bluuebunny/crossref_metadata_2025 huggingface dataset:
Why Do Patients not Keep their Appointments? Prospective Study in a Gastroenterology Outpatient Clinic
Authors: Murdock A , Rodgers C , Lindsay H , Tham T C K
Published: November 2017

Unkept outpatient appointments are a drain on resources. In a prospective study we asked non-attenders at a gastroenterology clinic why they had missed their appointment.

103 patients missed their appointment (14% of the total invited); 3 had died. The remaining 100 were asked to complete questionnaires, 68 by mail (43 returned) and 32 by telephone (30 successful); the response rate was thus 73%. 49 of the respondents were new patients, 6 of them with urgent referrals. The explanations for non-attendance by the 73 patients were: forgot to attend or to cancel (30%); no reason (26%); clerical errors (10%); felt better (8%), fearful of being seen by junior doctor (3%); inpatient in another hospital (3%); miscellaneous other (20%). 13 (27%) of the review patients had not kept one or more previous appointments. The non-attendance rates for different clinics ranged from 10% to 25% (average 14%).

A substantial number of non-attenders claimed to have forgotten their appointment or to cancel it. If, as we surmise, this reflects apathy, no strategy to improve attendance is likely to have great impact. Since the non-attendance rate is reasonably constant, it can be taken into account when patients are booked.
Chronic Subdural Haematoma in the Elderly—A North Wales Experience
Authors: Asghar Muhammad , Adhiyaman Vedamurthy , Greenway M W , Bhowmick Bhimal K , Bates A
Published: November 2017

Chronic subdural haematoma (CSDH) is predominantly a disease of the elderly. Most of the existing data come from studies done several decades ago. We examined the incidence, risk factors, clinical presentation, management and outcome in elderly patients with CSDH by retrospective study of the period 1996–1999 in the three district hospitals of North Wales.

40 cases of CSDH were identified in patients > 65 years, the incidence in this population being 8.2/100000. Falls (57%) and antithrombotic therapy (33%) were the most frequent risk factors. The most common presenting features were altered mental state (52%) and focal neurological deficit (50%). 24 patients (60%) underwent surgical intervention with 4 deaths (17%). In the non-operated group mortality was 7/16 (44%).

Most of the deaths in this series were due either to CSDH or to the complications of frailty and poor mobility. Surgery itself was generally successful.
Health Issues in Ethnic Minorities: Awareness and Action
Authors: Memon M , Abbas F , Khaonolakar M , Dixon J , Singh I
Published: November 2017

A key issue in health provision is the approach to health inequalities. In the UK, black and ethnic minority populations are disadvantaged in this respect. We obtained annual/public health reports from 13 health authorities (HAs) and 22 primary care trusts/groups (PCT/Gs) serving conurbations with large black and ethnic minority populations, and examined them for mention of special health issues for these groups and the action being taken. 22 of the 35 reports referred to such issues but only 17 referred to special initiatives; the most frequently mentioned were diabetes and coronary heart disease. We recommend that HAs and PCT/Gs serving large black and ethnic minority populations state specifically in their annual reports their awareness of health-equality issues and the action being taken to address them.
Pacemaker Explosions in Crematoria: Problems and Possible Solutions
Authors: Gale Christopher P , Mulley Graham P
Published: November 2017

The number of artificial cardiac pacemakers is increasing, as is the number of bodies being cremated. Because of the explosive potential of pacemakers when heated, a statutory question on the cremation form asks whether the deceased has a pacemaker and if so whether it has been removed. We sent a questionnaire to all the crematoria in the UK enquiring about the frequency, consequences and prevention of pacemaker explosions. We found that about half of all crematoria in the UK experience pacemaker explosions, that pacemaker explosions may cause structural damage and injury and that most crematoria staff are unaware of the explosive potential of implantable cardiac defibrillators. Crematoria staff rely on the accurate completion of cremation forms, and doctors who sign cremation forms have a legal obligation to provide such information.
Screening for Sulphonylureas in the Investigation of Hypoglycaemia
Authors: Kwong P Y P , Teale J D
Published: November 2017

The most important cause of hypoglycaemia in the presence of high insulin and C-peptide concentrations is insulinoma. However, a similar picture arises from use of sulphonylureas, which is sometimes covert. All specimens received in two years by a supraregional assay service laboratory from adults with low glucose and inappropriately high insulin and C-peptide concentrations were tested for sulphonylureas by a radioimmunoassay that employed antibodies to glibenclamide. In sulphonylurea-positive cases a questionnaire was sent to the consultant responsible for the patient, to elicit further information.

