bluuebunny/crossref_metadata_2025 huggingface dataset:
Social Deprivation Indices of Patients on Renal Replacement Therapy (RRT) in Grampian
Authors: Khan I H , Cheng J , Catto G.R.D. , Edward N , MacLeod A.M.
Published: January 2017

The social deprivation scores of 169 patients who resided in Grampian region and commenced renal replacement therapy (RRT) in Aberdeen during the period 1 January 1985–30 June 1991 were measured when their serum creatinine concentrations were first >=300 μmol/l, using the Jarman Underprivileged Area (UPA) and Carstairs indices. The numbers in the population of Grampian for each score were obtained from the Information Services team of Grampian Health Board based on the 1981 census. Comparison of the numbers of patients in each category of both Jarman and Carstairs indices showed no differences between the observed numbers of patients and the numbers in the general population. Thus in this study social deprivation occurred no more frequently in those commencing RRT than in the general population.
Central Nervous System Histiocytosis X — Imaging and Responses to Chemotherapy
Authors: Forrest E. , Gallacher S.J. , Hadley D. , Soukop M. , Boyle I.T.
Published: January 2017

Histiocytosis X is the term first coined by Lichtenstein in 19531 to describe a heterogeneous group of disorders which is considered now to include Hand-Schuller-Christian disease, Letterer-Siwe disease and Eosinophilic Granuloma of bone. Gagel, in 1941, first described involvement of the central nervous system (CNS) in Histiocytosis X2 - in this case the hypothalamus and posterior pituitary were the areas principally affected. CNS involvement outwith these areas is rare, generally difficult to diagnose3, and little information on treatment is available. In this case we describe a man with cranial histiocytosis X who was treated with intrathecal and systemic chemotherapy and cranial irradiation, and we comment upon the value of magnetic resonance imaging (MRI) in this condition.
Opportunistic Group G Streptococcus Infection of Both Prosthetic Knee Joints
Authors: Dougall H.T. , Laing R.B.S. , Smith C.C.
Published: January 2017

A case of polyarticular sepsis from group G streptococcus is described in a patient with rheumatoid disease and decubitus ulcers. This is a rare condition which is often associated with a mosaic of predisposing factors and requires prompt and aggressive antimicrobial therapy.
Factors Affecting Women's Knowledge of Antenatal Serum Screening
Authors: Grewal G.K. , Moss H.J. , Aitken D.A. , Bjornsson S. , Cameron A.D. , Pell J.P.
Published: January 2017

Antenatal screening for fetal anomaly is offered routinely in Glasgow. This study assessed pregnant women S knowledge of the test and implications of results. Questionnaires were completed by 574 women. Knowledge of the nature and uses of the test was superior to earlier studies Two-thirds knew that screening was undertaken for Down's syndrome, and 81% for spina bifida. The majority were aware of the sample used, ages invited and gestation at which it was undertaken. Knowledge of the likely results and implications was poorer. Three-quarters were unaware that 10% of results would suggest an increased risk. Half did not realise that positive results could occur without fetal abnormality, or negative results could be falsely reassuring. Socioeconomic deprivation was associated with poorer knowledge but not lower uptake. Written information was associated with superior knowledge and higher uptake. Leaflets should be provided prior to booking, at which time resultant queries can be answered.
Trends in Survival of HIV Infected Patients Attending the Department of Genito-Urinary Medicine, Royal Infirmary of Edinburgh
Authors: Brockington A. , Scott G.R.
Published: January 2017

In the early 1980s, median survival for patients with the acquired immunodeficiency syndrome (AIDS) was only 11 months. Survival improved in the mid-1980s, reaching a median of 20 months. We have looked at the trends in survival of patients attending the Genito-urinary Medicine Department of Edinburgh Royal Infirmary between 1984 and 1996. Patients with an AIDS diagnosis between 1988 and 1991 had a median survival of 28 months, whereas patients given an AIDS diagnosis between 1992 and 1996 had a median survival of only 15 months (p = 0.01). However, survival from the point at which the CD4 lymphocyte count fell below 200 (CD4 200) remained unchanged. Patients diagnosed as AIDS after 1992 were more likely to have received prophylaxis against Pneumocystis carinii pneumonia or anti-retroviral therapy prior to an AIDS diagnosis. This may have resulted in the postponement of an AIDS defining diagnosis until the patients were more severely immuno-compromised, but has conferred no overall survival benefit.
Risk Stratification after Myocardial Infarction in Scotland
Authors: Mahy I. R. , Hillis G. S. , Jennings K. P.
Published: January 2017

The objective was to determine how patients are selected for invasive investigation after myocardial infarction in Scotland Cardiologists in Scotland were surveyed by postal questionnaire asking them to detail their approach to four sample clinical scenarios. Complete responses were obtained from 82% of those surveyed Substantial differences in practice were observed in the management of subjects with non-Q wave myocardial infarction. Of the cardiologists surveyed 40% would undertake coronary angiography irrespective of the results of non-invasive testing in a 45 year old patient, but only one would adopt the same policy in an otherwise fit 77 year old Only 44% would perform any investigations (beyond echocardiography) in the 77 year old A minority of respondents felt that their practice was influenced by resource limitation. Considerable variation continues to exist in the approach to risk stratification after myocardial infarction for some groups of patients. This variation may occur principally as a consequence of physician preference.
School Referral Survey
Authors: Macgregor D.M. , Hiscox J.A.
Published: January 2017

