens is warranted.
Suicide in deaf populations: a literature review
Authors: Turner Oliver , Windfuhr Kirsten , Kapur Navneet
Published: October 2007

Background

Studies have found that deaf individuals have higher rates of psychiatric disorder than those who are hearing, while at the same time encountering difficulties in accessing mental health services. These factors might increase the risk of suicide. However, the burden of suicidal behaviour in deaf people is currently unknown.

The aim of the present review was to provide a summary of literature on suicidal behaviour with specific reference to deaf individuals. The objectives of the review were to establish the incidence and prevalence of suicidal behaviour in deaf populations; describe risk factors for suicidal behaviour in deaf populations; describe approaches to intervention and suicide prevention that have been used in deaf populations.

Methods

A number of electronic databases (e.g. Medline, PsycINFO, CINAHL, EMBASE, Dissertation Abstracts International, Web of Science, ComDisDome, ASSIA, Education Sage Full Text, Google Scholar, and the grey literature databases FADE and SIGLE) were explored using a combination of key words and medical subject headings as search terms. Reference lists of papers were also searched. The Science and Social Sciences Citation Index electronic databases were used to identify studies that had cited key papers. We also contacted experts and organisations with an interest in the field.

Results

Very few studies focussed specifically on suicide in deaf populations. Those studies that were included (n = 13) generally involved small and unrepresentative samples. There were limited data on the rate of suicidal behaviour in deaf people. One study reported evidence of hearing impairment in 0.2% of all suicide deaths. Another found that individuals with tinnitus seen in specialist clinics had an elevated rate of suicide compared to the general population. The rates of attempted suicide in deaf school and college students during the previous year ranged from 1.7% to 18%, with lifetime rates as high as 30%. Little evidence was found to suggest that risk factors for suicide in deaf people differed systematically from those in the general population. However, studies did report higher levels of depression and higher levels of perceived risk among deaf individuals than hearing control groups. No firm evidence was found regarding the effectiveness of suicide prevention strategies in deaf people, but suggested strategies include developing specific screening tools, training clinical staff, promoting deaf awareness, increasing the availability of specialist mental health services for deaf people.

Conclusion

There is a significant gap in our understanding of suicide in deaf populations. Clinicians should be aware of the possible association between suicide and deafness. Specialist mental health services should be readily accessible to deaf individuals and specific preventative strategies may be of benefit. However, further research using a variety of study designs is needed to increase our understanding of this issue.
Concurrent Chemotherapy and Intensity-Modulated Radiation Therapy for Anal Canal Cancer Patients: A Multicenter Experience
Authors: Salama Joseph K. , Mell Loren K. , Schomas David A. , Miller Robert C. , Devisetty Kiran , Jani Ashesh B. , Mundt Arno J. , Roeske John C. , Liauw Stanley L. , Chmura Steven J.
Published: October 2007

Purpose

To report a multicenter experience treating anal canal cancer patients with concurrent chemotherapy and intensity-modulated radiation therapy (IMRT).

Patients and Methods

From October 2000 to June 2006, 53 patients were treated with concurrent chemotherapy and IMRT for anal squamous cell carcinoma at three tertiary-care academic medical centers. Sixty-two percent were T1-2, and 67% were N0; eight patients were HIV positive. Forty-eight patients received fluorouracil (FU)/mitomycin, one received FU/cisplatin, and four received FU alone. All patients underwent computed tomography–based treatment planning with pelvic regions and inguinal nodes receiving a median of 45 Gy. Primary sites and involved nodes were boosted to a median dose of 51.5 Gy. All acute toxicity was scored according to the Common Terminology Criteria for Adverse Events, version 3.0. All late toxicity was scored using Radiation Therapy Oncology Group criteria.

Results

Median follow-up was 14.5 months (range, 5.2 to 102.8 months). Acute grade 3+ toxicity included 15.1% GI and 37.7% dermatologic toxicity; all acute grade 4 toxicities were hematologic; and acute grade 4 leukopenia and neutropenia occurred in 30.2% and 34.0% of patients, respectively. Treatment breaks occurred in 41.5% of patients, lasting a median of 4 days. Forty-nine patients (92.5%) had a complete response, one patient had a partial response, and three had stable disease. All HIV-positive patients achieved a complete response. Eighteen-month colostomy-free survival, overall survival, freedom from local failure, and freedom from distant failure were 83.7%, 93.4%, 83.9%, and 92.9%, respectively.

