bluuebunny/crossref_metadata_2025 huggingface dataset:
Schizotypy: Phenotypic Marker as Risk Factor
Authors: Catts Stanley V. , Fox Allison M. , Ward Philip B. , McConaghy Nathaniel
Published: March 2018

Objective

To evaluate measures of schizotypy as familial risk factors for schizophrenia with the aim of making recommendations for assessing schizotypy as part of screening procedures for identifying people at risk of schizophrenia.

Method

Published studies using self-report and interview-based measures of schizotypy to assess relatives of patients with schizophrenia are reviewed. A parent study is reported evaluating the diagnostic accuracy of parental schizotypy as assessed by three questionnaire-based measures: the Chapman Perceptual Aberration and Physical Anhedonia Scales, and the Eysenck Psychoticism Scale. Group scores for these self-report ratings of 23 parent-pairs of patients with schizophrenia, 20 parent-pairs of patients with chronic nonpsychotic psychiatric disorder, and 19 parent-pairs of healthy comparison subjects are compared.

Results

Consistent with published evidence that self-report measures of psychosis-proneness and schizotypy do not consistently reflect familial risk factors that are specific for schizophrenia, scores on questionnaire measures of schizotypy did not distinguish the parents of patients with schizophrenia from the parents in the other two groups.

Conclusions

Interview-based assessments of schizotypy better assess familial risk factors than self-report measures of schizotypy. Questionnaire measures of schizotypy should be supplemented by interview-based assessments when screening for individuals at risk of schizophrenia.
Biological Markers and Schizophrenia
Authors: Copolov David , Crook Jeremy
Published: March 2018

Objective

The delivery of biological markers for schizophrenia would greatly assist preventative strategies by identifying at-risk individuals who could then be monitored and treated in a manner with a view to minimising subsequent morbidity. This paper aims to present a selection of biological measures that may indicate risk of schizophrenia.

Method

A selective and brief review is provided of intensively studied putative markers, including enlarged cerebral ventricles, dopamine D2receptor density, amphetamine-stimulated central nervous system dopamine release, plasma homovanillic acid and smooth pursuit eye tracking dysfunction.

Results

A number of biological measures have been reported to be correlated with schizophrenia.

Conclusions

Presently, none of these measures has satisfactory performance characteristics in terms of predictive validity, noninvasiveness, ease of testing and low cost that would enable their widespread use. However, a few have potential for further investigation and development.
Structural Brain Imaging and the Prevention of Schizophrenia: Can We Identify Neuroanatomical Markers for Young People at Risk for the Development of Schizophrenia?
Authors: Ward Philip B.
Published: March 2018

Objective

To examine the potential role of measures derived from structural brain imaging as phenotypic markers for the development of schizophrenia.

Method

Literature review of results of MRI-based assessments of brain structure in patients with schizophrenia, their first-degree relatives and factors that affect interpretation of such results.

Results

Reliable differences in brain structure can be detected in patients with schizophrenia, including those experiencing a first episode of psychosis. Further research is required to determine whether these differences are progressive, how they relate to potential confounding factors such as comorbid substance abuse and the functional consequences of the relatively subtle changes observed.

Conclusions

Further research is needed before structural brain change can be considered as a phenotypic marker for those at risk of developing schizophrenia. Large-scale collaborative research in clinical and normal volunteer groups using standardised assessment protocols would enable the early identification of those findings with predictive power in at-risk populations.
General Practice Recruitment for People at Risk of Schizophrenia: The Buckingham Experience
Authors: Falloon Ian R. H.
Published: March 2018

Objective

The process of detecting people at high risk of schizophrenia from a community sample is a major challenge for prevention of psychotic disorders. The aim of this paper is to describe early detection procedures that can be implemented in primary care settings.

Methods

A selected literature review is supplemented by experiences and data obtained during the Buckingham Integrated Mental Health Care Project.

Results

General medical practitioners have been favoured as the agents most likely to prove helpful in detecting the key risk factors that predict the onset of schizophrenic disorders, as well as in recognising the earliest signs and symptoms of these conditions. However, the practical problems of screening for multiple and subtle risk factors in general practice are substantial, and general practitioners (GPs) often have difficulty recognising the earliest signs of a psychotic episode. A range of strategies to assist GPs detect early signs of psychosis in their patients are considered.

Conclusions

It is feasible to implement primary care setting early detection procedures for people at risk of schizophrenia. Implementation is aided by the use of a brief screening questionnaire, training sessions and case supervision; and increased collaboration with mental health services and other community agencies.
General Practice Recruitment for Schizophrenia Prevention Studies
Authors: Harris Mark
Published: March 2018

Objective

To examine the barriers and incentives that may exist for Australian general practitioners (GPs) to screen for and detect individuals at risk of developing schizophrenia and to participate in studies aimed at assessing screening procedures.

Method

Examination of literature, existing procedures in general practice, informed by experience in the GP Integration Support, Evaluation and Resource Unit during 1995–1999 and the General Practice Integration Research Programme and the reports arising from this.