Many schools refer children who have sustained an injury, directly to the local Accident & Emergency (A&E) department. This prospective study monitored these referrals for one school term (08.01.96 – 31.03.96). During this time 200 children under the age of14 years presented from school to the A&E department of the Royal Aberdeen Childrens Hospital (RACH). The majority presented with trivial or mild injuries and 45% of parents felt that attending A&E was inappropriate. Half the accidents happened to unsupervised children. Rural children and children of working parents were less likely to attend A&E. In Grampian Region school referrals to A&E generate a significant workload for the A&E department with resultant cost implications. It would appear that a large number of these attendances are medically unnecessary and result from a desire by the school to avoid any complaint or litigation.
“The Spotlight Initiative”: Evidence from Oral and Maxillofacial Surgery
Authors: Shaw R.J. , McLennan A.S.
Published: January 2017

In 1996 Strathclyde Police launched a campaign in order to reduce crime, especially violent crime in the region. Surgical data have been previously suggested as a more accurate reflection of violent activity than police statistics. Whilst police figures record success in reducing serious violent crime during this initiative, there was a slight increase in facial fractures resulting from assault in public places in the same period although this increase was not significant at the p<0.05 level.
Virtual Reality: A New Prosthesis for Brain Injury Rehabilitation
Authors: Johnson D.A. , Rose ED , Rushton S. , Pentland B. , Attree E.A.
Published: January 2017

Virtual Reality (VR) technology is a relatively new application to rehabilitation medicine, yet it offers considerable potential to achieve significant successes in assessment, treatment and improved outcome, thereby increasing our knowledge of neuroplasticity. The capabilities of VR are especially evident in neurological rehabilitation, where cognitive and behavioural problems often interact with physical impairments to reduce the overall level of functioning and interaction. The need for effective interventions in neurological rehabilitation demands communication and collaboration between disciplines. This paper presents some of the current areas of the clinical applications of VR, emphasising the link between experimental evidence on recovery after brain damage and the clinical problems encountered in a ward setting.
Gliomatosis Cerebri: A Brain Tumour Which is too Difficult to Treat?
Authors: Choi D. , Schulz U. , Seex K.
Published: January 2017

Gliomatosis cerebri is a rare form of primary diffuse brain tumour first described by Nevin in 1938.1 It was originally considered to be a post-mortem diagnosis before Troost et al reported a clinically diagnosed case in 1987.2 However antemortem diagnosis remains difficult due to vague clinical symptoms and often non-specific findings on CT scanning. Gliomatosis cerebri has been classified by the World Health Organisation as an infiltrative tumoural process, which involves at least two, and usually three, lobes of the brain.3 Magnetic resonance (MR) imaging shows a diffuse infiltrative process with possible mass effect but no necrosis. histology is usually of a low grade astrocytic neoplasm which seemingly infiltrates out of proportion to the degree of anaplasia.

We report two patients who presented over the past year, whose clinical and radiological features prompted a preoperative diagnosis of gliomatosis cerebri, confirmed by biopsy.
Anaesthetic Pre-Registration House Officers: A Survey of Doctors and Medical Students Opinions
Authors: Sharma A.D.
Published: January 2017

The GMC has accepted a proposal from the Royal College of Anaesthetists for a four-month module in anaesthesia, pain management and intensive care for pre-registration house officers. All 135 final year medical students at Aberdeen University and all GPs and hospital doctors (608 doctors) in the highland region of Scotland were sent a postal questionnaire asking their opinions on this module. Sixty-four per cent of medical students, 39% of hospital doctors and 22% of GPs replied. Eighty-three per cent of medical students would apply for the module if available. Eighty-eight per cent of doctors would have found the module useful in their careers. Sixty-seven per cent of doctors would recommend the module to trainees in their current speciality. This survey demonstrates a high level of support and interest in the module. This has considerable implications for the organisation of the pre-registration house officer year.
Intranet Technology in Scottish NHS Trusts
Authors: Wilson S.M. , Jackson K.A.
Published: January 2017

Intranet technology has the potential to turn everything we've taken for granted in internal communication upside down. This paper looks at the uptake and use of Intranet technology in NHS Trusts in Scotland and discusses some of the uses of an Intranet system.
Acute Renal Failure Due to Retroperitoneal Haematoma: A Question of Warfarin Dispensation
Authors: Waring W.S. , Cumming A.D.
Published: January 2017

We report a case of an important and uncommon haemorrhagic complication in a patient receiving warfarin treatment. We reflect on the importance of close monitoring of anticoagulant therapy to prevent haemorrhagic complications and to ensure safety in longterm use.
The Football World Cup 1998: An Analysis of Related Attendances to an Accident and Emergency Department
Authors: Mattick A.P.
Published: January 2017

Throughout the Football World Cup Finals of France 1998, patients attended our inner city Accident and Emergency department with a variety of conditions related to the event. Analysis was made on the total of 151 patients who attended with World Cup related presentations during this five-week period. The majority were young men involved in alcohol related trauma. The workload of the department was only substantially affected after one match, that of the opening game between Brazil and Scotland.
Immediate Psychiatric Discharge Letters by Fax
Authors: Carey S.J. , Hall D.J.
Published: January 2017

Much psychiatric care is provided outside the hospital setting. It is important for general practitioners (GPs) to have available information of good quality, provided promptly, after patients' discharges from in-patient psychiatric care to enable them to provide a high standard of follow-up care. In order to assess the value of hand-written Immediate Discharge Letters sent by fax we undertook a postal questionnaire survey of GPs, and examined a proportion of the clinical notes relating to 160 patients who between January and March 1998 had been discharged from in-patient care in the psychiatry admission wards at Crichton Royal Hospital, Dumfries. We found that structured letters, hand-written on a patient's discharge from in-patient status were generally valued by GPs as was their transmission by fax. Though certain deficiencies were confirmed in their completion, they are of value pending the arrival of a more definitive final discharge summary. We conclude that the continued use of such immediate discharge letters in psychiatry and their continued transmission by fax is justified.
Educational Technology-Related Performance of Teaching Faculty in Higher Education
Authors: Larbi-Apau Josephine A. , Guerra-Lopez Ingrid , Moseley James L. , Spannaus Timothy , Yaprak Attila
Published: January 2017

The study examined teaching faculty’s educational technology-related performances (ETRP) as a measure for predicting eLearning management in Ghana. A total of valid data ( n = 164) were collected and analyzed on applied ISTE-NETS-T Performance Standards using descriptive and ANOVA statistics. Results showed an overall moderate performance with the highest recorded for technology operation and concepts and the lowest for observance of social, ethical, legal, and human factors. Effects of age and academic discipline on ETRP were significant but gender and professional status had no significant effects.
Relationship Between Subjectively Evaluated Health and Fear of Death Among Elderly in Three Cultural Contexts
Authors: Hofer Jan , Busch Holger , Šolcová Iva Poláčková , Tavel Peter
Published: January 2017

It is often argued that declining health in elderly people makes death more salient and threatening. However, we argue that health, optimism, and social support interact to predict fear of death in samples from Cameroon, the Czech Republic, and Germany. Low health was associated with enhanced fear of death for participants who received only little social support. As the measure of optimism did not comply with psychometric requirements in the Cameroonian sample, the three-way interaction was tested only in the Czech and German samples. It was found that the two-way interaction was further qualified by optimism in that low health was associated with enhanced fear of death for participants with little social support unless they reported pronounced optimism. Thus, internal and external resources, respectively, can serve to buffer the effect of declining health on the fear of death in the elderly.
Clinical Practice Guidelines: The Warped Incentives in the U.S. Healthcare System
Authors: Avraham Ronen
Published: January 2017

The healthcare system is sick. The players are incentivized to maximize their own benefit and externalize their costs onto the other parties. This paper examines the warped incentives that underlie the system. The tort system, lacking expertise and slow to adapt, is unable to overcome cognitive biases to adequately solve the problems. Clinical practice guidelines could pose a solution, but not as they are currently developed. Guidelines promulgated by healthcare associations are infected by a web of conflicts of interest with every player in the industry. Government agencies, and their revolving doors, are underfunded and also subject to the industry's web of conflicts. Even if adequate guidelines could consistently be produced, state legislatures and courts have been unwilling and unable to substantially incorporate guidelines into the legal landscape. Lastly, this article proposes a private regulation regime that could be a solution which would align all of the players' incentives to society's interests.
Urethral Stricture after Coronary Artery Bypass Grafting
Authors: Ferrie B G , Sethia B , Kirk D
Published: January 2017

An unusually high incidence of urethral stricture has been reported in men who have undergone cardiac surgery (Ruutu et al. 1982, Sutherland et al. 1983). Our experience with this condition in 1983 is reported.
Operative Cholangiography — Techniques and Inadequacies
Authors: Foster M E , Foster D R
Published: January 2017

The effectiveness of three methods of operative cholangiography in outlining biliary anatomy was assessed in 60 patients undergoing routine cholecystectomy for gallbladder calculi. X-rays were scored according to bile duct visualization and an overall score calculated. There were no statistically significant differences between the three groups. However, ductal opacification was inadequate in a majority of patients. It is suggested that closer cooperation with the radiologist and more emphasis on technique are required if cholangiography is used to identify unsuspected calculi.
Intussusception of Invaginated Meckel's Diverticulum
Authors: Williamson R C N , Cooper M J , Thomas W E G
Published: January 2017

Two middle-aged patients are reported who came to laparotomy with a presumptive diagnosis of small bowel tumour. There was no overt evidence of small bowel obstruction in either case. They were found at laparotomy to have intussusception of an invaginated Meckel's diverticulum. This condition should be considered in the differential diagnosis of ileal tumours.
Primary Carcinoma of the Fallopian Tube: Favourable Response to New Chemotherapeutic Agent, CHIP
Authors: Wong W S Felix , Tindall V R , Wagstaff John , Crowther Derek , Bramwell Vivien
Published: January 2017

Two cases are reported of recurrent fallopian tube carcinoma treated with CHIP (cis-dichloro-transdihydroxy-bis-isopropylamine platinum IV), a new cis-platinum analogue, resulting in one complete (though transient) and one good partial remission.
Minneapolis Hip Prosthesis in Severe Destructive Lesions of the Femur
Authors: Kumar J M , Norcross K
Published: January 2017