Conclusion

Preliminary outcomes suggest that concurrent chemotherapy and IMRT for anal canal cancers is effective and tolerated favorably compared with historical standards.
Human Papillomavirus-16 Is the Predominant Type Etiologically Involved in Penile Squamous Cell Carcinoma
Authors: Heideman Daniëlle A.M. , Waterboer Tim , Pawlita Michael , Delis-van Diemen Pien , Nindl Ingo , Leijte Joost A. , Bonfrer Johannes M.G. , Horenblas Simon , Meijer Chris J.L.M. , Snijders Peter J.F.
Published: October 2007

Purpose

Human papillomavirus (HPV) infections are suggested to be involved in the development of penile squamous cell carcinoma (SCC), but comprehensive studies to define the association are limited. Therefore, we performed molecular and serologic analyses for a broad spectrum of HPV types on a large series of 83 penile SCCs, and we compared serological findings to those of age-matched male controls (N = 83).

Methods

Penile SCCs were subjected to detection and typing assays for mucosal and cutaneous HPVs and to subsequent, type-specific viral load and viral gene expression assays. Sera of patients and of controls were analyzed for type-specific mucosal and cutaneous HPV L1, E6, and/or E7 antibodies using bead-based, multiplex serology.

Results

HPV DNA of mucosal and/or cutaneous types was found in 46 of 83 (55%) penile SCCs. HPV16 was the predominant type, appearing in 24 (52%) of 46 of penile SCCs. The majority of HPV16 DNA–positive SCCs (18 of 24; 75%) demonstrated E6 transcriptional activity and a high viral load. Additionally, HPV16 molecular findings were strongly associated with HPV16 L1-, E6-, and E7-antibody seropositivity. Furthermore, serologic case-control analyses demonstrated that, in addition to the association of HPV16 with penile SCC, seropositivity against any HPV type was significantly more common in patients compared with in controls. HPV18 and HPV6 seropositivity were associated with HPV16-negative SCCs but were not correlated to molecular findings.

Conclusion

HPV16 is the main HPV type etiologically involved in the development of penile SCC. Although individuals who develop penile SCC show a greater prior exposure to a broad spectrum of HPV types, insufficient evidence was found to claim a role for HPV types other than HPV16 in penile carcinogenesis.
Cisplatin Plus Gemcitabine or Vinorelbine for Elderly Patients With Advanced Non–Small-Cell Lung Cancer: The MILES-2P Studies
Authors: Gridelli Cesare , Maione Paolo , Illiano Alfonso , Piantedosi Franco Vito , Favaretto Adolfo , Bearz Alessandra , Robbiati Sergio Federico , Filipazzi Virginio , Lorusso Vito , Carrozza Francesco , Iaffaioli Rosario Vincenzo , Manzione Luigi , Gallo Ciro , Morabito Alessandro , Perrone Francesco
Published: October 2007

Purpose

Two phase I/II trials were done to evaluate the feasibility of cisplatin combined with gemcitabine or vinorelbine in elderly patients with advanced non–small-cell lung cancer (NSCLC).

Patients and Methods

Patients with advanced NSCLC who were older than 70 years of age and who had a performance status of 0 to 1 were eligible. Cisplatin was given on day 1 (a starting dose of 50 mg/m2 with increasing increments of 10 mg/m2 at each level) and gemcitabine (1,000 mg/m2) or vinorelbine (25 mg/m2) on days 1 and 8. Cycles were repeated every 21 days. A two-stage flexible optimal design was applied in the phase II study, and unacceptable toxicity was the primary end point.

Results

Overall, 159 patients were enrolled: 38 in phase I and 121 in phase II studies. Cisplatin was feasible at 60 mg/m2 with gemcitabine and at 40 mg/m2 with vinorelbine. With the former combination, 50 of 60 (83.3%) patients were treated without unacceptable toxicity; objective responses were reported in 26 of 60 patients (43.5%; 95% CI, 30.6 to 56.8); median progression-free and overall survivals were 25.3 and 43.6 weeks, respectively. With the latter combination, 50 (82.0%) of 61 patients were treated without unacceptable toxicity; objective responses were reported in 22 of 61 patients (36.1%; 95% CI, 24.2 to 49.4); median progression-free and overall survivals were 21.1 and 33.1 weeks, respectively.