Samples from 93 adult patients met the criteria, and 34 (37%) of these gave a positive result on screening for sulphonylureas. The consultants provided further information on 31 of the 34, and in 20 the presence of a sulphonylurea was unexpected. In 10 the features were such as to raise the possibility of factitious drug ingestion.

A simple screening technique applied to specimens from patients with hyperinsulinaemic hypoglycaemia indicated that, in a substantial proportion of cases, the patient was taking a sulphonylurea.
Relations between Desire for Early Death, Depressive Symptoms and Antidepressant Prescribing in Terminally Ill Patients with Cancer
Authors: Tiernan E , Casey P , O'Boyle C , Birkbeck G , Mangan M , O'Siorain L , Kearney M
Published: November 2017

Some patients with advanced cancer express the wish for an early death. This may be associated with depression. We examined the relations between depressive symptoms and desire for early death (natural or by euthanasia or physician-assisted suicide) in 142 terminally ill patients with cancer being cared for by a specialist palliative care team. They completed the Hospital Anxiety and Depression Scale questionnaire and answered four supplementary questions on desire for early death.

Only 2 patients expressed a strong wish for death by some form of suicide or euthanasia. 120 denied that they ever wished for early release. The desire for early death correlated with depression scores. Depressive symptoms were common in the whole group but few were on antidepressant therapy.

Better recognition and treatment of depression might improve the lives of people with terminal illness and so lessen desire for early death, whether natural or by suicide.
Relations between Offending, Injury and Illness
Authors: Shepherd Jonathan , Farrington David , Potts John
Published: November 2017

The objectives of this study were to determine relations between offending and health, and how illness and injury relate to concurrent offending—whether offending predicts health or vice versa, and whether relations persist after adjustment for childhood predictors of offending. Data collected in the Cambridge Study in Delinquent Development were analysed. This is a prospective longitudinal survey of 411 South London males first recruited at age 8. Information about injuries and illnesses between ages 16 and 18 was set against information on offending and other types of antisocial behaviour.

Males who were injured (especially in assaults) tended to be convicted, to be violent, to have unskilled manual jobs and to be generally antisocial. Respiratory tract illnesses were negatively related to convictions and antisocial behaviour in general. Drug users were significantly likely to be ill. Adult convictions were predicted by childhood troublesome behaviour, daring/hyperactivity, low IQ/attainment, a convicted parent, family disruption/poor supervision and poverty. Assault injuries and respiratory tract illnesses did not predict adult convictions independently of these childhood factors.

It was concluded that injury is one symptom of an antisocial personality that arises in childhood and persists into adulthood. Therefore, measures that lead to a reduction in offending should also lead to a reduction in concurrent injuries. Negative relations between a range of antisocial behaviours and respiratory tract illness deserve further study.
In-Training Assessment for Specialist Registrars: Views of Trainees and Trainers in the Mersey Deanery
Authors: Bache John , Brown Jeremy , Graham David
Published: November 2017

Annual review of specialist registrars and production of a record of in-training assessment (RITA) is a mandatory component of training that has attracted criticism. Mersey Deanery has established a system of review that includes wider evaluation of the trainee's needs and of training requirements. We conducted a survey to ascertain whether this broadened review process was thought beneficial. In one year 1093 questionnaires were distributed to trainees and trainers.

605 (81%) of 744 trainees and 309 (89%) of 349 trainers responded. At least 89% of both groups said that the procedure had been effective in reviewing the previous year and the most recent post and in identifying training requirements. More than 90% rated the overall process positively. Trainees particularly appreciated the advice on future training, on careers and on research.