The use of the Minneapolis prosthesis was abandoned about 1955 by its originators, who had used it without acrylic for uncomplicated fractures of the femoral neck. This is the first report of its use with ‘cement’ fixation. It has been found to be very useful and reliable for arthroplasty of the hip in 57 patients with carcinomatous or other severe destructive lesions in the trochanteric region of the femur, being more convenient and easier to use than alternative prostheses and especially valuable in metastatic disease. Technical points relating to operative techniques are described, and postoperative Hamilton-Russell traction is recommended.
Skin Oxygen Tension in Venous Insufficiency of the Lower Leg
Authors: Dodd H J , Gaylarde P M , Sarkany I
Published: January 2017

Tissue anoxia has for long been invoked as a cause of venous leg ulcers, and recently it has been suggested that pericapillary fibrin prevents the diffusion of oxygen in the skin. In the present study direct measurements of skin oxygen levels on the lower leg were made using a transcutaneous oxygen monitor. In the recumbent position mean oxygen tensions were higher in patients than in controls, thus disproving the existence of any block to oxygen diffusion. In both groups there was a fall in oxygen tension to low levels on standing as a result of the normal reflex vasoconstrictor response to increased venous pressure. Exercise produced a marked rise in skin oxygen tension in normal legs but not in those affected by venous insufficiency. In normal subjects exercise reduces venous pressure, thus removing the stimulus for reflex vasoconstriction. In patients with defective valves, the venous pressure remains high during exercise and reflex vasoconstriction persists. It is concluded from this study that the sustained low skin oxygen tension in the upright position even during exercise is responsible for leg ulcer formation associated with venous insufficiency. Normal legs are protected by a rise in skin oxygenation during exercise.
Internal Fixation for Stress Fractures of the Ankylosed Spine
Authors: Marsh C H
Published: January 2017

Three cases of stress fractures affecting the rigid spine of ankylosing spondylitis are reported. Even without the typical destructive features of the Romanus lesion, symptoms may be very prolonged and disabling and the diagnosis difficult. Internal fixation produces immediate pain relief and rapid fracture union.
Cardiovascular Risk Factors in American and Japanese Executives
Authors: Comstock G W , Suzuki T , Stone R W , Crumrine J L , Johnson D H , Sakai Y , Matsuya T , Sasaki S
Published: January 2017

A standardized cardiovascular risk factor examination was given to executives in the headquarters of the American Telephone and Telegraph Company and the Nippon Telegraph and Telephone Public Corporation. As expected from the national mortality data, evidence of ischaemic heart disease was more common among American than Japanese executives. The frequency of some but not all risk factors was consistent with the observed differences in ischaemic heart disease. Americans were fatter than their Japanese counterparts, obtained a higher proportion of their caloric intake from animal fats, had higher serum cholesterol levels, and more of them felt that their lives were highly stressful. On the other hand, Japanese executives were much more likely to be cigarette smokers and showed a greater increase in blood pressure with age. Serum high-density lipoprotein cholesterol levels and the ratio of saturated to unsaturated fatty acids in the serum were similar in the two groups.
Total Knee Replacement in Osteoarthritis and Rheumatoid Arthritis
Authors: Kaltsas D S , Klugman D J
Published: January 2017

Between 1974 and 1983, 187 total knee replacements were performed in 163 patients at four East Kent district general hospitals. With few exceptions pain was the most common indication for the operation and it produced complete or almost complete relief in 90% of cases. The most frequently used prostheses were the Attenborough, Stanmore and Geomedic.
Assessing the Needs of the Elderly Using Unsolicited Visits by Health Visitors
Authors: Harrison Susan , Rous Sian , Martin Edwin , Wilson Sheila
Published: January 2017

Thirty-five percent of patients over 70 years old who received an unsolicited visit by a health visitor were found to have previously unidentified needs. In all, 71% of the 110 patients surveyed were found to have problems involving mobility, communication or caring for themselves. Most of their needs were social ones. It was concluded that unsolicited visiting by health visitors was efficient use of time by members of the primary health care team. Changes in practice administration are suggested to improve access to medical care for elderly patients.
Racial Distribution of Aneurysms in Zimbabwe
Authors: Kitchen N D
Published: January 2017

The distribution of aneurysms amongst African and Caucasian patients in two hospitals in Zimbabwe was surveyed in a retrospective study. Aneurysms were more common amongst the Caucasian patients and abdominal aortic aneurysms predominated (85%). Amongst the African patients there was a high incidence of thoracic aortic aneurysms (42%). Possible roles of atherosclerosis and syphilis in explaining these results are discussed.
Impaired Renal Tubular Function in Chronic Alcoholics
Authors: Labib M , Abdel-Kader M , Ranganath L , Martin S , Marks V
Published: January 2017

Despite the well known effects of chronic alcohol abuse on the gastrointestinal, cardiovascular, nervous and endocrine systems, little information is available on its effect on renal function. To assess renal function we measured urinary excretion of albumin, α1 microglobulin and retinol binding protein in 30 chronic alcoholic patients. Our data shows that 40% of chronic alcoholic patients have impaired renal tubular function.
Severe Herpes Zoster Infection in the United Kingdom: Experience in a Regional Infectious Disease Unit
Authors: Bannister P , Crosse B
Published: January 2017

Seventy-three cases of severe herpes zoster infection admitted to a regional infectious disease unit over a 3-year period were reviewed. Complications were common. Elderly patients were in the majority (55%), were hospitalized for longer and accounted for 78% of all complications. Acyclovir therapy was used in 44 cases with a reduction in both the duration of hospital stay and complication rate.
Brittleness evaluation of the Upper Ordovician Wufeng–Lower Silurian Longmaxi shale in Southern Sichuan Basin, China
Authors: Zhang Chenchen , Dong Dazhong , Wang Yuman , Guan Quanzhong
Published: January 2017

Rock brittleness is now one of the significant parameters for geological evaluation of shale gas reservoirs due to the wide application of hydraulic fracturing in shale gas development. Currently, the evaluation of shale brittleness is generally based on mineral composition or elastic parameters, which both derive from the exploration experiences in North America. Due to the easier access of mineral composition data through x-ray diffraction method than rock mechanical data through array sonic logging method, the mineral-based brittleness indices have stronger practicability. However, there is not a unified definition of brittle minerals yet, which now usually refers to quartz or quartz and carbonate minerals. Considering the specific conditions of Wufeng–Longmaxi Formation in Southern Sichuan Basin; depositional environment of calcareous shelf; and higher content of calcite, dolomite, and pyrite, we redefined brittle minerals according to the elastic parameters of each mineral, taking quartz, dolomite, and pyrite which best satisfy the standard of “Young’s modulus>30 GPa and Poisson’s ratio<0.25” as brittle minerals to establish a new brittleness index, which was proved to be more accurate and applicable than the current mineral-based brittleness indices. Then we applied the new evaluation model to Well W201, and selected “sweet spot” intervals combining with lithology, total organic carbon (TOC), thickness, and other geological parameters. The results showed that the “sweet spot” interval of this well is the black siliceous shale developed in Rhuddanian–middle Aeronian stage with an average brittleness index of 50.66%, TOC of 2.3–6.2%, and total thickness of about 19 m.
Genetic types and sources of Lower Paleozoic natural gas in the Daniudi gas field, Ordos Basin, China
Authors: Wu Xiaoqi , Zhu Jianhui , Ni Chunhua , Li Kuang , Wang Yanqing , Hu Ye , Lv Jianhong , Wu Yingli , Qiu Qi
Published: January 2017

The molecular composition, stable carbon and hydrogen isotopes, and light hydrocarbons of the Lower Paleozoic natural gas in the Daniudi gas field in the Ordos Basin were investigated to study the geochemical characteristics. The Lower Paleozoic gas in the Daniudi gas field displays methane contents of 87.41–93.34%, dryness coefficients (C1/C1–5) ranging from 0.886 to 0.978, δ13C1 and δ13C2 values ranging from −40.3 to −36.4‰, with an average of −38.3‰, and from −33.6 to −24.2‰, with an average of −28.4‰, respectively, and δD1 values ranging from −197 to −160‰. The alkane gas generally displays positive carbon and hydrogen isotopic series, and the C7 and C5–7 light hydrocarbons of the Lower Paleozoic gas are dominated by methylcyclohexane and iso-alkanes, respectively. The Lower Paleozoic gas in the Daniudi gas field is mixed from coal-derived and oil-associated gases, similar to that observed in the Jingbian gas field. The oil-associated gas in the Lower Paleozoic gas is secondary oil cracking gas and displays a lower cracking extent than that in the Jingbian gas field. The coal-derived gas in the Lower Paleozoic gas in the Daniudi gas field migrated from the Upper Paleozoic gas through the window area where the iron–aluminum mudstone caprocks in the Upper Carboniferous Benxi Formation were missing. The oil-associated gas in the Lower Paleozoic gas in the Daniudi gas field was probably derived from presalt source rocks in the Lower Ordovician Majiagou Formation rather than the limestone in the Upper Carboniferous Taiyuan Formation. It seems unlikely that the marlstone in the Upper Ordovician Beiguoshan Formation and shale in the Middle Ordovician Pingliang Formation on the western and southwestern margins of the Ordos Basin contributed to the oil-associated gas in the Lower Paleozoic gas in the Daniudi gas field.
Development of a Computer Adaptive Test for Depression Based on the Dutch-Flemish Version of the PROMIS Item Bank
Authors: Flens Gerard , Smits Niels , Terwee Caroline B. , Dekker Joost , Huijbrechts Irma , de Beurs Edwin
Published: January 2017

We developed a Dutch-Flemish version of the patient-reported outcomes measurement information system (PROMIS) adult V1.0 item bank for depression as input for computerized adaptive testing (CAT). As item bank, we used the Dutch-Flemish translation of the original PROMIS item bank (28 items) and additionally translated 28 U.S. depression items that failed to make the final U.S. item bank. Through psychometric analysis of a combined clinical and general population sample ( N = 2,010), 8 added items were removed. With the final item bank, we performed several CAT simulations to assess the efficiency of the extended (48 items) and the original item bank (28 items), using various stopping rules. Both item banks resulted in highly efficient and precise measurement of depression and showed high similarity between the CAT simulation scores and the full item bank scores. We discuss the implications of using each item bank and stopping rule for further CAT development.
The development of emotional and behavioral self-regulation and their effects on academic achievement in childhood
Authors: Edossa Ashenafi Kassahun , Schroeders Ulrich , Weinert Sabine , Artelt Cordula
Published: January 2017

Self-regulation is an essential ability of children to cope with various developmental challenges. This study examines the developmental interplay between emotional and behavioral self-regulation during childhood and the relationship with academic achievement using data from the longitudinal Millennium Cohort Study (UK). Using cross-lagged panel analyses, we found that emotional and behavioral self-regulation were separate and stable constructs. In addition, both emotional and behavioral self-regulation had positive cross-lagged effects from ages 3 to 7. At an early developmental stage (ages 3 to 5), emotional regulation affected behavioral regulation more strongly than later developmental stages. However, the difference between the reciprocal effects was small from ages 5 to 7. Moreover, behavioral regulation during the third year of primary education (age 7) had a substantial and positive effect on teachers’ evaluations of educational achievement during the last year of primary school (age 11). In contrast, emotional self-regulation only had a small indirect and positive effect via behavioral self-regulation. The current study suggests the structure of self-regulation was multidimensional and its facets are mutually dependent in the child’s development. In order to gain a complete picture of the development of self-regulation and its effect on educational achievement, the facets emotional and behavioral regulation should both be studied in concert.
Testing for homocysteine in clinical practice
Authors: Nichols John
Published: January 2017

The theory that raised blood homocysteine is a major factor in the development of cardiovascular disease was initially rejected by the medical establishment. Trials of a treatment to lower homocysteine in moderately advanced disease have failed to show benefits (except in those not treated with anti-platelet drug), but there is mounting evidence for a role in treatment of very early disease and as a preventive strategy. Recent evidence has shown that lowering of high blood homocysteine significantly slows cognitive decline and the brain shrinkage associated with Alzheimer’s disease. This is a test that should be done more frequently by National Health Service (NHS) general practitioners and private practitioners.
Business Information Needs in Northern Ireland
Authors: Butterwick Eleanor
Published: January 2017

Reports the findings of a survey of business information needs in Northern Ireland. Investigates information topics of most interest to business; topics posing difficulties; the availability of internal facilities for acquiring information; attitudes to business information provision; types of sources used; satisfaction ratings for sources used; information-gathering habits; spending on information; and preferred media.
Chinese Business Databases
Authors: Drew Jo
Published: January 2017

This review aims to identify Chinese business information databases which have recently been produced to provide up-to-date information for companies wishing to enter or expand their presence in the Chinese market.
Efficacy of the Comprehensive Objective Mapping, Precise Image Guided Injection, Anti-Reflux Positioning and Sequential Sclerotherapy (COMPASS) Technique in the Management of Greater Saphenous Varicosities with Saphenofemoral Incompetence
Authors: McDonagh B. , Huntley D. E. , Rosenfeld R. , King T. , Harry J. L. , Sorenson S. , Guptan R. C.
Published: January 2017

Objective:

To evaluate the efficacy of the COMPASS technique in the management of greater saphenous varicosities with saphenofemoral incompetence.

Design:

Prospective open trial (2-6 year follow-up).

Patients:

One hundred and eighty-six limbs with refluxing greater saphenous vein (5.4–25.4 mm) and incompetent saphenofemoral junction (6.1–31.3 mm).

Main outcome measure:

Obliteration, recanalisation, residual veins, neovascularisation, venous dysfunction score.

Results:

Greater saphenous varicosity is commonly a disease of individuals in their forties, with morbid clinical presentations. Three stages of the COMPASS technique achieved 100% and 98% obliteration of the saphenofemoral junction and greater saphenous vein respectively. There was significant improvement in the venous dysfunction score. Residual refluxing veins were easily managed by sequential treatment. The results are sustained in the 3.4 SD 1.7 year follow up. There was no serious adverse experience reported.

Conclusion:

The COMPASS technique is safe and highly efficacious in the management of extensive large vein varicose disease.
The Saphenofemoral Valve: Gate Keeper Turned into Rear Guard
Authors: Fassiadis N. , Holdstock J. M. , Whiteley M. S.
Published: January 2017

Objective:

Trendelenburg's theory was based on the concept of a descending valvular incompetence com mencing at the saphenofemoral junction (SFJ) with subsequent distal progression of reflux. The aim of this study was to evaluate the distribution of reflux in patients with superficial venous incompetence in order to assess validity of the above hypothesis.

Procedures:

The superficial and deep venous system of a consecutive series of 443 patients presenting with primary varicose veins was examined by one vascular technologist using colour flow ultrasonography.

Results:

Six hundred and eleven lower limbs in 443 patients were examined. The distribution of long saphenous vein (LSV) reflux was the following: Of the 611 limbs 454 showed LSV reflux, with 240 legs exhibiting total reflux (SFJ and LSV) and 214 legs exhibiting reflux in evolution (LSV reflux with competent saphenofemoral valve, isolated posterior arch reflux and lateral anterior thigh vein reflux with SFJ reflux).

Conclusion:

These results suggest that reflux starts distally and progresses proximally, thus throwing the Trendelenburg theory into dispute.
Effect of Posture on the Pressure Exerted by Below-Knee Class II Compression Stockings on Normal Subjects
Authors: Aryal K. , Dodds S. R. , Chukwulobelu R.
Published: January 2017

Background:

Below-knee elastic compression stockings are widely used for the treatment of chronic venous insufficiency. The exact amount of pressure exerted by these stockings on different parts of leg and in different postures remains controversial.

Objective:

To examine the pressure exerted by correctly fitted class II below knee compression stockings at different levels and postures in normal subjects.

Methods:

Seven healthy human volunteers (mean age 38 years) were fitted with CEN class II below-knee compression stockings. Interface pressure measurements were recorded at 4 cm intervals from the malleolus to the top of the stocking on the medial and lateral aspects of the leg in supine, sitting and standing postures.

Results:

The interface pressure at 4 cm and 32 cm above the medial malleolus was not significantly different from the recommended values for class II socks and did not change significantly with posture. In the supine position the pressure at the mid-calf (12 cm) was greater than at the ankle (p < 0.05), creating a reverse pressure gradient, which increased further on standing (p < 0.05).

Conclusion:

The pressure profile under correctly fitted class II socks varies with posture due to the change in shape of the leg. The resulting profile deviates from the theoretical ideal of a graduated pressure gradient that adapts with posture. The clinical significance of this effect is not known.
The Quality of Local Anaesthesia Associated with Intravenous Administration of Ketoprofen in Radical Operations for Leg Varicose Veins
Authors: Glinka M. , Urbaniak A. , Kalemba J.
Published: January 2017

Objective:

To evaluate the use of intravenous ketoprofen administration during varicose vein surgery undertaken under local anaesthesia.

Setting:

Regional general hospital in Poland.

Patients:

One hundred and six patients presenting with primary long saphenous varicose veins, including those with skin changes and leg ulceration.

Interventions:

Patients underwent sapheno-femoral ligation and long saphenous stripping under local anaesthesia including femoral nerve block, having first received an intravenous infusion of ketoprofen.

Outcome measures:

Patients recorded their level of discomfort or pain on a five-point scale. Blood pressure and pulse were also recorded.

Results:

One hundred and two patients found the level of analgesia produced by this technique to be acceptable, and 75 reported no discomfort at all.

Conclusions:

The combined use of intravenous ketoprofen and local anaesthesia allowed the treatment of all patients with superficial venous incompetence irrespective of their fitness for general anaesthesia.
Leg Ulcers: A Cross-Sectional Survey of Management Practices and Treatment Costs in Ireland
Authors: O'Brien J. F. , Clarke-Moloney M. , Grace P. A. , Perry I. J. , Burk P. E.
Published: January 2017

Objective:

To review the management and the cost of leg ulcers.

Design:

Cross-sectional survey based on a questionnaire completed by healthcare workers caring for patients with leg ulcers in a defined population.

Setting:

The Mid-Western Health Board area in Ireland with a population of 317069.

Patients:

All patients receiving healthcare for active leg ulceration.

Results:

Leg ulcers were recorded for 389 individuals and public health nurses primarily provided care (n = 283). Patients had open ulcers for a median period of 8 months (interquartile range: 3 months — 2 years) with almost half (n = 181) reporting previous episodes of ulceration. Fifty different dressing products were used to treat leg ulcers in the region. Only 52.2% (203/389) of patients had the aetiology of their leg ulcers properly investigated and evidence-based care was generally apparent in this group. Otherwise, care appeared haphazard and at times inappropriate. The estimated annual direct cost of dressing leg ulcers was £585 660.

Conclusion:

A regional strategy for managing leg ulcers needs to be clarified and implemented if practitioners are to incorporate evidence-based care into routine work.
Cost-Effectiveness of Venous Thromboembolism Prophylaxis after Total Hip Replacement
Authors: Caprini J. A. , Arcelus J. I. , Kudraa J. C. , Sehgal L. R. , Oyslender M. , Maksimovic D. , MacDougall A.
Published: January 2017

Objective:

To determine the cost-effectiveness of three strategies used for the prevention of venous thromboem-bolism (VTE) in patients undergoing total hip replace-ment (THR), and to perform a sensitivity analysis comparing VTE rates based on different methods of detection.

Methods:

In this cost-effectiveness analysis, three strategies of prophylaxis of postoperative VTE and THR were compared: (1) low-molecular-weight heparin (LMWH); Enoxaparin, (2) warfarin and (3) a combination of warfarin, heparin (UFH), graduated stockings and sequential long-leg pneumatic compression devices. The model estimates were based on pooled data from the published literature and from personal data in our series of hip replacement patients. Expected direct costs of VTE care, including prophylaxis, diagnosis and manage-ment of thromboembolic and hemorrhagic complications, were estimated for a hypothetical cohort of 100 patients in 2001 US dollars from data available for patients hospitalized at Evanston Northwestern Health-care. A sensitivity analysis was performed with different rates of VTE based on routine venography, routine duplex ultrasound, or selective diagnosis and treatment of symptomatic patients.

Results:

When venography was used to diagnose VTE, the cost of warfarin or LMWH treatment was $118 422 and $104 732 per 100 patients, respectively, providing cost savings of $ 13 690 per hundred patients for LMWH. When VTE rates were based on duplex ultrasound diagnoses, LMWH resulted in cost savings of $4602 and $1345 per 100 patients compared with the use of warfarin or the combined approach, respectively. However, when the rates of VTE were based on confirmed symptomatic cases, the use of LMWH resulted in an increased cost of $4486 and $10015 per 100 patients compared with warfarin and the combined approach, respectively.

Conclusions:

The use of LMWH for the prevention of VTE after THR was more cost-effective than using warfarin or the combined approach, when the VTE rate was based on routine venography or duplex ultrasound. However, the combined approach was more cost-effective than the use of warfarin or LMWH alone when only patients with confirmed, symptomatic VTE were treated.
Non-Arteritic Anterior Ischaemic Optic Neuropathy: A New Indication for Carotid Endarterectomy
Authors: Ogunbiyi S. O. , Coxon M. , Morris-Stiff G. , Ram R. , Lewis M. H.
Published: January 2017

We present a case of non-arteritic anterior ischaemic optic neuropathy (NAION) associated with ipsilateral internal carotid artery stenosis, in a patient who presented with sudden loss of vision. This patient underwent a carotid endarterectomy and reported both subjective and objective improvement in vision in the immediate postoperative period and a complete resolution of symptoms at 6 weeks follow-up. This case raises the question of a new indication for carotid endarter-ectomy in selected cases of NAION.
Anticardiolipin Antibodies and Protein S Deficiency: Two Case Reports
Authors: de Godoy J. M. P. , Braile D. M. , Ruiz M. A.
Published: January 2017

Objective:

To describe episodes of venous thrombosis in two young patients with combined congenital and acquired thrombophilias.

Patients:

Two patients attending a university hospital with episodes of deep vein thrombosis presenting at an unusually young age were studied. Tests for thrombo-philias showed these patients had protein S deficiency combined with high titres of cardiolipin antibodies.

Interventions:

The patients were anticoagulated with oral anticoagulants.

Results:

No further episode of thrombosis was seen in either patient over the following 2 years.

Cnclusions:

A detailed search for inherited and acquired thrombophilias should be undertaken in patients presenting with extensive venous thrombosis at an unusually young age. Oral anticoagulants are effective in managing this clinical problem. Indefinite anticoagulation may be required in patients presenting with combined thrombophilias.
Endothelium and Venotropic Drugs in Chronic Venous Insufficiency: A Review
Authors: Michiels C. , Remacle J. , Bouaziz N.
Published: January 2017

Objective:

To review the literature concerning chronic venous disease of the leg and the mechanisms of action of venotropic drugs.

Methods:

The authors identified relevant papers from their own collection and from medical literature databases.

Synthesis:

Endothelial cell activation caused by ex-posure to the hypoxic conditions that develop during blood stasis in chronic venous insufficiency patients is proposed to be one factor initiating a pro-inflammatory process in the leg veins. Recruited and activated neutrophils would then be responsible for alterations of the venous wall, typical of what is observed in varicose veins. Venotropic drugs used in the treatment of chronic venous insufficiency patients have long been known to decrease vascular permeability and increase venous tone. Recently, it has been shown that they are also able to prevent endothelial cell activation by hypoxia and a precise biochemical target common to all of them has been identified: the mitochondrial respiratory chain.

Conclusion:

The influence of venotropic drugs on the mitochondrial respiratory chain provides a rational explanation for the therapeutic benefit to patients of this class of drugs.
Mechanical Properties of Skin in Venous Lower Limb Syndrome
Authors: Kuiper J.P. , Jagtman B.A. , Brakkee A.J.M.
Published: January 2017

The authors have investigated the theory of loss of skin elasticity in conditions of chronic venous insufficiency and have attempted to establish a possible link between the mechanical properties of the skin and the venous wall. They conclude that while diminished skin elasticity is found in conjunction with reticular varicose veins, there is no correlation with truncal varicocities. They suggest therefore that different aetiological factors are concerned in truncal and reticular varicose veins.
Possible Explanations for Recurrence of Varicose Veins
Authors: Davy A. , Ouvry P.
Published: January 2017

The authors begin by defining what they mean by recurrence. Next they compare valvular (or trunk, or systematized varicose, depending on which terminology is used) disorders, and parietal (diffused varicose) disorders while at the same time recognizing the existence of mixed forms of the condition. They examine the case histories of 400 patients with recurrence. Of these, 107 recurred even though they were given correct treatment initially. They were re-operated and studied according to their age, sex, profession, whether they took the oestroprogesterone contraceptive pill and according to the anatomoclinical type of varicosity. Based on this study, the authors specify which types of varicose disorder are susceptible to relapse, and give possible explanations for the relapse in terms of the histology, biophysics, biochemistry, genetics and endocrinology. The aetiopathology, however, remains to be fully identified.
Should the Incompetent Saphenous Vein be Stripped to the Ankle?
Authors: Negus David
Published: January 2017

Long saphenous stripping from ankle to groin is followed by an unacceptably high (23-58%) instance of neurological complications resulting from saphenous nerve trauma. Sapheno-femoral ligation without stripping avoids this complication, but with a reported varicose vein recurrence rate of 60%. Stripping the incompetent long saphenous vein from groin to upper calf in 96 legs of 71 patients has been followed by saphenous neurological symptoms in 4.2%, with a recurrence rate of 12.5%, half of which were suitable for injection sclerotherapy.