Conclusion

Both cisplatin (60 mg/m2) plus gemcitabine and cisplatin (40 mg/m2) plus vinorelbine are feasible and active in the treatment of elderly patients with advanced NSCLC. The former combination, which provides a higher dose of cisplatin, deserves comparison versus single-agent chemotherapy in this setting of patients.
Determination of the Absolute Configuration of Primary Amines in Polar NMR Solvents
Authors: Ahn Hee Choon , Choi Kihang
Published: October 2007

N-(2-Nitrophenyl)proline (2-NPP) can be used in a wide range of solvents as an effective chiral auxiliary for the absolute configuration assignment of α-chiral primary amines. Even in competitive hydrogen-bonding solvents, 2-NPP amides of primary amines retain the conformation preference for intramolecular hydrogen bonding and produce significant anisotropic effects on the amine substituents. As a result, the absolute configuration can be assigned by comparing the 1H NMR spectra of diastereomeric 2-NPP amides recorded in polar NMR solvents.
Biochemical analysis of pleural and ascitic fluid: effect of sample timing on interpretation of results
Authors: Jenkinson Fiona , Murphy Michael J
Published: October 2007

Background: Modified Light's criteria are widely used to categorize pleural fluids as either exudates or transudates. Similarly, the serum-ascites albumin gradient (SAAG) is used in the differential diagnosis of ascites, particularly with reference to the prediction of portal hypertension. Fluid and serum samples are required for both of these to be applied. The effect of the time interval between fluid and serum samples on the interpretation of results has not been studied.

Methods: We examined the effect of sample timing on (a) the application of modified Light's criteria, and (b) the categorization of SAAG as wide (≥11 g/L) or narrow (<11 g/L). Specifically, we compared the use of a 'routine' serum sample, i.e. one that was not formally paired by the requesting clinician with the fluid sample, with serum samples collected within 2 h of the fluid sample.

Results: Of 77 pleural fluids included for analysis, 45/47 were categorized as exudates, and 32/30 as transudates, using near-simultaneous/routine serum samples respectively. Discrepant categorization was observed in two cases ( P=0.74). Of 109 ascitic fluids, SAAG was ≥11 g/L in 100/95 cases, and <11 g/L in 9/14, using near-simultaneous/routine serum samples respectively. Discrepant categorization was observed in five cases ( P=0.27).

Conclusions: With reference to categorizing pleural and ascitic fluids as described above under (a) and (b), in most cases the use of routine serum samples does not alter the fluid categorization compared with the use of serum samples collected within 2 h.
Can we manage demand for allergy testing by restricting requests to a small number of prime target allergens?
Authors: Reynolds Timothy M , Twomey Patrick J
Published: October 2007

Background: Demand for expensive tests such as allergen-specific IgE is expanding far faster than for cheaper tests: at Burton Hospital the annual growth rate is 24%. Different hospitals have different policies on allergen testing. We report a comparison of the effect of requesting policy on diagnostic yield.

Methods: All results from five years of allergen testing were downloaded from the data warehouse at Burton, and a representative sample of recent results was evaluated from Ipswich Hospital. Statistical analysis by x2 test and significance tests for differences of proportions were carried out.

Results: Ipswich hospital used a standard four-allergen panel for respiratory patients and demonstrated a statistically significantly lower positivity rate for three of those four allergens. No relationship between the number of allergens tested and the probability of a positive result was shown - the probability of a positive result was approximately 0.3. Number of allergen-specific IgE tests requested/patient have remained roughly constant over 5½ years but total demand has increased.

Conclusions: Selective requesting for allergen-specific IgE testing may be more effective than use of a standard panel but this cannot be conclusively proven. It is not appropriate to attempt to limit workload by specifying a maximum number of tests that are allowed for any individual patient.
Central pontine myelinolysis following 'optimal' rate of correction of hyponatraemia with a good clinical outcome
Authors: Georgy V , Mullhi D , Jones A F
Published: October 2007

Central pontine myelinolyis (CPM), an acute demyelinating condition of the brain stem, is a recognized complication of the treatment of patients with chronic hyponatraemia (hyponatraemia >48 h), particularly in those who abuse alcohol. The risk of CPM is believed to be associated with a rapid (>8 mmol/L/day) correction of the serum sodium concentration, which is said to lead to an osmotically-induced demyelination. CPM is also commonly believed to have a poor, and often fatal, outcome. We report the case of a 37-year-old female alcoholic patient who presented following a collapse, and who was hyponatraemic (serum sodium concentration 105 mmol/L). The rate at which the serum sodium concentration was corrected to normal was less than the 8 mmol/L/day guideline, but nonetheless she developed the clinical and radiological features of CPM. She made a good neurological recovery, however, and was able to be discharged from hospital. CPM does not necessarily have a bleak prognosis, and may occur even with optimal rates of correction of the serum sodium concentration. Clinicians should recognize that the outcome of CPM is not inevitably poor, and the complication may occur despite appropriate management. It is possible that CPM is a complication of the hyponatraemia itself, rather than the treatment of the biochemical disturbance.
Evaluation of a card test for procalcitonin in continuous ambulatory peritoneal dialysis peritonitis
Authors: Yilmaz Fatma Meriç , Yilmaz Gülsen , Akay Hatice , Duranay Murat , Yücel Doğan
Published: October 2007

Background: Peritonitis is an important complication in continuous ambulatory peritoneal dialysis (CAPD) patients. Procalcitonin (PCT) has recently been identified as an inflammation marker and recommended as a new potential marker in CAPD peritonitis. We aimed to study a card test for PCT and compare the results with the conventional markers such as C-reactive protein (CRP), erythrocyte sedimentation rate (ESR) and white blood cell (WBC) count.

Patients and methods: A total of 40 CAPD patients; 20 patients with an episode of peritonitis and 20 patients without any clinical or laboratory sign of infection were included in the study. PCT, CRP, ESR, WBC and dialysate cell count were performed at the beginning of the clinical signs of peritonitis.

Results: CRP and ESR had the highest sensitivities (100% for both) but lower specificities (55 and 10%; respectively) and PCT had the highest specificity with a relatively low sensitivity (100 and 70%) according to the calculated results.

Conclusions: The card test for PCT seems to be suitable for the adjunctional use in CAPD peritonitis, with its shorter turn-around time, appropriateness for near-patient testing and high specificity.
Successful rescue of severe hypernatraemia (196 mmol/L) by treatment with hypotonic fluid
Authors: Jeffery Jinny , Ayling Ruth M , McGonigle Richard J S
Published: October 2007

Hypernatraemia over 160 mmol/L is considered to be severe. This case reports a patient who developed extreme hypernatraemia with a serum sodium concentration of 196 mmol/L. The patient was known to have chronic renal impairment and was admitted with acute deterioration of renal function secondary to dehydration. This was considered to be secondary to poor oral fluid intake (related to depression) and lithium-induced nephrogenic diabetes insipidus with salt-losing nephropathy. The patient had a high urinary sodium excretion but was also in a pure water losing state as evidenced by an inappropriately low urine osmolality for the plasma osmolality and was successfully treated with hypotonic intravenous fluid and desmopressin.
The relation among the diameter of the great saphenous vein, clinical state and haemodynamic pattern of the saphenofemoral junction in chronic superficial venous insufficiency
Authors: Mdez-Herrero A , Gutiérrez J , Camblor L , Carreño J , Llaneza J , Rguez-Olay J , Suarez E
Published: October 2007

Objective: To find out if there is a relation among the diameter of the great saphenous vein (GSV) when it is incompetent, the clinical gravity of the varicose syndrome and the type of insufficiency of the saphenofemoral junction (SFJ) in patients with chronic venous insufficiency (CVI) by means of duplex exploration.

Methods: The sample included 145 extremities, 38 normal as a control group and 107 with incompetence of the GSV. According to the results of the Valsalva and Parana manoeuvres in the SFJ, they were distributed into four groups. The diameter of the GSV and the clinical state according to the clinical, aetiological, anatomical and pathological element classification were recorded for each group.

Results: Statistically significant differences were obtained for the diameter and the clinical state in patients with positive manoeuvres with regard to other groups. The diameter was greater and the clinical state more severe (C4, C5 and C6) when two manoeuvres were positive.

Conclusions: The presence of both positive manoeuvres in the SFJ is related to severe clinical states and greater diameters of the GSV, allowing the establishment of a prognosis of the CVI and the most suitable surgical approach.
Embryology and three-dimensional anatomy of the superficial venous system of the lower limbs
Authors: Uhl J-F , Gillot C
Published: October 2007

Objectives: The purpose of this study is to better understand the anatomy of the venous network of the lower limbs by using new imaging techniques, particularly the three-dimensional modelling by computerized tomographic (CT) venography. This new tool is combined with anatomical dissection techniques and the results of Duplex ultrasound imaging.

Methods: The embryogenesis of the venous network, which explains the main variations of the venous system, and a description using the new terminology of the veins.

Results: Physiologically, the muscular veins play a crucial role, owing to the effect of the muscular pumps by their aspiration power on the superficial system via the perforators. They always act at the same level. This explains the fixity of the main perforator veins and the interest of their anatomical knowledge.

Conclusion: The new imaging techniques and treatments dedicated to the venous system of the lower limbs make their descriptive anatomy increasingly useful. It will be the basis of a common language between radiologists, phlebologists and surgeons.
Newborn sickle cell disease screening: the Jamaican experience (1995–2006)
Authors: King L , Fraser R , Forbes M , Grindley M , Ali S , Reid M
Published: October 2007

Objectives: The aim of this study was to evaluate the existing newborn sickle haemoglobinopathy screening programme in Jamaica.

Methods: A retrospective analysis of infants screened during the period 8 November 1995 to 22 July 2006 was performed. Patient data for analyses was restricted to patients with homozygous (Hb SS) sickle cell disease. Published data from the Jamaican Sickle Cell Cohort Study was used to make comparisons with the study sample.

Results: The study sample consisted of 435 patients with Hb SS disease. Acute chest syndrome was the most common clinical (non-death) event accounting for ∼50% of all events. Acute splenic sequestration, no longer a significant cause of mortality, was responsible for ∼32% of clinical events. Seven deaths (1.8%) occurred during the study period compared with 17.6% to the same age in the Jamaican Sickle Cell Cohort Study. There was a lower proportion of hospital admissions and episodes of serious illness in the study group compared with controls.

Conclusions: Survival estimates for the study sample showed improvement compared with the Jamaican Sickle Cell Cohort Study. This study continues to demonstrate the benefits of, and as such shows support for, newborn screening and early interventions in sickle cell disease. In addition, it highlights some of the areas for continued focus and research development. Although the current system is providing an essential and beneficial service, the study emphasizes the need for newborn screening programmes to be comprehensive care systems to be fully effective.
Improved survival rate for women with interval breast cancer – results from the breast cancer screening programme in Malmö, Sweden 1976–1999
Authors: Zackrisson Sophia , Janzon Lars , Manjer Jonas , Andersson Ingvar
Published: October 2007

Objective: Breast cancers detected between screening examinations can influence the sensitivity of a screening programme. Studies of the prognosis of these so-called interval breast cancers show diverging results. We investigated the course of interval breast cancer over time in the Malmö Mammographic Screening Trial (MMST) 1976–86 and the Malmö Mammographic Service Screening Programme (MMSSP) 1990–99.

Material and methods: Stage distribution and survival of interval cancers in MMSSP were compared with screen-detected and non-attender cancer cases in MMSSP, with interval cancers in MMST and with breast cancer cases in a non-screened population five years before the start of MMSSP (pre-screening cancer cases).

Results: In MMSSP 1990–99, the interval cancers did not differ in stage distribution or survival compared with cancer cases in non-attenders, while screen-detected cancer cases had more favourable stage distribution and rate of survival than had the interval cancer cases. The MMST interval cancer cases, 1976–1986, had more favourable stage distribution but higher overall case fatality rate, relative risks (RR) 1.78 (1.00–3.20), and breast cancer case fatality rate, RR 2.05 (1.05–4.00), compared with the more recent MMSSP interval cancer cases. No significant difference in five-year survival was seen in the MMSSP interval cancer cases compared with pre-screening cancer cases not exposed to screening.

Conclusion: In this urban population invited to mammographic screening, the survival rate for women with interval cancer has improved over a period of 20 years. Further studies are needed to assess what factors might explain changes in the course of interval breast cancer.
Exclusion on grounds of language ability – a reporting gap in health services research?
Authors: Murray Susan , Buller Ana Maria
Published: October 2007

Background: Health services research practices in the context of ethnic and cultural diversity are under scrutiny. One issue that needs to be considered is that of inclusion in, and exclusion from, research studies on the basis of language ability. We explore current reporting practice concerning recruitment of participants in health services research using examples from one 'high impact' journal and suggest ways in which future reporting can be strengthened.

Methods: Retrospective review of 207 'original research pieces' published in the BMJ. Inclusion criteria: articles published in 2003 and 2004 reporting research entailing direct communication between a researcher and health service users. A data extraction checklist was applied concerning the reporting of language-related decisions in recruitment.

Results: Eighty-four percent of the research articles did not engage with language issues at all. For most papers it was impossible to ascertain whether research was carried out in a monolingual population or whether researchers had effectively excluded non-primary language speakers in their recruitment procedures. Over half ( n = 34) of the papers that mentioned language did so in relation to exclusion criteria, usually without further comment.

Conclusions: Reporting practice on language-related decisions in recruitment and on the exclusion of research participants on grounds of language ability needs to be improved. A checklist for authors, reviewers or editors is offered with the aim of encouraging fuller reporting on the language composition of source and sample populations, and greater consideration of any implications that exclusion/inclusion on the grounds of language may have for studies and their findings.
A review of the outcomes of the recommendations made during paediatric telepsychiatry consultations
Authors: Boydell Katherine M , Volpe Tiziana , Kertes Angela , Greenberg Natasha
Published: October 2007

Little is known about whether the recommendations made during telepsychiatry are actually implemented. We reviewed 100 telepsychiatry consultations, chosen randomly from a paediatric telepsychiatry programme serving rural communities in Ontario. Treatment recommendations had been made for each case reviewed and up to nine recommendations had been made for a single case. Twenty-seven percent of recommendations revolved around monitoring (10%), changing (9%), starting (4%), continuing (3%) and stopping (1%) medication. Case managers associated with 54 of the cases were interviewed to determine whether the recommendations had been implemented and to examine the barriers and facilitators to implementation. The results indicated that cooperation of both child and parent, clear communication of recommendations, involvement of the school and local health providers, stability of the agencies and availability of services were key components in the successful implementation of recommendations. The matter of technology or technological difficulties acting as a barrier to telepsychiatric consultations was not mentioned by case managers, suggesting that it was not a problem.
A cohort study of acute plastic surgery trauma and burn referrals using telemedicine
Authors: Wallace David L , Smith Roger W , Pickford Mark A
Published: October 2007

A store-and-forward telemedicine system was used to supplement normal telephone referrals to the plastic surgery unit at the Queen Victoria Hospital (QVH). During a 12-week prospective study, 11 units (8 hospitals and 3 minor injury units) with the telemedicine system and 10 units (8 hospitals and 2 minor injury units) without it regularly made referrals (at least 10) to the QVH. There were 389 referrals from the telemedicine-equipped units and 607 telephone referrals from the non-telemedicine units. The telemedicine system was used for 246 of the 389 referrals (63%) made from telemedicine-equipped units. There was a significant difference in the management of patients when the telemedicine system was available, with more patients booked directly into day surgery and fewer attending for assessment. The burns unit and the day surgery unit demonstrated a significantly improved accuracy of triage. Telemedicine could have a valuable role to play in the triage and planning of acute plastic surgery referrals.
Support for the clinician in providing a regional telehealth service
Authors: Williams Michael L
Published: October 2007

However attractive the idea of telehealth may appear to them, clinicians in regional hospitals will be preoccupied with clinical matters and are unlikely to have either the time or the expertise necessary to address the infrastructure and organizational aspects of establishing a telehealth service. Our experience of telepaediatrics in Queensland has shown that the support of the central service and coordinator has been essential in overcoming initial difficulties and has freed us as clinicians to concentrate on appropriate clinical referrals and consultation via telehealth. The central service is also able to assist in data collection, and in the analysis and interpretation of telehealth activity, for example in measuring cost-effectiveness. We have found that consolidating most consultations into planned clinics creates efficiency. The central coordinator can teach and support those new to telehealth in the regional and primary care setting, thus relieving the local clinician of this responsibility. As telehealth services expand in a regional centre, having a dedicated local telehealth coordinator may become appropriate. A central telehealth support service, which is clinically focused and responsive to clinicians' needs, is an essential foundation for successful telehealth.
Internet interventions can meet the emotional needs of patients and carers managing long-term conditions
Authors: Murray Elizabeth , Kerr Cicely , Stevenson Fiona , Gore Charles , Nazareth Irwin
Published: October 2007

Experiencing and managing a long-term condition places heavy emotional demands on a patient or carer. We conducted disease-specific focus groups for patients or carers. We recruited adults with diabetes, heart disease or hepatitis C, parents of children with asthma or diabetes, and carers of people with Alzheimer's disease. Participants had sole access to a PC and were asked to use three Internet interventions, each for 30 min. We conducted 10 disease-specific focus groups in three areas of the UK, involving a total of 40 participants. Three main themes emerged from the data: dealing with negative emotions, boosting positive emotions and social support. Designers of Internet interventions should consider users’ emotional needs and how to meet these needs with every section or facility within an intervention.
Problems arising when a system of automated weight monitoring is introduced into the home as part of the care for patients with chronic heart failure
Authors: Johnston Glenis , Weatherburn Gwyneth , Ward Stephen , Hendry Julie
Published: October 2007

Patients with a history of chronic heart failure participated in a study to evaluate a home telemedicine system which monitored their weight daily. Within three weeks of beginning the study, interviews were conducted with patients (n = 5), their partners (n = 4) and their heart failure nurses (n = 3). A thematic analysis was carried out in order to probe their experiences of the illness and their perception of how telemedicine might affect those experiences. When asked, the participants and their partners did not consider that the electronic monitoring system would be much use to them. Nurses also had a number of misconceptions about the telemedicine service. The results demonstrated that patients needed better education, both in the management of their condition and in the use of the telemedicine equipment and the service provided by the call centre, before the telemedicine system could fulfil its potential.
Improved communication between hospital and general practice using online patient discharge summaries
Authors: Scullard Paul , Iqbal Nosheen , White Lindsay , Olla Edward , Thomson George A
Published: October 2007

We compared the information contained in traditional ‘To Take Out (TTO)’ discharge prescriptions and dictated letters with the information in discharge summaries from an online system. We also investigated the satisfaction of general practitioners (GPs) with the two types of discharge communication. One group of 30 patients were discharged using traditional TTOs and dictated letters and a second group of 30 patients was discharged using the computer generated summary. The summaries were assessed against the 17 criteria of the Scottish Intercollegiate Guidelines Network. The number of criteria met in the conventional summaries was 10.5 (SD 4.3); the number of criteria met in the computer-generated summaries was 14 (SD 1.2), which was significantly higher (P<0.002). Twelve of the 30 traditional TTOs (40%) were considered illegible. The response rate to the questionnaire was 86%. Eighty-three percent of responding GPs preferred computer generated discharge summaries. The computer generated discharge summaries largely satisfied the guidelines and were enthusiastically received by the GPs surveyed.
Tele-education may be a valuable approach for educating patients with asthma in under-served communities
Authors: Borgiani Mariana , Böhn György Miklós , Wen Chao Lung
Published: October 2007

In Brazil, few people have access to asthma specialists. We conducted a survey in São Paulo city to evaluate the population's general knowledge about asthma. The results were used to guide the development of a 3-D video for patient education. The video presentation was about 12 min long. It used animated sequences to explain the pathophysiology of asthma (e.g. the anatomy of the respiratory system, the lung, the alveoli, mechanism of respiration). The object was to motivate the general public to change their habits. The motivation video can be delivered via the Internet or by DVD and can used by non-medical professionals. It will need to be tested formally in the context of primary care from the point of view of knowledge retention, cost and patient motivation.
Development of a Web portal to assist in diabetes education and self-management
Authors: Devlin Steven , Harper Roy , Reynolds Phyl , Mccullagh Paul
Published: October 2007

A Web portal was developed to assist in diabetes education and self-management. Access to reliable information is an essential component of effective self-care in diabetes. Education was provided as a series of learning objects, aimed at patients with either Type 1 or Type 2 diabetes. Where appropriate, material was also provided via multimedia learning tools, such as tutorials and interactive quizzes. Throughout the development of the Web portal, periodic assessment was carried out by an expert patient group. This comprised 10 individuals, four of whom had Type 1 diabetes and two with Type 2. The expert group provided feedback to the health-care professionals involved with content development. There were also regular discussion forums with both patients and health-care staff. The portal was designed to facilitate effective self-management, by providing ongoing support with regular feedback on progress.
Perceptions of risk as a barrier to the use of telemedicine
Authors: Mair Frances , Finch Tracy , May Carl , Hiscock Julia , Beaton Susan , Goldstein Pauline , Mcquillan Siobhann
Published: October 2007

There is little published information about the perceptions of risk in the use of telemedicine services. The present study drew on data from two separate research projects. The data comprised interviews with health professionals, technologists, managers and patient advocates involved in telemedicine. The interviews were recorded, transcribed and analysed thematically. Key themes included the need to balance risks against potential benefits and the suggestion that risk was a method of resisting change. Another theme was trust, both in health professionals and the technology itself. It appears that risk management issues may be an important barrier to the implementation of telemedicine services.
An evaluation of the economic impact of ten European e-health applications
Authors: Stroetmann Karl A , Jones Tom , Dobrev Alexander , Stroetmann Veli N
Published: October 2007

We conducted a cost benefit analysis of ten e-health applications in different European countries. All ten cases showed a positive economic impact – a sustainable net benefit. For the ten cases together, it would take four years for the present value of annual benefits to exceed the present value annual costs. The range was from 2 years (for teleradiology) to 7 years (for an electronic patient record system and search meta-engine, and for a Web-based, national electronic health record system). The wide range reflects the differences in scope and complexity between sites. The average time needed for total benefits to exceed total costs was five years. This means that e-health spending must be dealt with as an investment in health-care resources along with other investments in staff and assets, on a medium to long-term planning horizon.
Patient satisfaction with a nurse-led, telephone-based disease management service in Birmingham
Authors: Azarmina Pejman , Lewis Jill
Published: October 2007

In April 2006, a nurse-led telephone-based service was launched in Birmingham to improve the health outcomes of up to 2000 patients with high-risk, long-term conditions. Patients received regular telephone calls and educational materials selected according to their conditions. In August 2006, 506 questionnaires with 30 five-point Likert-type questions were sent to patients and 128 were returned within four weeks (25% response rate). The results showed that 96% of the respondents strongly agreed or agreed that they were satisfied with the quality of service being provided by the care managers. The educational material (care books) was found to be informative, easy to read and easy to understand. The qualitative feedback indicated that patients perceived the service to be useful, accessible and helped them to be more efficient in taking care of themselves. More than 40% of the patients agreed that the service reduced their need to go to hospital. Using a telephone-based disease management service seems to be an acceptable option for patients with long-term conditions in the UK.
vCJD Donor Notification Exercise: 2005
Authors: Hewitt PE , Moore C , Soldan K
Published: October 2007

UK blood services, supported by the Health Protection Agency/Health Protection Scotland, carried out an exercise over the summer of 2005 to notify 110 donors whose blood was transfused to three recipients who later developed vCJD. These donors were to be informed that they were now considered 'at risk of vCJD for public health purposes'. The notification began on 20 July 2005 and was completed (barring follow-up) at the end of the first week of October 2005. Apart from two donors who had died, contact was attempted with all donors, including four who were not currently registered with a GP. The lessons learnt about the conduct of such notification have been reviewed. The limited ad hoc feedback available suggests the process and content of this notification was acceptable to donors and their GPs.
Truth-telling in the doctor-patient relationship: a case analysis
Authors: Sokol Daniel K
Published: October 2007

Using a real-life case involving an accidental discovery of misattributed paternity as a springboard for discussion, I reflect on several practical and theoretical issues surrounding truth-telling in the doctor-patient relationship. I present the moral dilemma and identify arguments in favour of and against disclosure. I then examine the theoretical difficulties in balancing conflicting reasons and in establishing what constitutes the 'truth'. I conclude that withholding the information from the patients would be ethically permissible and, more generally, that honesty is not always the best policy.
Living well and dying well - facing the challenges at a children's hospital
Authors: Larcher Vic , Goldman Ann
Published: October 2007

We outline a process, undertaken at a large tertiary children's hospital, intended to provide practical guidance and support for those involved in the management of children with life-limiting conditions. Initial discussions with representatives of clinical and support services identified communication problems and ethical dilemmas as key issues. These were further explored in multidisciplinary hospital meetings, culminating in a conference (Living Well, Dying Well) where individual perspectives - clinical, multi-faith, parental and legal - and cases were presented. Communication problems were found to involve unrealistic expectations, failures of anticipation and difficulties in discussing sensitive issues, while ethical dilemmas arose from balancing burdens and benefits, clinical uncertainty, respecting autonomy and achieving equity and justice in delivery of care. An integrated service has been developed that is intended to provide clinical and spiritual care, psychosocial and ethical support, advice and mediation for children, families and staff, and to address the latter's educational and training needs.
Clinician autonomy: doctor's orders?
Authors: Price D , Samanta J , Harvey B , Healey P
Published: October 2007

This paper questions the dogmatic stance of the domestic courts toward mandatory orders for treatment, arguing that this has the potential to subjugate patients' interests to clinical discretion, and proposing a via media to accommodate the legitimate concerns of all parties.
The Impact of Regulatory Focus on Adolescents’ Response to Antismoking Advertising Campaigns
Authors: Zhao Guangzhi , Pechmann Cornelia
Published: October 2007

The authors demonstrate that antismoking advertisements are the most persuasive when the viewers’ regulatory focus, the message's regulatory focus, and the message frame function synergistically. In two experiments, 1000 adolescents saw either antismoking advertising about smoking's social consequences or control advertising in a television show. The authors find that for promotion-focused adolescents, a promotion-focused positively framed antismoking message is the most effective at persuading them not to smoke; for prevention-focused adolescents, a prevention-focused negatively framed antismoking message is the most effective. The enhanced ad effectiveness is mediated by message accessibility and diagnosticity.
Book Reviews
Authors: TETREAULT CHANTAL
Published: October 2007

Algeria in France: Transpolitics, Race, and Nation. Paul Silverstein. Bloomington: University of Indiana Press, 2004. xi + 275 pp., bibliography, index.