This form of review is expensive in consultant time but was valued by both trainees and trainers.
How Objective are Systematic Reviews? Differences between Reviews on Complementary Medicine
Authors: Linde Klaus , Willich Stefan N
Published: November 2017

Systematic reviews are considered the most reliable tool to summarize existing evidence. To determine whether reviews that address the same questions can produce different answers we examined systematic reviews of herbal medicine, homeopathy, and acupuncture taken from a previously established database. Information on literature searching, inclusion criteria, selection process, quality assessment, data extraction, methods to summarize primary studies, number of included studies, results and conclusions was compared qualitatively.

Seventeen topics (eight on acupuncture, six on herbal medicines, three on homeopathy) had been addressed by 2–5 systematic reviews each. The number of primary studies in the reviews varied greatly within most topics. The most obvious reason for discrepancies between the samples was different inclusion criteria (in thirteen topics). Methods of literature searching may have contributed with some topics but the equivalence of the searches was difficult to assess. Differences were frequently observed in other methodological aspects, in results and in conclusions.

This analysis shows that, at least in the three areas examined, systematic reviews often differ considerably. Readers should be aware that apparently minor decisions in the review process can have major impact.
The Doctor-Patient Relationship in US Primary Care
Authors: Lings Pam , Evans Philip , Seamark David , Seamark Clare , Sweeney Kieran , Dixon Michael , Gray Denis Pereira
Published: November 2017

Changes in the organization of primary care in the UK are driven by a need to improve access and availability, but doctor–patient relationships may suffer. To investigate the importance of such relationships in a different setting, we analysed focus-group data obtained in a primary care facility in the USA (Rochester, NY). The findings pointed to three key factors in these relationships—namely, an asymmetry of perceptions on the two sides, belying the notion of a meeting of experts; the importance on both sides of ‘liking’; and the value set by both parties on development of trust. The last two of these factors are probably related to continuity of care, now under threat.
Diagnosis of Perforated Enterocystoplasty
Authors: Fontaine Eric , Leaver Rachel , Woodhouse Christopher R J
Published: November 2017

In the operation of enterocystoplasty, now widely practised, segments of bowel are used to augment or replace the urinary bladder. An occasional complication is perforation, and this may present in non-specialist settings. We investigated the management of spontaneous perforations among 264 patients with enterocystoplasty followed by one surgeon for 2-18 years. Patients’ charts were examined for data on presentation, diagnosis and treatment.

10 patients had thirteen perforations; data were available for nine perforations in 9 patients. Mean time from enterocystoplasty to perforation was 45 months. Presentation was shoulder pain in 1 and abdominal pain (with or without fever) in 8. Perforation was diagnosed without delay in 3, but the initial diagnosis was urinary tract infection in 4 and small-bowel obstruction in 2. Ultrasound was the most useful investigation being diagnostic in 6 of 7 cases; contrast cystography showed a leak in only 2 of the 6 patients in whom it was performed. Treatment was successful in 8 cases (surgery 6; percutaneous drainage 2); 1 patient, who remained undiagnosed, was treated medically and died.

Patients with enterocystoplasty need to be educated about this potentially lethal complication, so that they can alert non-specialist clinicians to what may have happened. In any patient with enterocystoplasty who reports abdominal pain or shoulder pain, perforation has to be ruled out.
How will the Two-Weeks-Wait Rule Affect Delays in Management of Urological Cancers?
Authors: Subramonian K R , Puranik S , Mufti G R
Published: November 2017

The UK National Health Service has now specified a maximum interval of two weeks between general practitioner (GP) referral and specialist assessment for patients with suspected cancer. We examined progress through the cancer pathway in 160 patients with potentially curable cancers of the prostate, bladder, kidney and testis before implementation of this rule. Median intervals with interquartile ranges were quantified from the first GP consultation to hospital referral, then to the first hospital consultation, confirmation of diagnosis and definitive surgery.

34% of patients were seen at the hospital within two weeks of referral. The overall median interval from GP consultation to radical surgery was 137 days, the longest being for prostate cancer (median 244). For prostate, bladder and renal cancers the principal element of delay was from the time of diagnosis to surgery (76, 73 and 26 days respectively).

These results indicate that, under the two-weeks-wait rule, 2 out of every 3 patients achieve earlier initial assessment. However, the overall delay will not be substantially reduced without concomitant increases in diagnostic facilities, theatre time and human resources.
Relation between Severe Illness and Non-Completion of Quality-of-Life Questionnaires by Patients with Rectal Cancer
Authors: Kopp Ina , Lorenz Wilfried , Rothmund Matthias , Koller Michael
Published: November 2017

Quality of life (QoL) is an important outcome measure in clinical studies, but interpretation is hindered by incompleteness of data. We addressed this issue in a population-based cohort study of 146 patients with newly diagnosed rectal cancer. QoL was assessed by means of European Organization for the Research and Treatment of Cancer questionnaires at discharge from hospital after primary treatment and then every 3 months for 2 years. In parallel, objective clinical data were documented. Analyses were conducted in three steps: participants versus non-participants with QoL-assessment; poor compliers who filled in only one or two questionnaires ( n=20) versus good compliers who filled in all or nearly all questionnaires ( n=18); and the proportion of missing forms and critical (very poor) QoL scores in risk patients versus non-risk patients over the course of 2 years.

Non-participants and poor compliers were older, were more likely to receive palliative (rather than curative) treatment, and had worse scores for physical status. Tumour progression and therapeutic interventions were more frequent in poor compliers than in good-compliers. Patients with risk factors (age <75 years, poor physical status, palliative treatment) were more likely to have missing questionnaires and critical QoL scores in respect of physical functioning and global quality of life over the course of 2 years.

Missing values for QoL have clinical as well as methodological implications, because QoL scores can enhance a clinician's insight. Unwillingness to fill in a questionnaire is an indicator of serious illness. Studies that report sample statistics without specifying compliance rates and the characteristics of non-compliers will give a misleadingly positive picture.
Telephone Reminders to Reduce Non-Attendance Rate for Endoscopy
Authors: Lee C S , McCormick P A
Published: November 2017

Non-attendance at clinics and endoscopy units wastes resources and lengthens waiting lists. In a previous study elsewhere, a substantial proportion of patients claimed to have forgotten their appointment. We therefore assessed the value of telephoning patients a week before their booked day-case endoscopy. An observation period of two months was followed by an intervention period of two months in which patients were contacted by phone and asked if they wished to come for their investigation. A maximum of three separate attempts were made to contact each patient. Patients cancelling the appointment were replaced by others on the reserve list. The non-attendance rate was expressed as the percentage of unused beds.

During the observation period 56 patients were admitted and 18 beds were unused. During the intervention period it was possible to contact 73 of 88 patients and 8 of these cancelled. 87 beds were available and 83 patients were admitted. When clerical error, overbooking and failure to replace patients were taken into account, the non-attendance rate declined from 23.3% during the observation period to 5.7% during the intervention period (P≤0.05). The intervention seemed more effective in reducing non-attendance in outpatients referrals (0/48) than in general practitioner referrals (5/40).
Risk Factors in Acquired Faecal Incontinence
Authors: Lunniss Peter J , Gladman Marc A , Hetzer Franc H , Williams Norman S , Scott S Mark
Published: November 2017

Acquired faecal incontinence arising in the non-elderly population is a common and often devastating condition. We conducted a retrospective cohort analysis in 629 patients (475 female) referred to a tertiary centre, to determine the relative importance of individual risk factors in the development of faecal incontinence, as demonstrated by abnormal results on physiological testing.

Potential risk factors were identified in all but 6% of patients (7 female, 32 male). In women, the principal risk factor was childbirth (91%), and in most cases at least one vaginal delivery had met with complications such as perineal injury or the need for forceps delivery. Of the males, half had undergone anal surgery and this was the only identified risk factor in 59%. In many instances, assignment of cause was hampered by a long interval between the supposed precipitating event and the development of symptoms. Abnormalities of anorectal physiology were identified in 76% of males and 96% of females (in whom they were more commonly multiple).

These findings add to evidence that occult damage to the continence mechanism, especially through vaginal delivery and anal surgery, can result in subsequent faecal incontinence, sometimes after an interval of many years.
The Two-Week-Wait Cancer Initiative in Urology: Useful Modernization?
Authors: Allen Darrell , Popert Rick , O'Brien Tim
Published: November 2017

The two-week-wait cancer initiative in the UK was designed to speed referral of patients suspected of having cancer and, by so doing, improve their outcome. We reviewed the case notes of all patients referred under this scheme to a single urology department over twelve months.

In the department, nearly one-third of new outpatient appointments came under this scheme. 124 patients were referred and all but 7 were seen within the 14-day deadline. In 62 the reason for referral was haematuria, which was macroscopic in 42. Of those with macroscopic haematuria 6 proved to have cancer, newly diagnosed in 4 (2 bladder, 2 renal); no patient with microscopic haematuria had cancer. Of 35 referred with a raised prostate-specific antigen 11 had prostate cancer, in most cases beyond cure. Cancer was found in 1 of 19 patients referred with a testicular mass.

In patients referred under the two-week-wait scheme with macroscopic haematuria, cancer is common. Microscopic haematuria is seldom significant. Carcinoma of the prostate is usually advanced and beyond cure at presentation. Among patients referred with scrotal lumps, cancer of the testis is not common. The scheme as a whole is unlikely to improve cancer outcomes. Patients with macroscopic haematuria might be better served by one-stop clinics. For those with testicular lumps, most of which will be benign, the best answer might be direct general practitioner access to scrotal ultrasonography.
Routine Biochemistry in Suspected Vitamin D Deficiency
Authors: Peacey Steven R
Published: November 2017

Vitamin D deficiency, which continues to be widespread amongst persons of Asian descent in the UK, is often detected from abnormal results on routine biochemistry. The aim of this study was to assess the frequency of abnormal results from routine baseline tests of serum calcium, phosphate, and alkaline phosphatase in patients who subsequently proved to have vitamin D deficiency and secondary hyperparathyroidism. A retrospective examination was undertaken to assess these baseline indices in a cohort of 84 such patients seen in Bradford—5 male; 80 of Asian descent; median age 46 years (range 16-82); serum 25-hydroxyvitamin D < 10 μg/L; parathyroid hormone >54ng/L.

Calcium was normal in 55 patients (66%), phosphate in 68 (81%) and alkaline phosphatase in 24 (29%). In only 5 patients were all three indices outside the normal range. The median parathyroid hormone concentration was significantly greater in patients with abnormal routine biochemistry (145 [range 55-1662] ng/L) than in patients with normal routine biochemistry (88 [59-322] ng/L) but the median 25-hydroxyvitamin D levels did not differ (3.1 [1.3-9.9] and 3.0 [1.5-7.3] μg/L). Routine biochemistry was normal in 20% of cases.

If routine biochemistry is relied upon to detect vitamin D deficiency and osteomalacia, a substantial minority of cases will be missed.
Scoring Posters at Scientific Meetings: First Impressions Count
Authors: Smith Philip E M , Fuller Geraint , Dunstan Frank
Published: November 2017

Many specialist societies present ‘best poster’ prizes, yet without generally agreed assessment methods. 31 posters at a neurology meeting were divided randomly into two sets; 14 neurologists, randomized into two groups, were each assigned one poster set. They ‘quick scored’ the first half, viewing posters for 10-15 seconds, and ‘detailed scored’ the others. 11 administrators and pharmaceutical representatives quick scored all posters. Neurologists’ quick score ranking correlated highly ( r=0.75) with other neurologists’ detailed score ranking, and identified four of their six top-ranked posters. Correlations were strongest for presentation ( r=0.65), message ( r=0.65) and star-quality ( r=0.64), but weak for facts ( r=0.09), originality ( r=0.15) or science ( r=0.02). Non-neurologists could not identify the posters ranked highest by neurologists. We conclude that quick ranking by specialists can efficiently identify the best posters for more detailed assessment. On this basis we offer poster-scoring guidelines for use at scientific meetings.
Extra Vertebrae in Ingres’ La Grande Odalisque
Authors: Maigne Jean-Yves , Chatellier Gilles , Norlöff Hélène
Published: November 2017

La Grande Odalisque, a painting by Jean-Auguste Ingres (1780-1867), was throughout the 19th century notorious for its anatomical inaccuracy; in particular, the woman was said to have three lumbar vertebrae too many. This view was accepted by all art critics, but never tested and proven. We measured the length of the back and of the pelvis in human models, expressed the mean values in terms of head height, and transferred them to the painting. The deformation was found to be greater than originally assumed (five, rather than three, extra lumbar vertebrae), and to involve both the back and the pelvis. Ingres’ paintings skilfully combine realism and symbolism. We suggest that the deformation may have been introduced for psychological reasons. By placing the harem woman's head further away from her pelvis the artist may have been marking the gulf between her thoughts (expressed by her aloof, resigned look) and her social role (symbolized by her deliberately lengthened pelvis).
Community Hospitals: an Under-Recognized Resource for Palliative Care
Authors: Payne Sheila , Kerr Chris , Hawker Sheila , Seamark David , Davis Carol , Roberts Helen , Jarrett Nicola , Roderick Paul , Smith Helen
Published: November 2017

In the UK there are concerns that, in certain groups of dying patients such as the old, those with non-cancer diagnoses and those in rural areas, the quality of care is unacceptably variable. There has been no systematic survey of the extent to which community hospitals provide general palliative care for such patients. Therefore, by means of a structured questionnaire we asked senior nurses/managers at all 478 community hospitals in the UK for information on staff expertise, facilities and specialist equipment, liaison arrangements with specialist palliative care providers, priorities, practice and policy in end-of-life care.

Of the 346 hospitals (72%) that responded, only 28 were in urban areas. 73% of hospitals employed at least one nurse with additional training in palliative care, 72% had access to 24-hour specialist palliative care advice and 51% had separate overnight accommodation for relatives, but only 22% had designated palliative care beds. Most hospitals did not have written policies or guidelines for patient assessment or symptom control.

These findings add to evidence that community hospitals represent an important resource to improve access to palliative care for groups that are currently under-served.
Incidence of Fatigue Symptoms and Diagnoses Presenting in UK Primary Care from 1990 to 2001
Authors: Gallagher Arlene M , Thomas Janice M , Hamilton William T , White Peter D
Published: November 2017

Little is known about whether the incidence of symptoms of fatigue presented in primary care, and the consequent diagnoses made, change over time. The UK General Practice Research Database was used to investigate the annual incidence of both fatigue symptoms and diagnoses recorded in UK primary care from 1990 to 2001.

The overall incidence of all fatigue diagnoses decreased from 87 per 100000 patients in 1990 to 49 in 2001, a reduction of 44%, while postviral fatigue syndromes decreased from 81% of all fatigue diagnoses in 1990 to 60% in 2001. Chronic fatigue syndrome (CFS) and myalgic encephalomyelitis (ME) together increased from 9% to 26% of all fatigue diagnoses. The incidence of fibromyalgia increased from less than 1 per 100000 to 35 per 100000. In contrast, there was no consistent change in the incidence of all recorded symptoms of fatigue, with an average of 1503 per 100000, equivalent to 1.5% per year. CFS/ME and fibromyalgia were rarely diagnosed in children and were uncommon in the elderly. All symptoms and diagnoses were more common in females than in males.

The overall incidence of fatigue diagnoses in general has fallen, but the incidence rates of the specific diagnoses of CFS/ME and fibromyalgia have risen, against a background of little change in symptom reporting. This is likely to reflect fashions in diagnostic labelling rather than true changes in incidence.
Local Anaesthesia for Venous Cannulation and Arterial Blood Gas Sampling: Are Doctors Using It?
Authors: Sado Daniel M , Deakin Charles D
Published: November 2017

The pain of venous cannulation and arterial puncture can be greatly lessened by local anaesthesia. We sought information about the use of local anaesthesia for these procedures by doctors working in medicine, surgery and anaesthetics. A questionnaire was hand-delivered to 178 doctors in eight hospitals, all of whom responded.

For insertion of large-bore cannulae, local anaesthesia was used by all the anaesthetists but less than half the medical and surgical doctors. For arterial blood sampling it was used by 60% of anaesthetists and 2% of ward doctors.

Previous recommendations to use local anaesthesia seem to have been ignored, and in many instances these procedures are more painful than necessary.
Sex and Drugs in Popular Movies: An Analysis of the top 200 Films
Authors: Gunasekera Hasantha , