bluuebunny/crossref_metadata_2025 huggingface dataset:
Vocational Training for General Practice and Educational Objectives
Authors: Knox J. D. E.
Published: January 2017

The knowledge, skills and attitudes appropriate to general practice are concerned with clinical medicine and disease processes modified by consideration of human development and human behaviour. These considerations also determine to a greater extent than in hospital the manner in which therapy is prescribed and patients managed.

General practice however is concerned not only with patients and their families, but with a practice population and with the organisation of primary, continuing and long-term medical care. Within this framework the general practitioner deploys skills necessary to gather information on an extended scale; to form personal relationships; to identify problems; to initiate solutions and to order appropriate priorities. In making his decisions he must learn to be clinically effective although using scientifically inadequate data.

While general practice has progressed from the empirical and intuitive philosophy summed up in the oft-repeated ‘general practice isn't something you can teach, my boy, it has to be learned by years of experience !’ there is still sufficient truth in that saying to stimulate further effort to clarify our thinking and define our educational objectives.

In this way it is intended that the doctor of the future, better equipped and better trained, will meet more fully the needs of his patients and society.
Adjuvant Effect of Bendrofluazide on Propranolol in Hypertension
Authors: Mitchell I. , Lodge R. , Lawson A. A. H.
Published: January 2017

A double-blind trial was undertaken to assess the effect of bendro-fluazide in lowering the blood pressure in patients with essential hypertension controlled on propranolol. An increased hypotensive effect was found and the greatest fall occurred in the supine systolic blood pressure. Side-effects were mild and transient and did not interfere with treatment.
Hyperglycaemic Hyperosmolar Non-Ketotic Metabolic Decompensation in Diabetes
Authors: Campbell I. W. , Munro J. F. , Duncan L. J. P.
Published: January 2017

Eleven diabetics with hyperglycaemic hyperosmolar non-ketotic metabolic decompensation are described. In all but one an underlying cause was detected. Three had experienced previous episodes of severe ketoacidosis. The management was facilitated by the use of hypotonic fluid and the 2 deaths that occurred have been attributed to underlying disease.

Hyperosmolar non-ketotic coma is not a distinct clinical entity either with regard to aetiology, prognosis or treatment, but rather is one end of a wide spectrum of severe diabetic metabolic decompensation.
Clinical Bacteriology of Cephazolin
Authors: McAllister T. A. , Tait Susan C. , Perman Mary G. , Park Alison C.
Published: January 2017

Cephazolin, the latest parenteral cephalosporin produced by substitution of heterocyclic groups on the 7-aminocephalosporanic acid (7-ACA) nucleus, became available for clinical use in the U.K. in 1974. Its history is traced from the original Sardinian mould (1945) through isolation of cephalosporin C (1953) and 7-ACA (1962) to its discovery (1969) and subsequent clinical use.

Its mode of action is examined and its bactericidal nature confirmed. MICs of over 500 common pathogens are used to define its spectrum. The cut-off point for sensitivity and resistance is taken as 20 mg. per l. With 30 μg. discs zone sizes ≤ 14 mm. indicate resistance. The clinical relevance of MICs and attainable serum and urine levels is examined by relating them to clinical response in 12 patients.

A disc study compares cephazolin with 4 other available cephalosporins, namely cephaloridine, cephalothin, cephalexin and cephradine. Many major discrepancies indicate that they are not interchangeable. The laboratory and clinical implications are discussed, including the need for local policy decisions regarding choice of preparation. The change from a parenteral to an oral form should be preceded by a sensitivity test against the causal organism. The validity of using a single representative disc is questioned and the use of phrases such as ‘sensitive to the cephalosporins’ deprecated.

Cephazolin is potent, broad-spectrum and bactericidal and is potentially life-saving in serious hospital infections. The cephalosporins rival the aminoglycosides as ‘best-guess’ primary choice and are preferable in pregnancy, the puerperium and in pulmonary infections. Within the group cephazolin will seriously challenge or even oust cephaloridine and cephalothin.
The Serum Half-Life and Urine Concentrations of Cephazolin Sodium in Patients with Terminal Renal Failure: Effect of Haemodialysis
Authors: Eastwood J. B. , Gower P. E. , Curtis J. R.
Published: January 2017

The serum and plasma half-life of cephazolin has been determined in 5 maintenance haemodialysis patients during a non-dialysis period and then again in the same patients during haemodialysis with a Meltec Maxi-Multipoint dialyser using cuprophane membranes. The mean half-life during the non-dialysis period was 28.3 hours and fell to a mean of 4.97 hours during haemodialysis. Percentage recovery of cephazolin in the urine was markedly reduced in 4 maintenance dialysis patients although adequate urine concentrations of cephazolin were achieved for many sensitive organisms. A dosage schedule for patients with creatinine clearances of less than 5 ml. per minute and for maintenance haemodialysis patients is suggested.
Cephazolin Sodium in the Management of Complicated Urinary Tract Infection
Authors: Gow J. G.
Published: January 2017

Forty-three patients were treated with cephazolin sodium, a parenteral cephalosporin antibiotic for 45 episodes of urinary tract infection complicated by a variety of underlying conditions. In 42 episodes, there was a satisfactory clinical response, and in 37 episodes this was associated with elimination of the bacterial pathogen from the urine. In 21 out of 31 patients available for examination 3 months later, the urine was still free of bacteria.

A relatively prolonged plasma half-life and high urinary concentrations of the drug permit successful treatment of urinary tract infections with injections given only twice daily.
The Chemotherapy of Tuberculosis—A Personal Overview
Authors: Street E. W.
Published: January 2017

The story is told of how streptomycin, PAS and isoniazid came to be known as the first-line drugs. Although the present first line is generally accepted as rifampicin, ethambutol and isoniazid, the way in which these drugs should be used in different types of tuberculosis and in different parts of the world is discussed in relation to efficacy, toxicity and cost. Passing reference is also made to second-line drugs used in the retreatment of cases with bacterial resistance.
Spontaneous Rupture of the Spleen as the Presenting Feature of Chronic Myeloid Leukaemia
Authors: Pelosi A. J. , Sinclair D. J. M.
Published: January 2017

Spontaneous rupture of the spleen is an unusual complication of leukaemia. We report a case of splenic rupture as the initial presenting feature of chronic myeloid leukaemia, with a successful surgical outcome.
A Study of Difficult Respiratory Infections in General Practice
Authors: Langan C.E. , Platt D.J. , Guthrie A.J.
Published: January 2017

Augmentin was used to treat 40 patients in general practice with exacerbations of bronchiectasis or chronic obstructive airways disease who had not responded clinically to treatment with antimicrobial agents. After ten days treatment 15 patients (38%) were clinically free from infection, 21 (52%) had improved but their sputum still contained pus. Four patients (10%) did not respond to treatment. Pathogens were isolated from 63 per cent of the patients; Haemophilus influenzae was the most common. The clinical response was significantly better in patients from whom recognised pathogens were not isolated.
Haematocrit in Patients Attending a Hypertension Clinic
Authors: Lowe G.D.O. , Robertson J. , Dunn F.G. , Lorimer A.R. , Forbes C.D.
Published: January 2017

In view of recent interest in the relationship of haematocrit and blood viscosity to hypertension and vascular disease, we have analysed retrospectively the relationship of haematocrit to blood pressure, vascular complications and other variables in 2,381 patients referred to the Glasgow Blood Pressure Clinic. Haematocrit correlated negatively with age and systolic pressure in men, and positively with age and systolic pressure in females. Positive correlations were found in both sexes between haematocrit and serum alanine aminotransferase (possibly due to mutual correlation with alcohol); and between haematocrit and overweight (Quetelet Index) but not obesity (Ponderal Index). Increased haematocrit was also associated with cigarette smoking; and with history of angina, myocardial infarction and intermittent claudication in females. No correlation was observed between haematocrit and history of stroke. These findings suggest that prospective studies of haematocrit in hypertensives may be of interest.
Medical and Nursing Services to ST Kilda
Authors: Collacott R. A.
Published: January 2017

The problem of serving the smaller Scottish islands with an adequate medical service has existed since the middle of the nineteenth century. The problem is still unresolved. This paper examines the difficulties faced, through a historical perspective on the island of St Kilda, which lies some forty miles west of the Outer Hebrides.
The Parallel Effects of a Very Low Molecular Weight Heparin (CY222) on anti Xa Activity and Thyroid Hormone Levels in Blood
Authors: Wilson R. , Gordon D. , Johnstone R. V. , Johnstone P. , Beastall G. H. , Thomson J. A.
Published: January 2017

A very low molecular weight heparin fragment (CY222) was administered by subcutaneous injection to a group of normal volunteers. This drug caused increased anti Xa activity with peak levels being observed two hours after injection. This coincided with changes in thyroid hormone levels especially with a fall in red cell thyroxine levels. Larger doses of CY222 caused a fall in serum total thyroxine and triiodothyronine, a rise in free thyroxine and a fall in TSH levels. It was thought that these findings may be due to the production of a circulating inhibitor of cellular uptake of thyroxine and that this might be related to the elevated levels of serum free fatty acids produced by the heparin.
Is Elective Surgery in the Elderly Worthwhile?
Authors: Robb J. E. , Murray I. , MacKay C.
Published: January 2017

In a prospective study 102 patients (median age 70.9 years) were interviewed at home before and after elective surgery to assess whether they would have any difficulties in managing their activities of daily living (ADL) post-operatively. The patients were consecutive admissions in general surgery, gynaecology and urology. All patients were alive six months after surgery and 98 were cured of their condition. Twelve patients suffered a deterioration in their ability to perform various ADLs but none was institutionalised as additional help was given either by a spouse or by a home help. Elective surgery in this age group is worthwhile and carries with it minimal deleterious effects on social rehabilitation and few demands on community resources.
Neuroparalytic Keratitis and the Effect of Cervical Sympathectomy following Operative Procedures for Trigeminal Neuralgia
Authors: Adams G.G.W. , Cullen J.F.
Published: January 2017

A study of 248 patients who underwent operative procedures for trigeminal neuralgia over a nineteen year period is presented, with particular reference to those who developed neuroparalytic keratitis to see if cervical sympathectomy had any protective effect on the cornea. 51 patients underwent cervical sympathectomy, 46 as a prophylactic procedure, and 5 as a treatment for neuroparalytic keratitis. Of these patients 3 (5.9%) developed neuroparalytic keratitis, but 2 of them had had an inadequate sympathectomy. Forty seven patients who did not undergo cervical sympathectomy had either an anaesthetic cornea or a reduced corneal reflex, and of these 11 (23.4%) developed neuroparalytic keratitis. An adequate cervical sympathectomy therefore appears to have a protective effect on the cornea against the development of neuroparalytic keratitis.
No Alcohol, but Wine is Permitted: A Survey of Obstetric Units in Scotland
Authors: McGarva K. , Murray A. K.
Published: January 2017

Many health-care professionals have expressed increasing concern over the growing use of licit and illicit substances. Considerable interest has also been shown in the effects of substance use on the developing fetus.

In view of both the media and academic coverage of this subject, the possible dangers to health of both mother and child should (presumably) be common knowledge. It would seem reasonable, therefore, to assume that screening women in the early ante-natal period for their use of tobacco, alcohol and other drugs would be routine practice.

This survey attempted to obtain an overview of the approach of ante-natal clinics to substance use and, if possible, identify any areas of need which might exist. The responses obtained indicate that the approach taken by midwives and obstetricians was not uniform. A number of factors were identified as influencing service provision.
Simultaneous Streptococcus Pneumoniae, Giardia Lamblia and Campylobacter Pylori Infection: An Adult Presentation of X-Linked Hypogammaglobulinaemia
Authors: Nathwani D. , Morris A.J. , Smith C.C.
Published: January 2017

Primary X-linked (Bruton's) hypogammaglobulinaemia is uncommon. It usually presents clinically within the first two years of life — Typically after the age of three months when maternal IgG is exhausted.1 Its diagnosis in middle life is exceptional. The presentation of the condition as a triple infection in a middle-aged man therefore seemed worthwhile reporting, as effective and safe prophylactic immunotherapy is now available.
Anterior Fontanelle Size in Scottish Infants
Authors: Lyall H. , Ogston S.A. , Paterson C.R.
Published: January 2017

Very limited information is available on the normal size of the anterior fontanelle but this measurement may be of value in the early diagnosis for example of bone diseases, and of hypothyroidism. The purpose of this study was to provide a reference range applicable to the first two years of life, using a larger sample population than previous studies. Measurements were made of the anterior-posterior and transverse dimensions in 334 full term infants between birth and the age of 24 months. Despite the wide variation, both in size and age of closure, it proved possible to define a reference range and also, for the first time, to present a centile chart.
Initial Experience of an Emergency Helicopter Transport Service in the Outer Hebrides
Authors: Hawksworth C.R.E.
Published: January 2017

The outcome of patients transported by coastguard helicopter to the Lewis Hospital, Stornoway was studied for the first 30 months of the service. Although undoubtedly life-saving in some cases, some patients were transferred for trivial reasons. Feedback between the hospital and ships' captains and owners may reduce possible abuse of this service. Most patients were uplifted entirely appropriately.
Dental Disease, Fibrinogen and White Cell Count; Links with Myocardial Infarction?
Authors: Kweider M. , Lowe G.D.O. , Murray G.D. , Kinane D.F. , McGowan D.A.
Published: January 2017

Plasma fibrinogen and white blood cell count were compared in fifty patients aged 25–50 years with periodontal disease and in fifty age-matched controls with relatively healthy periodontal tissues. Patients had significantly higher levels of fibrinogen and white cell count, and dental indices correlated significantly with these two cardiovascular risk factors on multivariate analyses. We suggest that inflammatory dental disease may be a determinant of fibrinogen level and white cell count in the general population, and that fibrinogen and white cell count may be two mediators of the link between dental disease and myocardial infarction.
When Should Patients with Bacterial Meningitis be Referred to a Neurosurgical Unit?
Authors: Ballantyne E.S. , Chaseling R. , Miller J.D.
Published: January 2017

The case records of 97 patients with proven bacterial meningitis who were referred to a regional neurosurgical unit between 1964 and 1991 were reviewed. Mortality declined from 34% in the first cohort referred between the years 1964–82 to 5% for 1983–91 (X2=11.78;p<0.001). Fewer patients were admitted in coma, (X2=4.43; p<0.05), or with focal neurological signs (X2=7.57; p<0.01) in the second cohort. The rate of referral increased in the later period but the incidence of unsuspected brain abscess (16% and 15%) did not change. There was a strong correlation between coma on admission and death, (X2=17.3; p<0.001) and with brain abscess and death (X2=6.73; p<0.01). in conclusion patients with known or suspected bacterial meningitis coupled with a decreasing level of consciousness or focal neurological signs should be referred to a neurosurgical centre.
Pure Alexia without Agraphia: A Classical Cortical Syndrome Revisited
Authors: Duffield J S , de Silva R N , Grant R
Published: January 2017

A patient who developed pure alexia without agraphia following a stroke is described. An infarction of the left occipital pole was demonstrated by Magnetic Resonance Imaging (MRI). The literature on this rare syndrome is reviewed, and the localisation of damage in relation to the clinical findings discussed.
Are Safety Committees Really Safe?
Authors: Bergqvist D. , Forbes C.D. , Minder C.E. , Planes A. , Cate J.W.T.
Published: January 2017

In an increasing number of recent major clinical trials, independent safety committees or safety monitors have been involved Their role and function is not yet defined and continues to evolve. The aim of this paper is to discuss the role and tasks of safety committees as a result of our collective experience as members of three safety committees of studies evaluating antithrombotic prophylaxis against postoperative deep vein thrombosis. We believe that the type of pharmacological intervention used is of less importance than the general experiences gained, which can be extrapolated to other studies and should stimulate a more general debate.
Minor Morbidity after Day-Case Surgery
Authors: Hunter J.D. , Chambers W.A. , Penny K.I.
Published: January 2017

The number of patients and procedures considered suitable for day-case anaesthesia and surgery continues to grow and it is hoped that 50–60% of all operations in the UK will eventually be performed on a day-patient basis.1 However, minor but troublesome post-operative side effects remain common. We have examined the incidence of the most common causes of minor morbidity, namely headache, nausea /vomiting and pain occurring after a wide variety of day-case surgical and diagnostic procedures. Patient satisfaction with treatment and the impact of day case surgery on the workload of the general practitioner was also assessed. The anaesthetic records of the patients involved were reviewed in an attempt to determine if there was any association between the anaesthetic technique and an adverse outcome. A simple postal questionnaire completed on the morning after surgery was returned by 553 patients (response rate over 87%). More than 50% of respondents complained of some morbidity, with 40% complaining of pain, 19% of headache and 9% of nausea and vomiting. One third self-medicated to modify their symptoms, and in most cases (81%) this was effective. However, 6% of patients called their GP for advice and 2% received a home visit. No patient required readmission. A total of 92 patients (17%) would have preferred treatment as an in-patient. Analysis of the anaesthetic drugs and techniques suggested that the commonly used anti-emetics droperidol and metoclopramide had little effect on the incidence of postoperative nausea and vomiting. Intubation was associated with a significantly higher incidence of minor morbidity although this may be related to surgical factors.
The Fate of Natural Law at the Turning of the Ages
Authors: Ziegler Philip G.
Published: January 2017

With an eye to the present resurgence of interest in natural law within Protestant theology and ethics, the author explores the transformation of the concept of the “natural” within Paul's telling of the gospel of God as presented in the work of J. Louis Martyn and others in the so-called Union School. What does a quest for moral order via natural law have to do with the ethical question as Paul puts it: “Who is Lord?” or “Who owns the earth?” The apocalyptic gospel renders that the apocalyptic gospel renders untenable claims that a rationally accessible moral order of creation simply abides undisturbed by the outworking of the drama of salvation. Attention to the cosmic dimensions of Paul's witness raises a sharp challenge to the viability of natural law ethics within any Christian theology that hopes to keep faith with the twice-born apostle, even as other ways of achieving the aims pursued by appeal to natural law are opened up thereby.

The concept of the natural must be recovered on the basis of the gospel itself.
Is something better than nothing? The impact of foreclosed and lease-purchase properties on residential property values
Authors: Seo Youngme , Craw Michael
Published: January 2017

Lease-purchase (L-P) programmes that rehabilitate foreclosed property for sale as affordable housing may provide a way to reduce foreclosure externalities on nearby property values. This paper investigates the feasibility of such a strategy by estimating the effects of foreclosed properties on nearby residential property values compared with those of an L-P programme operated by the Cleveland Housing Network, Cleveland, Ohio. The findings indicate that although both L-P and foreclosed properties have a negative effect on the value of nearby non-distressed homes, the negative effect of foreclosure is larger. At the same time, the scope of the foreclosure externality is greater in low- and moderate-income neighbourhoods, while the foreclosure externality is generally smaller in high income neighbourhoods. Such results imply that an L-P strategy is likely to be more effective in offsetting foreclosure externalities in low- and moderate-income neighbourhoods than in high income neighbourhoods.
Neighborhood Effects: A LISREL Model for Clustered Samples
Authors: Bielby WILLIAM T.
Published: January 2017

This article presents a structural equation model for assessing the effects of group membership when observations are clustered by group. Within a LISREL specification, the net similarity in outcomes between a pair of observations in the same cluster is generated by an unobservable which captures the group effect. Analogies to the conventional ANCOVA model are noted, and an application to the assessment of “neighborhood effects” in reports of “neighborhood quality” from the 1976 Annual Housing Survey is presented. Estimates from the unobservable variable model are compared to those from a naive regression model and the model subjected to a specification test. The pitfalls of proceeding with the naive model are discussed, and the potential for future work exploiting the clustering in large-scale social surveys is emphasized.
Doctors for the Poor in Urban Nepal
Authors: Allaby Martin A K
Published: January 2017

Altruism on the part of doctors and other health workers may help make health services affordable for the poor, but the altruistic contribution of doctors who are nationals of developing countries has largely been ignored. This paper describes the results of two related surveys carried out between February and April 2001 to determine the characteristics of indigenous charitable clinics in Patan, Nepal, and the attitudes of the Nepali health professionals who work in them.

In 2001, 33 Nepali health professionals were working without payment in 13 charitable clinics in Patan.

Altogether they provided care to the same number of city residents as the general out-patient clinics of the city's 330-bed hospital. The scale of this activity had not previously been recognized. Half the clinics received an external subsidy; they were larger and had been running for longer than those without a subsidy. The most frequently mentioned reasons for deciding to work in a charitable clinic were a desire to serve the poor and improve society; to gain personal satisfaction; and a desire to help one's own community.

To make best use of any indigenous professionals who do voluntary work for the poor, health planners should identify the number and type of charitable clinics in their area; provide them with small subsidies for essential drugs and equipment; publicize them to make sure they are well attended; and develop referral systems between charitable clinics and other local providers of primary healthcare.
Motives, Sexual Behaviour, and Risk Factors Associated with HIV in Individuals Seeking Voluntary Counselling and Testing in a Rural District of Malawi
Authors: Zachariah R , Spielmann M P , Harries A D , Buhendwa L , Chingi C
Published: January 2017

A study was conducted among individuals seeking voluntary HIV counselling and testing (VCT) in order to (a) describe their motives and source(s) of information, (b) describe their sexual behaviour; and (c) identify risk factors associated with HIV infection. Of 723 individuals who sought VCT, the most common reason (50%) was recent knowledge of HIV/AIDS and a desire to know their HIV status. The majority (77%) underwent VCT after being encouraged by others who knew their status. Ninety five per cent reported sexual encounters, with 337 (49%) engaging in unprotected sex. HIV prevalence was 31% and an HIV-positive status was associated with being female, being over 25 years of age and/or being a farmer.

There is a demand for VCT, and the service provides an opportunity for intensive education about HIV/AIDS prevention on a one-to-one basis. It could also be an entry point to prevention and care for those who are infected.
Training Teachers of Day Care Centres for Primary Ear Care
Authors: Abraham V J , Balraj Vinohar , Shankar N , Job Anand , Joseph A
Published: January 2017

The feasibility of training teachers of day care centres for children (balwadi teachers) to recognize and manage common ear problems was studied so that they could provide primary care for ear related morbidity in the community. A training module was designed, piloted on grass root level workers and used to train 19 balwadi teachers. Their knowledge, skills and technique of examination was assessed following training. Pathways for referral were established between the balwadis, secondary and tertiary hospitals.

The knowledge score of the balwadi teachers increased from a mean of 28.4% to 86%; they scored an average of 75% in an assessment of their examination technique. Their sensitivity in identifying overall ear related morbidity was 75%, and 96% in identifying children with ear discharge, specifically. Age, education and experience did not affect the outcome of their training.

While it may be premature to comment on the impact of the training, periodic supervision, close monitoring and review sessions would sharpen the skills of the balwadi teachers and improve their efficiency.
Bacterial Meningitis in a High HIV Prevalence Setting in Sub-Saharan Africa –Challenges to a Better Outcome
Authors: Scarborough Matthew , Njalale Yasin
Published: January 2017

Bacterial meningitis remains an important cause of mortality and morbidity worldwide. Approaches to reducing the incidence include the deployment of effective anti-retroviral therapy in areas where HIV co-infection is common, vaccination, and prophylactic antibiotic therapy. Health education, improved diagnostic speed and capacity, and ensuring appropriate antibiotic therapy may improve outcome amongst patients presenting with bacterial meningitis.
Perception of Severity of Acute Respiratory Tract Infections and Diarrhoea in Children under the Age of Five in Rural India: Utilization Pattern of Health Services
Authors: Nagaraj Anandhi , Nagaraj V K , Lobo J
Published: January 2017

A cross-sectional survey of 970 children under the age of 5 in 870 households showed a biweekly incidence of acute respiratory tract infections (ARIs) and diarrhoea of 9 and 8.7%, respectively. Ninety per cent of the mothers, irrespective of their educational status, could identify correctly the severe forms of the illness. When perceived as severe the majority (75%) of them went to unqualified indigenous practitioners and only when perceived as mild did they use the government services. This shows that the user preferences for acute healthcare services vary with their perception of the illness and unqualified practitioners are the main source of healthcare providers especially in the rural areas.
The Brain Smear, a Rapid Affordable Intraoperative Diagnostic Technique for Brain Tumours Appropriate for Africa
Authors: Olasode Babatunde J , Ironside James W
Published: January 2017

Accurate preoperative and intraoperative diagnosis is important in neurosurgery. The most common method of intraoperative diagnosis is the frozen section which relies on trained personnel and regular supply of electricity or gas, both of which are in short supply in sub-Saharan Africa. The smear technique provides a cheap alternative without the need for extra personnel. This method can be easily learnt and provides an alternative to the frozen section with reasonable diagnostic accuracy. It is hoped that the method can be introduced in areas. where intraoperative diagnosis is required for brain tumours and the frozen section is not available.
Tetanus: An Analysis of the Prognosticating Factors of Cases Seen in a Tertiary Hospital in a Developing African Country between 1990 and 2000
Authors: Ogunrin Olubunmi A , Unuigbe Evelyn I
Published: January 2017

This is an analysis of the effects of prognosticating factors on the outcome of a case series of 66 patients with tetanus, presenting between 1990 and 2000. The mortality rate was 26.2% with a fatality rate of 16.2% for those under 40 years of age. This increased to 75% for those patients above 70 years of age. The socio-economic status, immunization status, the incubation period, and age of the patient together with the severity of the spasms, duration of hospital stay, type of treatment received and time of onset were found to affect the outcome of the patients.
Compressive Peroneal Neuropathy during Harvesting Season in Indian Farmers
Authors: Sangwan S S , Marya KM , Kundu Z S , Yadav V , Devgan A , Siwach R C
Published: January 2017

Thirty patients (34 limbs) with compressive peroneal neuropathy induced by prolonged squatting of more than 5 h during harvesting season were treated conservatively and followed-up to an average of 28.2 months. A marked preponderance of involvement of the left side was noticed. We attribute this to the intermittent extension of the right lower limb habitually used by Indian farmers to propel themselves forwards while squatting during harvesting. All but two lesions recovered fully within 3 to 9 weeks: one patient took 16 and another 20 weeks. We recommend non-operative treatment for this benign lesion.
Treatment of Chronic Osteomyelitis with Gentamicin-PMMA Beads
Authors: HÖök Margareta , Lindberg Lars
Published: January 2017

The purpose of this work was to try gentamicin-PMMA beads for treating chronic osteomyelitis in the often primitive conditions in a developing country. The long-term healing of the infections compared well with that obtained by other methods. As the method is simple and less resource-demanding than earlier methods, it seems to be an excellent method for a developing country.
Utility of Arm Circumference as a Screening Instrument to Identify Women at Nutritional Risk
Authors: Rodrigues V C , Rao R S Phaneendra , Lena A
Published: January 2017

Anthropometric measurements of 567 healthy non-pregnant women aged 20–40 years were studied to assess the utility of mid-upper-arm-circumference as a screening test to detect malnutrition. The prevalence of malnutrition in the study sample was 38.4%. A cut-off point of 24 cm was found to be most appropriate in the study setting as at that level the sensitivity, specificity and positive predictive values were 71.1%, 69.6% and 59.4%, respectively.
Aggressive Fluid Resuscitation and Broad Spectrum Antibiotics Decrease Mortality from Typhoid Ileal Perforation
Authors: Mock Charles , Visser Lucia , Denno Donna , Maier Ronald
Published: January 2017

One of the most severe complications of typhoid enteritis is perforation of ileal ulcerations. The typically high mortality rates from these perforations are in part due to extremely limited supportive care in hospitals in typhoid endemic areas. In the setting of a rural African hospital, this study demonstrated a decrease in overall mortality rate from 40% with one layer closure and chloramphenicol alone to 19% with two-layer closure and chloramphenicol, gentamicin and metronidazole. This was primarily due to a decrease in late (> 24 h) mortality. There was also a decrease in overall mortality rate from 43% with < 10 ml/kg of intraoperative fluid administration to 14% with > 10 ml/kg. This was primarily due to a decrease in early (< 24 h) mortality. Even within the constraints of the rural developing world, more aggressive initial fluid resuscitation can decrease early mortality, while broader spectrum antibiotics and two-layer closure can decrease late mortality from typhoid ileal perforation.
Echocardiographic Diagnosis of Heart Disease in Uganda
Authors: Freers J , Mayanja-Kizza H , Ziegler J L , Rutakingirwa M
Published: January 2017

Five hundred consecutive cardiological patients were reviewed and evaluated by echocardiography in Mulago Hospital as a referral service. All diagnostic problems in cardiology in the hospital and to a certain degree from other institutions were reviewed. The commonest diagnosis was endomyocardial fibrosis (EMF) 19.8%, followed by congenital heart disease (CHD) 15% and rheumatic heart disease (RHD) 11%. The anatomical distribution of fibrotic lesions in EMF (left, right or biventricular) correlated with that found in previous autopsy series from Mulago Hospital thus demonstrating the accuracy of echocardiography. We were able to quantify the contribution of echocardiography to a correct diagnosis which varied between 13% in RHD to 90% in mitral valve prolapse (MVP). Echocardiography was able to confirm the clinical diagnosis of subacute bacterial endocarditis (SBE) in 69% of cases.

The obtained data suggests that EMF may be the most common heart disease in Uganda contrary to the pattern of heart disease outlined in earlier works.

The favourable cost/benefit ratio of echocardiography (i.e. its easy availability and maintenance), as well as the absence of consumable materials in comparison to other cardiac diagnostic tools such as catheterization, chest X-ray and ECG is emphasized, together with the multipurpose use of the machine.
How to bring Surgery to Remote Tribal Areas
Authors: Gnanaraj J , Gnanaraj L , Shah V K
Published: January 2017

In a mission hospital located in a tribal area in India we found that surgical patients were not coming to the hospital due to a variety of reasons. Table 1 summarizes the main problems and how they were overcome. The effectiveness of our efforts was reflected in the increase in the number of operations after these measures were carried out (1022 before and 1865 after).
HIV and Syphilis Serostatus of Antenatals in Traditional Maasai Pasturalist Communities in Kajiado District, Kenya: 1989–1992
Authors: Valadez Joseph J , Loolpapit P Mores , Nyangao Ambrose , Dikir Francis
Published: January 2017

Although much research has been carried out on high risk populations, little is known about HIV prevalence in traditional rural communities who limit contact with other tribes, non-traditional tribesman and Europeans. This study considers traditional Maasai living near a high HIV transmission area.

A time series analysis assessed the trend of HIV-1 and syphilis prevalences in the study area. Data consist of antenatal blood specimens ( n = 2082 women) collected during 1989–1992. An estimated 100% of pregnant women residing in the study areas are included in the study. Standardized HIV-1 prevalences among women for 1989–1992 ranged between 0.95% and 2.23%. A χ2 test for trends was not significant, analysis of age-specific prevalences revealed no significant result. Standardized syphilis prevalence varied from 1.89% to 12.82% during the 3 years. Prevalence declined in 1990, but increased significantly thereafter. A steep 1992 increase in syphilis was not associated with an increase in HIV. Chi square test for trends for age-specific syphilis was not significant. In 2082 samples only one woman was positive for both HIV and syphilis.

In 4 years no increase in HIV prevalence was detected among traditional Maasai woman living near a high transmission area. No significant variation across ages was detected. However, syphilis increased sharply in one time period, 1992. Despite the low HIV prevalence among Maasai, the higher prevalence of syphilis suggests that the HIV epidemic is at an early phase and may increase soon. It may also suggest that HIV does not yet have a high prevalence at markets where Maasai sell their herds, but is concentrated at truck stops.
Oropharyngeal Delivery of Oxygen to Children
Authors: Daga S R , Vesma B , Gosavi D V
Published: January 2017

Oropharyngeal oxygen was administered to 13 patients with rapid breathing and hypoxaemia, six of whom were newborns. Feeding tube, No. 8F, was used in newborns for delivery of oxygen and No. 1 OF for others. Oxygen flow rate, 0.5 litre/min for four newborns and 1 litre/min, for the rest, was adequate to maintain oxygen saturations 90% and above. There were no instances of tube blockage or displacement.
Spillover Effects From Customer to Citizen Orientation: How Performance Management Reforms Can Foster Public Participation
Authors: Kroll Alexander , Neshkova Milena I. , Pandey Sanjay K.
Published: January 2017

Government reforms, even when inspired by competing schools of thought, might reinforce each other in unexpected ways. This study shows how performance management can bolster citizen participation, despite the fact that the two approaches have been associated with different reform movements. We argue that by fostering a positive state of mind toward external feedback, performance management reforms have made public administrators more receptive to citizen input. We also distinguish between “frontstage” and “backstage” modes of citizen participation and, using data on U.S. local governments, find greater spillover effects occurring on the backstages of public administration.
Redefining the Physician Selection Process and Rewriting Medical Malpractice Settlement Disclosure Webpages
Authors: Brown Matthew E.
Published: January 2017

Consider a mother of two who works full-time as a secretary in order to provide for her family. For several months in early 2000, she had excruciating lower back painthe consequences, she believed, of playing high-school and college fieldhockey. At work, she was unable to stand up from her chair without tremendous pain; at home, she was unable to sleep soundly. After visiting several physicians and undergoing a battery of diagnostic tests, the need for surgery became apparent. She consulted an orthopedic surgeon and was impressed with his qualifications. After informing her employer and seeking the advice of her family and friends, she consented to surgery. What the mother of two did not know, however, was that she had entrusted her life and livelihood to a surgeon who, in the ten years preceding her surgery, had settled twelve medical malpractice claims for an average of just under $300,000 per claim.
Merck KGaA v. Integra Lifesciences I, Ltd: Implications of the Supreme Court's Decision for the People Who Matter Most … the Consumer
Authors: Jaquette Ian
Published: January 2017

Sales of brand and generic pharmaceuticals in the United States reached $274.7 billion in 2006. Consumers in this country, including the federal government, are paying tremendous amounts of money for drugs and the cost continues to be a growing concern for all parties involved. Part of this increased cost encountered by consumers can be directly attributed to the ever-increasing costs manufacturers must cope with in the development of new drugs. Economists estimate that it takes twelve to fifteen years to develop a single new drug and have it approved by the Food and Drug Administration (“FDA”). The average cost: $800 million. For every 10,000 compounds investigated, only five are ever tested as potential medicines in clinical trials and only one is ever approved for patient use. Of all the drugs approved by the FDA, only three out of ten generate revenues that meet or exceed average research and development costs.
Modernizing Medicaid Eligibility Criteria for Children with Significant Disabilities: Moving from a Disabling to an Enabling Paradigm
Authors: Musumeci MaryBeth
Published: January 2017

Children with significant disabilities may qualify for Medicaid benefits, regardless of household income, if their state elects to offer the Tax Equity Fiscal Responsibility Act (TEFRA) option. However, a significant number of children with serious medical problems presently are being denied eligibility for, or terminated from, this Medicaid program. This Article describes the ways in which the existing health insurance system inadequately meets the needs of children with significant disabilities, recounts the history and development of the TEFRA Medicaid coverage option, and analyzes the eligibility criteria used by the various states. It proceeds to consider how disability should be legally defined in the health care context and proposes reforms to modernize the eligibility standards so that these benefits can be more effectively, efficiently, and fairly allocated. To accomplish this goal, the federal statute and regulation that define disability, as well as corresponding state laws, must be reformed so that the law can keep pace with advances in modern medical science, and people with disabilities are not, in effect, penalized for receiving currently accepted preventative care that maintains health but will never cure the underlying disease.
Constitutional Ratemaking and the Affordable Care Act: A New Source of Vulnerability
Authors: Epstein Richard A. , Stannard Paula M.
Published: January 2017

As this Article is being written, the Patient Protection and Affordable Care Act (ACA) is being besieged with two different types of challenges. The first is a Commerce Clause challenge to the individual mandate on the ground that, although the Commerce Clause allows the government to “regulate” the transactions into which people choose to enter, it does not allow the state to force people to enter into disadvantageous transactions against their own will. The second of these challenges deals with the imposition of the Medicaid expansion provisions requiring a state to forego all of its additional Medicaid support unless it is prepared to extend Medicaid coverage, partially at its own expense, to individuals whose income levels put them at 100% to 133% of the federal poverty level.
The PPACA in Wonderland
Authors: Lawson Gary , Kopel David B.
Published: January 2017

On August 22, 2009, when then-Speaker of the House Nancy Pelosi was asked by a reporter whether the Patient Protection and Affordable Care Act (PPACA) was constitutional, she answered: “Are you serious? Are you serious?” Two years later, many federal judges, more than half of the States, and a flood of distinguished constitutional scholars have examined the PPACA and found at least part of it to be unconstitutional. The question was indeed serious.

It remains serious today, as a Supreme Court decision on the constitutionality of the PPACA is expected in June 2012. Because the legality of the PPACA has emerged as perhaps the most publicly visible constitutional question since Roe v. Wade, clarity is vital not only for the PPACA itself, but also for general public understanding of the Constitution. Accordingly, our goals in this Article are to provide an opinionated but hopefully fair-minded guide to the constitutional issues of the PPACA and to clarify some misunderstandings that plague both popular and professional discussions of the issues.
The Use and Misuse of Biomedical Data: Is Bigger Really Better?
Authors: Hoffman Sharona , Podgurski Andy
Published: January 2017

Very large biomedical research databases, containing electronic health records (EHR) and genomic data from millions of patients, have been heralded recently for their potential to accelerate scientific discovery and produce dramatic improvements in medical treatments. Research enabled by these databases may also lead to profound changes in law, regulation, social policy, and even litigation strategies. Yet, is “big data” necessarily better data?

This paper makes an original contribution to the legal literature by focusing on what can go wrong in the process of biomedical database research and what precautions are necessary to avoid critical mistakes. We address three main reasons for approaching such research with care and being cautious in relying on its outcomes for purposes of public policy or litigation. First, the data contained in biomedical databases is surprisingly likely to be incorrect or incomplete. Second, systematic biases, arising from both the nature of the data and the preconceptions of investigators, are serious threats to the validity of research results, especially in answering causal questions. Third, data mining of biomedical databases makes it easier for individuals with political, social, or economic agendas to generate ostensibly scientific but misleading research findings for the purpose of manipulating public opinion and swaying policymakers.

In short, this paper sheds much-needed light on the problems of credulous and uninformed acceptance of research results derived from biomedical databases. An understanding of the pitfalls of big data analysis is of critical importance to anyone who will rely on or dispute its outcomes, including lawyers, policymakers, and the public at large. The Article also recommends technical, methodological, and educational interventions to combat the dangers of database errors and abuses.
Gas Exchange in Abdominal Cavity during Laparoscopy
Authors: Cameron A E , de Dear G L , Pocock T J , Tennant R W G
Published: January 2017

Gas exchange occurring in the abdominal cavity during laparoscopy, using carbon dioxide as the insufflating gas, was investigated in 25 female patients being ventilated with 66.6% nitrous oxide and 33.3% oxygen. The gas remaining in the abdomen at the end of the procedure was collected and measurements were made using an infrared spectrometer, a paramagnetic analyser and a mass spectrometer. The mean duration of the laparoscopy was 9.5 minutes and the mean volume of carbon dioxide delivered was 6.8 litres. Nitrous oxide concentration in the abdomen was found to increase significantly with the duration of the procedure, varying from 1.4% to 12.8% with a mean of 4.3% (s.d.±2.4). Oxygen concentration measured from 0.1 to 1.8% with a mean of 0.7% (s.d.±0.4). Nitrogen concentration varied from zero to 1.8%, having a mean concentration of 0.8% (s.d.±0.5). Carbon dioxide content was from 85.7 to 99.6% with a mean concentration of 94.2% (s.d.±3.1).