Results

The attitudes and responses of GPs to research proposals and to working with researchers will be influenced by their overall relationship with mental health services. As the average GP will only have a small caseload of patients with schizophrenia, it is important to provide some incentive to encourage GP involvement in schizophrenia prevention studies. Key incentives include: the availability of specialist support from mental health practitioners; systems development in general practice; inclusion in the research team; and Quality Assurance points.

Conclusions

General practitioners have shown willingness to engage in a diversity of research projects, including mental health research. Divisions of General Practice are increasingly interested in evaluation and research and may be a useful entry point for approaching GPs as a group.
Evaluating the Importance of Reducing the Duration of Untreated Psychosis
Authors: McGorry Patrick D.
Published: March 2018

Objective

The concept of duration of untreated psychosis or DUP has been a strong candidate for intervention as part of the early intervention paradigm. However, its importance has been questioned. This paper aims to present selected issues concerning attempts to reduce DUP and evaluate the impact of these attempts.

Method

Current research designs are critiqued and alternatives considered.

Results

Evidence suggests that it is difficult to design studies that are both ethical and potent enough to determine the contribution of treatment delay to outcome.

Conclusions

Further research is justified but this should not obstruct commonsense service reforms.
Identification of Young People at Risk of Psychosis: Validation of Personal Assessment and Crisis Evaluation Clinic Intake Criteria
Authors: Phillips Lisa J. , Yung Alison R. , McGorry Patrick D.
Published: March 2018

Objective

To describe the development and validation of the criteria used at the Personal Assessment and Crisis Evaluation (PACE) Clinic to identify young people at ‘ultra-high’ risk of developing a psychotic disorder within a short follow-up period.

Method

The PACE Clinic criteria initially grew out of clinical observations and retrospective research describing the prodromal phase of first-episode psychosis. Early prospective research refined the criteria into the three intake groups for the Clinic. These criteria combine putative state and trait risk factors for psychosis. Whether or not a person meets criteria for one or more of these groups can usually be determined by a thorough psychological assessment interview. Two early studies are described that assess the validity of this screening protocol.

Results

The transition rate to acute psychosis of the ‘ultra-high’ risk group identified in the second study was 41%.

Conclusions

These results suggest that it is possible to accurately identify young people at imminent risk of psychosis. The PACE criteria have now been adopted (or adapted) by a number of other clinical research programs both in Australia (i.e. Psychological Assistance Service in Newcastle) and other programs in the United States and elsewhere. This research may lead the way to the development of preventive interventions for the ultra-high risk group.
Early Intervention and Sustaining the Management of Vulnerability
Authors: Birchwood Max
Published: March 2018

Objective

The purpose of this article is to consider the issue of how long early intervention needs to be sustained to have a long-term impact on the course of psychosis.

Method

Factors relevant to the concept of secondary prevention in psychosis are discussed. The need for sustained intervention for long-term impact on psychosis is examined. Evidence concerning the length of time required for the maximal impact of early intervention services and interventions that have been demonstrated as effective in achieving long-term change is reviewed. The article discusses individuals of low and high vulnerability to schizophrenia and the interaction between this vulnerability and the length and type of treatment they require to change the deteriorating course of psychosis.

Results

There is increasing evidence for the concept of a ‘critical period’ lasting up to 5 years after first presentation, during which the long-term level of vulnerability to relapse and disability may be determined.

Conclusions

For many highly vulnerable patients, early intervention must be sustained for a minimum of 3 years to prevent or limit the potential for early decline. A core unanswered question is whether effective early intervention prevents potential long-term disability or merely delays it.
Problem Solving as a Core Strategy in the Prevention of Schizophrenia and other Mental Disorders
Authors: Falloon Ian R. H.
Published: March 2018

Objective

To outline the rationale for implementing training in structured problem solving as a primary prevention strategy for major mental disorders.

Method

The evidence that training people in a structured method of solving their personal problems is an effective strategy in the treatment of established cases of schizophrenic and major mood disorders, is selectively reviewed.

Results

Most of the relevant research focused on the prevention of major recurrent episodes of psychosis. There is some evidence to support the hypothesis that this strategy may assist many people to achieve a full and sustained recovery from the clinical and social impairments of these disorders, especially when patients are taught to use structured problem solving with members of their personal resource groups, and they continue to take optimal doses of psychoactive medication. There is support for the hypothesis that the key therapeutic factor associated with these benefits is the improved efficiency of the management of life stress.

Conclusions

The simplicity of problem solving, the educational methods used, and the widespread application to a person's lifestyle would appear to make this a possible candidate for a primary prevention program for major mental disorders. Guidebooks and teaching aids have been developed and show excellent consumer acceptance.
What Genetic Advances Might Mean for the Consumer in Mental Illness
Authors: Mitchell Marilyn
Published: March 2018

Objective

Increased research efforts into screening young people at risk of schizophrenia is anticipated. The aim of the present paper is to consider the ethical concerns raised by this research from a consumer's perspective.

Method

Insights into relevant ethical concerns obtained from personal experiences of psychotic illness are described.

Results

A range of salient ethical issues were identified that need to be addressed in research proposals regarding the screening of people for schizophrenia risk factors.

Conclusions

The importance of research into the development of screening procedures for schizophrenia risk factors suggests that the ethical issues identified need urgent attention. Consumer input is essential in this endeavour.
New Medications in the Treatment of Nonalcoholic Steatohepatitis
Authors: Walker Scot
Published: March 2018

Nonalcoholic fatty liver disease, an accumulation of fat in the liver, is estimated to occur in almost 1 in 5 adults. With 2 of the most common risk factors being obesity and diabetes, its prevalence is growing. Nonalcoholic steatohepatitis is a more severe form of nonalcoholic fatty liver disease. There are currently no approved drugs to treat nonalcoholic steatohepatitis, but several drugs are being developed to treat this disease.
The Personal Hero Technique: A Therapeutic Strategy That Promotes Self-Transformation and Interdependence
Authors: Bland Andrew M.
Published: March 2018

This article introduces and provides initial qualitative support for the effectiveness of the personal hero technique (PHT), a second-order change strategy rooted in humanistic-existential psychology that builds on and practically applies the emerging heroism science literature. Specifically, I ask clients to identify a hero/heroine. Then I ask them to identify five characteristics that they admire in that person, five ways in which they see themselves as similar to that person, and five things they can do to become more like that person. During debriefing, I engage in dialogue with the clients regarding how they may apply insights gleaned from the exercise in the interest of promoting self-reflection and developmental maturation/transformation as well as other-awareness and relational connectedness. In this article, I survey the theoretical/philosophical basis of the PHT and its connections to humanistic-existential principles and other extant heroism literature. Then I describe how to implement the PHT as well as discuss its effectiveness using two case illustrations. Finally, I provide suggestions for future research on the PHT in a variety of contexts.
Exploring the link between work-family conflict and job burnout among Indian police officers
Authors: Lambert Eric G , Qureshi Hanif , Keena Linda D , Frank James , Hogan Nancy L
Published: March 2018

Working in law enforcement can be a trying experience that can result in work-family conflict. Work-family conflict occurs when the domains of work and home spill into one another, causing strain and conflict for a person. There are four major dimensions of work-family conflict: time-based, behaviour-based, strain-based and family-based. One consequence of being exposed to the stressor of work-family conflict over time is job burnout. Job burnout has three major dimensions: emotional exhaustion, depersonalisation and a reduced sense of personal accomplishment on the job. The current study explored the association between four types of work-family conflict with the three dimensions of burnout among Indian police officers. All four types of work-family conflict were positively related to emotional burnout. Time-based, behaviour-based and family-based conflict had significant positive associations with depersonalisation burnout and with reduced sense of personal accomplishment burnout.
A prospective observational study of emergency department presentations following novel psychoactive substance use
Authors: Henshall David E , Innes Callum WD , Morrison Scott R , Wilson Blair , Brown Ryan A , McAllister Shannon M , Culshaw Seamus L , Reda Elaina
Published: March 2018

Background and aims

Novel psychoactive substances are compounds intended to mimic the effects of illicit drugs. They provide a unique challenge to healthcare, as complications of their use and their impact on services are relatively unknown. This study aims to determine nature of presentations, patient demographics and impact on healthcare.

Methods

Novel psychoactive substances users who presented to a large urban emergency department over 4 weeks were prospectively identified and followed for 1 year. Patients over 13 years old were eligible for inclusion. Information regarding patient demographics and presentations was collected.

Results

During the study period, 53 patients (39 male), mean age 32.6 ± 8.9 (±standard deviation), presented 148 times with complaints relating to novel psychoactive substances use. Study population characteristics included history of illicit drug use (83.0%), intravenous drug use (64.2%), psychiatric diagnosis or symptoms (56.6%), methadone prescription (52.8%) and having no fixed abode (37.7%). Injection was the most common method of use (72.3%), Burst the most commonly named agent (19.6%) and behavioural change the most common presenting complaint (31.1%). Patients collectively spent 10,620 h in hospital over 1 year.

Conclusion

This study highlights differences between the young population targeted by government campaigns regarding novel psychoactive substances use and the presenting population to hospital, and the associated burden on the National Health Service.
Current standards for assessing pregnancy status before surgery are subjective and should be replaced with definitive, objective evidence
Authors: Clement Keiran D , Luhmann Andreas , Wilson Michael SJ , Patil Pradeep
Published: March 2018

We report a case of a young woman admitted electively for laparoscopic Nissen fundoplication, and again three days post-operatively as an emergency with profuse vomiting and abdominal pain. She underwent diagnostic laparoscopy, and a small gastric perforation was found at the site of the fundoplication and this was suture-repaired. On both admissions, she was “screened” for pregnancy as per current guidelines. On the second admission, following a CT scan, she was found to have a gravid uterus with a foetus of 16–18 weeks’ gestation. In the opinion of the authors, this case highlights that current National Institute for Health and Care Excellence guidelines may be insufficient and could lead to unnecessary harm either to mother or foetus pre-, peri- or post-operatively.
Strangulation of giant rectal prolapse
Authors: El Moussaoui Imad , Limbga Augustin , Dika Manke , Mehdi Abdelilah
Published: March 2018

Introduction

Rectal prolapse is the complete protrusion of the rectum through the anal canal, incarceration rarely complicates rectal prolapse. Even more rarely, it becomes strangulated and gangrenous, necessitating emergency surgery.

Case presentation

We present the first reported case of strangulated acute rectal prolapse as the first manifestation of rectal prolapse. The patient was a 26-year-old man who presented with a 20×6 cm semi-spherical mass extra-anally. Rectosigmoidectomy with sacral rectopexy was performed, resecting 20 cm of the incarcerated rectum and sigmoid colon. The postoperative course was uneventful with a good final result after colostomy closure and continuity restoration.

Conclusion

The successful treatment of this patient illustrates the value of surgery in this difficult and unusual case scenario of rectal incarceration.
Best Laid Plans: How Community College Student Success Courses Work
Authors: Hatch Deryl K. , Mardock-Uman Naomi , Garcia Crystal E. , Johnson Mary
Published: March 2018

Objective: Beyond understanding whether first-year student success interventions in community colleges are effective—for which there is mixed evidence in the literature—this study’s purpose was to uncover how they work to realize observed outcomes, including at times unanticipated undesirable outcomes. Method: This qualitative multiple case study used cultural historical activity theory (CHAT) to unpack interactions and tensions among programmatic-level features and individual-level experiences and actions. We conducted classroom observation, document analysis, and interviews with instructors and students in four student success courses across diverse contexts. Results: Regardless of particular designs and course emphases, we found in all cases a blurring of activity elements, wherein learning tools and learning goals were often coterminous, or instructors effectively took on the role of learning tools themselves, in the form of object lessons and mediators, for instance. Courses had a distinctive character as rehearsal for college that simultaneously created a welcoming peer environment but an uncertain learning and assessment environment. Contributions: Because of their nature as metacourses—college courses about college-going—success courses’ means and ends ultimately may be functionally inseparable, thus helping to explain their continual evolution and contested roles. Whereas such courses are typically justified as means to teach college skills, we found this utilitarian rationale to be insufficient to describe the experiential dimensions of social learning that participants reported. Instead, we found these courses reveal how college-going is an emergent social literacy, one that a single course is insufficient to fully realize.
Military Significance of Q Fever: A Review
Authors: Spicer A J
Published: March 2018

Q fever is undoubtedly a disease of military significance. Whilst so far it has only been described in troops operating in Mediterranean countries, the Balkans and southern Europe, it is a potential hazard for nonindigenous soldiers in at least 51 countries on 5 continents. Sheep and goats are the main source of infection, and the disease is almost entirely acquired by inhalation of dust-borne rickettsiae from an environment contaminated with infected placentae. The commonest vehicle of transmission is infected hay and straw.

On the available evidence, Q fever is simply and largely preventible as a significant military disease by implementation of the following measures: (I) Education on the source and methods of infection. (2) Banning the use of hay and straw for bedding, and the clearing and burning of hay and straw fromfarm buildings prior to occupation. (3) The exclusion of sheep and goats from military areas. (4) Regular serological surveillance of flocks adjoining military areas for evidence of heavy infection by Coxiella burnet;’ (5) Vigilance for an unusually high incidence of abortion in flocks adjoining military areas, which should initiate an immediate serological survey to determine the possibility of gross environmental contamination by the Q fever organism. (6) The possible use of short term prophylaxis with tetracycline for limited exposures to Q fever.
Post-Transplantation Development of Malignant Lymphoma, an Experimental Model: Syngeneic Lymph Node Transplants
Authors: Goldsmith A E , Ryan G F , Joseph A B
Published: March 2018

Previously, malignant lymphomas in mice have been found to be the late sequelae of the autologous transplantation of skin grafts pretreated with CO2; these did not occur with grafts cultured in air alone. The clinical result in this autologous system reflects environmental differences in vitro (Goldsmith & Narvaez 1975). In the present study the syngeneic transplantation in BALB/c mice of lymph node tissue resulted in the late appearance of malignant lymphomas (48–69%), irrespective of the pretransplantation treatment of the grafts. Lymph node grafts were exposed to three different environments before transplantation into syngeneic hosts: (1) to culture in air (24 hours); (2) to culture in an atmosphere of 45% CO2 in air (24 hours); (3) direct transplantation without in vitro exposure. Transplantation of these three groups of differently treated grafts was followed by the same clinical results in their recipients. These were: (1) The development of lymphoma whereas the spontaneous incidence was zero. (2) The proliferation of T-lymphocytes in the spleen; the incidence of this abnormality correlates with the lymphoma incidence. (3) A higher than normal occurence of immune-associated lesions (amyloidosis, interstitial nephritis and myocarditis). Both syngeneic and autologous transplantations may serve as animal models for the study of clinical malignant lymphoma.
An Evaluation of the Role and Clinical Contribution of New Cross Dental Therapists
Authors: Holt R D , Murray J J
Published: March 2018

The first dental therapists (previously called dental auxiliaries), started their training in 1960 and, by the end of 1976, 792 women had qualified after a two-year course. In the present study the role of all dental therapists was investigated by means of a postal survey. The clinical contribution made by these ancillaries was assessed by means of a retrospective analysis of clinic day sheets recorded by 55 dental therapists employed in the community dental services. It was found that dental therapists, in terms of their working pattern and family profile, are typical of women of their age and level of qualification in Britain. The return to work by therapists, after a break from practice because of family commitments, will depend mainly on the availability of posts, particularly part-time posts. Dental therapists provide treatment predominantly for younger children. Compared with previous studies, a noticeable increase in the clinical preventive care provided by therapists was observed.
Royal Naval Dockyards Asbestosis Research Project: Nine-Year follow-up Study of Men Exposed to Asbestos in Devonport Dockyard
Authors: Rossiter C E , Heath J R , Harries P G
Published: March 2018

Progression of asbestos-related disease was assessed in a group of 253 dockyard workers examined in 1966 and 1975. Despite the almost complete protection from exposure to asbestos since 1966, radiographic parenchymal abnormalities increased and occurred more frequently during the next 9 years in those men who had been more heavily exposed to asbestos. Lung function values were lower in those most heavily exposed and were declining at a faster rate than in those with less dust exposure. The most sensitive lung function index was the transfer factor.

Those men with persistent crackles in 1966 exhibited a restrictive pattern of lung function, whereas an obstructive pattern was seen in men with wheezes in 1966. The men with irregular small opacities of category 1/1 or more or with diffuse pleural change in 1966 and who survived to 1975 had worse lung functions than any other groups.

Progression of disease was greater for smokers than non-smokers, with those who gave up smoking between 1966 and 1975 suffering the greatest changes. This latter group showed most increase in small opacities and included almost all new cases of diffuse pleural changes. They also showed the greatest declines in forced expiratory volume and forced vital capacity.
Effects of Phenoxybenzamine on Bladder Neck Opening1
Authors: Waterfall N B , Williams Grant
Published: March 2018

A study of the effects of the action of phenoxybenzamine on bladder neck opening during micturition is reported. Twenty patients with symptoms of prostatism but minimal prostatic enlargement were studied. Bladder neck opening was measured radiographically. Phenoxybenzamine was shown to increase bladder neck opening by an average of 30% and give symptomatic relief. Minimal side effects were noted.
Pressure Therapy for Hypertrophic Scarring: Preliminary Communication
Authors: Robertson J C , Hodgson B , Druett J E , Druett Jane
Published: March 2018

A six-point programme for the prevention and pressure therapy of hypertrophic scarring started in 1975 at Odstock Hospital. The work reported here includes a pressure calibration of batches of the material chosen for pressure bandaging; a pressure study of the bandages on volunteers’ limbs; and the formation of a pressure therapy clinic. The clinic results were similar to those reported by Thomson (1974) and were considered sufficiently favourable to justify continuing the clinic and instituting a policy of close review and early therapy for all burns patients. The programme proved the accuracy of the pressure sensor and attempted to develop an objective method of recording progress. Arguments for pressure versus occlusion as the therapeutic agent are discussed and supported by a case report. It is suggested that a controlled trial of pressure therapy should be carried out.
Squamous Carcinomas of the Head and Neck: Some Patterns of Spread
Authors: Carter R L , Pittam M R
Published: March 2018

Patterns of tumour spread are examined in 160 patients with squamous carcinomas of the head and neck with reference to perineural infiltration, direct invasion of bone and ossified cartilage, and lymph node metastases in the previously irradiated neck. Perineural spread is comparatively common in large (T3, T4) tumours; it may be apparent early in the disease; it is often detectable clinically; and it is an adverse prognostic feature which may modify clinical management. Direct bone invasion is described with particular reference to tumours of the oral cavity. Most bone destruction is mediated by osteoclasts which appear to be stimulated by materials such as prostaglandins released in the vicinity of the tumour. The numbers of involved lymph nodes in surgical dissections from the irradiated neck are usually few and restricted to the submandibular and jugular groups; nodes in the posterior triangle are infrequently involved by metastatic carcinoma. Transcapsular spread and keratin granulomas are common. The scope of modified neck dissections in this group of patients is discussed.
Second Ear Stapedectomy
Authors: Sergeant R J , Wadsworth P V
Published: March 2018

A long-term follow up of a personal series of 79 second ear stapedectomies indicates that the procedure can be undertaken with minimal complications. No bilateral dead ears or vestibular disasters have occurred. The results were satisfactory in 87.5% of ears, and bilaterally symmetrical hearing with an air-bone gap of 30 dB or less was achieved in 24% of patients. Whilst the established dictum that only one ear should be operated upon should not be abandoned, the results reported in this paper may encourage the more experienced to operate on the second ear at a later date in carefully selected cases.
Foreign Bodies in the Rectum: A Review
Authors: Schofield Philip F
Published: March 2018

Foreign bodies which lodge above the anal sphincter mechanism may arrive from one of two portals of entry, the mouth or the anal canal. Ingestion of a foreign body is usually unknown to the patient, who presents with symptoms due to impaction and minor injury to the rectal ampulla or anal canal. The patient may have severe anal pain or sepsis associated with the foreign body. The diagnosis is usually obvious on examination under an anaesthetic, but before this there may be a difficult diagnostic problem.

Foreign bodies passed into the rectum through the anal sphincter are more common and show an extreme variety. The reasons for insertion are discussed. Management of the problem includes extraction of the foreign body and the recognition and treatment of any associated injury, both extraperitoneal and intraperitoneal. Minor extraperitoneal injuries may be treated expectantly, but in all intraperitoneal and major extraperitoneal injuries laparotomy and colostomy are required. It is stressed that most foreign bodies can be removed transanally, and laparotomy to remove the foreign body is rarely required.
Study of Antibody-Coated Fungi in Patients with Funguria and Suspected Disseminated Fungal Infections or Primary Fungal Pyelonephritis
Authors: Hall William J
Published: March 2018

The direct immunofluorescence method for the detection of antibody-coated bacteria in urine sediments has been used by investigators to distinguish invasive bacterial disease of the renal parenchyma from noninvasive bladder bacteriuria. The purpose of the present investigation was to test the usefulness of the demonstration of urinary fungal immunoglobulins and complement in distinguishing patients with fungal cystitis from those with suspected disseminated fungal disease. Twenty-one patients with microscopic funguria were suspected clinically of having disseminated fungal infection. Urine specimens from these patients were tested for the presence of antibody- and complement-coated fungi by direct immunofluorescence with the use of specific goat antisera to human immunoglobulins and complement. No unexpected frequencies of combinations of urinary yeast staining by specific antibody were noted. Urine specimens demonstrating funguria from 12 patients with uncomplicated illnesses were also examined for the presence of antibody- and complement-coated fungi; no unexpected frequencies of combinations of urinary yeast staining were noted in this group and no differences in frequencies of specific antibody staining were noted when compared with results in patients with suspected invasive fungal disease. Thus, no difference in the occurrence of specific antibody or complement adsorbed to urinary yeasts was observed between patients suspected of having invasive fungal disease and a small group of control patients.
Value of Xenografts in the Investigation of Prostatic Function: Preliminary Communication
Authors: Jones M A , Williams Grant , Davies A J S
Published: March 2018

Two of 33 prostatic tumour xenografts were established and passaged. Testosterone supplementation did not improve tumour take rates. The histological grade of the parent tumour was the principal factor affecting xenograft survival. Preliminary studies on established tumour xenografts suggest that their value lies in the study of tumour biology, and that they have no direct therapeutic application at present.
Caring for Old People in New York and London: The ‘Nurses’ Aide’ Interviews1
Authors: Godlove C , Dunn G , Wright H
Published: March 2018

As part of a comparative study of the institutionalized elderly in London and New York, random samples of nurses’ aides, nursing assistants and care assistants were interviewed. It is shown that the two long-term care ‘systems’ employ very similar people to provide basic care services, but far more in-service training is provided for New York staff. A detailed analysis of tasks performed suggests that New York staff may be more likely than their London counterparts to carry out technical ‘nursing’ procedures and to be actively involved in physical rehabilitation. The preferences of staff in caring for more or less dependent people showed considerable cross-national agreement, almost half of the total respondents reporting that they preferred immobile patients. Some of the reasons they gave are presented and the implications of this finding discussed.
Comparison of the Effects of Atropine and Glycopyrrolate on various End-Organs1
Authors: Mirakhur R K , Dundee J W
Published: March 2018

Atropine and glycopyrrolate (glycopyrronium bromide), a quaternary ammonium drug, were evaluated in volunteers following intramuscular administration with respect to effects on various end-organs with cholinergic innervation. Glycopyrrolate appears to be five to six times more potent than atropine in its antisialogogue effect and also exhibits a selective, though prolonged, effect on salivary secretion and sweat gland activity. It has minimal cardiovascular, ocular and central nervous system effects.
Simple Instructions for using Pressurized Aerosol Bronchodilators1
Authors: Newman Stephen P , Pavia Demetri , Clarke Stewart W
Published: March 2018

Although the manufacturers of pressurized aerosol bonchodilators issue instructions for using the inhalers, little or no experimental verification exists. Bronchodilatation has been measured after controlled inhalations of 500 μg terbutaline sulphate given in a systematic series of investigations to 8 patients with reversible airways obstruction at 2 different inhalation flow rates (25 1/min and 80 1/min), 3 different lung volumes (20%, 50% and 80% vital capacity) and followed by 2 different breath-holding pauses (4 and 10 seconds). The results indicate that patients may release the aerosol at any time during the course of a slow deep inhalation which should be followed by 10 seconds of breath-holding. This will ensure an optimal bronchodilator response.
Role of Suprapubic Catheterization in Retention of Urine
Authors: Abrams P H , Shah P J R , Gaches C G C , Ashken M H , Green N A
Published: March 2018

One hundred and nine male patients took part in a randomized trial of elective suprapubic or urethral catheterization in retention of urine. The self-retaining trocar suprapubic catheter proved safe and reliable in trained hands and its use was associated with a low incidence of side effects. The suprapubic catheter when used to allow continuous flow resection appeared to lead to decreased blood loss and reduced resection time. No decrease in urinary infection rate over the period of hospital stay was noted in the suprapubic group. The suprapubic catheter was more comfortable than the urethral and also allowed a trial of voiding prior to removal. Use of the suprapubic catheter was not associated with an increased hospital stay.
Collagenase Inhibition in the Healing Colon
Authors: Young Howard L , Wheeler Malcolm H
Published: March 2018

A randomized controlled trial was performed to assess the effect of intravenous aprotinin (Trasylol) on the healing of experimental colonic anastomoses in the rabbit following a standard left colonic resection anastomosis. Assessment of tensile strength was by means of both bursting pressure and breaking strength. Those animals subjected to bursting pressure assessment received intravenous aprotinin 80 000 KIU (kallikrein inhibitory units) at the time of anaesthesia, and postoperatively 160000 KIU per day given in divided doses for three days. Control animals received saline placebo. A further group of animals received a lower loading and maintenance aprotinin dose (40 000 KIU and 60000 KIU per day respectively) with control animals receiving saline. Breaking strength was employed as the means of assessment.

The mean bursting pressures were 47.7 ∓ 2.9 mmHg and 37.5 ∓ 3.4 mmHg for aprotinin and controls respectively (P≤0.05). The mean difference in collagen content of the anastomosis compared to the resected specimen was +1.25 ∓0.50 μg/mg and −1.02 ∓ 0.47 ug/mg for aprotinin and placebo groups (P ≤ 0.005).

The mean breaking strength in the aprotinin group was 169.6 ∓74.5 g and 110.0 ∓65.9 g for the saline group (P≤0.02). The mean difference in collagen content of the anastomosis compared to the resected specimen was +0.95 ∓0.69 ug/mg and −1.5 ∓0.78 ug/mg for the aprotinin and saline groups respectively (P≤0.05).

The significant elevation of both bursting pressure and breaking strength assessments, with a significant improvement in the collagen content of the anastomoses, may be the result of collagenase inhibition following the use of intravenous aprotinin in the experimental model.
Utilization of Computers in Clinical Practice - Role of Physician Networks: Preliminary Communication
Authors: Anderson J G , Jay S J
Published: March 2018

This study examines the influence of physician networks on the utilization of computers in clinical practice. Data on patient referrals, consultations, professional discussions, and on-call coverage were collected from 24 physicians who comprise a private group practice. Their utilization of a computerized hospital medical information system (HIS) in caring for patients admitted to a 1160-bed private, university affiliated, teaching hospital was determined. A matrix representing the professional relations among these physicians was subjected to smallest space analysis, a form of multidimensional scaling. Also, a number of indices that describe structural and interactional properties of the network and individual physicians were computed. The three-dimensional representation of the network that resulted from the analysis suggests a two-step process of adoption and utilization of medical technology. Physicians who were engaged in outside professional activities and in the training of medical students and house staff were more likely to utilize the system in caring for patients. These physicians, who were more centrally located and dominant in the referral and consultation process, were more likely to influence the practice patterns of their colleagues. The use of network analysis to identify influential physicians whose involvement is essential to the success of efforts aimed at introducing computers into clinical practice is discussed.
Femoral Neck Fracture Fixation: Rigidity of Five Techniques Compared
Authors: Mackechnie-Jarvis A C
Published: March 2018

Artificial cadaveric femoral neck fractures were internally fixed with five different devices and subjected to cyclical loading of 0–1.0 kilonewtons (approximately one body weight) whilst in an anatomical position. Displacement of the proximal fragment was detected by a transducer and charted. Bone strength was assessed by a preliminary control loading phase on the intact bone. Efficiency of each fracture fixator could then be directly compared by the relative movement in each case.

Five specimens each were tested with Moore's Pins, Trifin Nail, Garden Screws and a sliding screw-plate (OEC Ltd). By the criteria of the experiment, which put a severe shearing load on the implant, none of these devices reliably bore the representative body weight. An extended barrel-plate, which supported the sliding screw almost up to the fracture line, was then made. This device, employing some of Charnley's concepts, tolerated body weight in four cases out of five.
Exocrine and Endocrine Testicular Function in Patients with Unilateral Testicular Disease
Authors: Scheiber K , Marberger H , Bartsch G
Published: March 2018

Amongst 30 patients who had undergone untwisting and fixation for unilateral torsion of the testis, seminal analyses were normal in 15, equivocal in 3 and pathological in 12; and of 46 men with cryptorchidism who had had unilateral orchidopexy, seminal analyses were normal in 13, equivocal in 23 and pathological in 10. Follicle-stimulating hormone levels were found to be elevated in those with equivocal and pathological seminal analyses in both groups. Assessment of testicular function before orchidectomy in 36 patients with seminomas and non-seminomatous testicular tumours revealed only one (with a HCG-negative seminoma) with a normal seminal analysis. Men with HCG-positive testicular tumours were found to have decreased follicle-stimulating hormone levels and elevated 17–β-oestradiol and prolactin levels.
Acute Fatty Liver of Pregnancy1
Authors: Hague W M , Fenton D W , Duncan S L B , Slater D N
Published: March 2018

Six further cases of acute fatty liver of pregnancy are presented and discussed in relation to the world literature on this rare disease of pregnancy, the aetiology of which is still unknown. The importance of vomiting in late pregnancy is emphasized. A common feature seems to be a metabolic stress, possibly related to infection, which tips a susceptible liver into metabolic failure.
Weight control in university students
Authors: Salmons Paula H
Published: March 2018

A total of 1858 students of United Kingdom origin aged between 18 and 20 years of age completed questionnaires which investigated present weight, bingeing, vomiting and weight control. Men were significantly more likely than women to be overweight, while women were significantly more likely to be underweight. One-third of the women were actively controlling weight, with dieting as the preferred method, while over half had attempted weight control in the past three years. Daily or more frequent bingeing was reported by 1.9% of men and 1.2% of women. There was a statistically significant relationship between weight control and bingeing. Eleven percent of men and 24% of women thought they had a problem with weight control, although amongst both men and women the proportion who felt they were overweight was in excess of the proportion who actually were overweight.

It is suggested that health education programmes should take account of the pressures upon young women to conform to predetermined ideals in terms of body weight.
Retinitis pigmentosa and deafness
Authors: Mills R P , Calver D M
Published: March 2018

Seventeen patients with retinitis pigmentosa (RP) have been investigated audiologically. Of 9 found to have a significant hearing loss, 6 were examples of Usher's syndrome; these patients had a cochlear pattern of hearing loss. The other 3 were examples of Senior's syndrome, Kearne-Sayre syndrome and Lawrence-Moon-Biedle syndrome respectively. Two of these patients had absent stapedius reflexes. It is suggested that patients with different RP-deafness syndromes may have lesions in different parts of the auditory system.
Hyperthyroidism in Elderly Patients with Atrial Fibrillation and Normal Thyroid Hormone Measurements
Authors: Bruce S A , Rangedara D C , Lewis R R , Corless D
Published: March 2018

The results of a study to investigate possible underdiagnosis of hyperthyroidism in the elderly are reported. Four out of 24 patients with atrial fibrillation for which there was no obvious cause and who had normal thyroid hormone measurements were found to have subnormal thyrotropin responses to thyrotropin-releasing hormone and abnormal thyroid scans. The implications of this finding are discussed.
Building or Extending a Hospital Department: Radiology a Path through the Planning Minefield (2)
Authors: Roebuck E J , Manton D J , Fordham G L
Published: March 2018

This is the second of a series of articles on the planning and building of a new Radiology Department or the extension of an old one. While the series focuses on a Radiology Department, it will be of interest to anyone who is planning any part of a hospital, particularly in the detailed information about the planning process and the part to be played by hospital staff during the subsequent building and commissioning. (The first article in the series appeared in the January issue, p 40. Correspondence should be sent to DJM.)
Interviewing and Examination Skills in Paediatric Medicine: Videotape Analysis of Student and Consultant Performance
Authors: Menahem Samuel
Published: March 2018

Taking an adequate history and competently examining a patient remain essential prerequisites for making a diagnosis. Four 5th year medical students who had completed 18 months of clinical teaching were assessed at the start and end of their ten-week paediatric term and compared with 4 experienced consultants. A videorecording was made of each patient encounter.

The students’ history was often incomplete, at times inaccurate and imprecise, despite earlier provision of a framework to obtain the necessary information. The students spent a great proportion of their time examining the child, yet their findings were questionable particularly if the child was uncooperative. The second recording made at the end of the student's paediatric term revealed a general improvement in their confidence and knowledge, though similar deficiencies were observed.

The consultants, as expected, did better. They also showed a greater awareness of understanding the child within the context of his family. They spent more time interviewing the parent and child, offered a fuller explanation of the diagnosis and carefully reviewed the management.

These findings further emphasize the need to improve and assess the clinical performance of students.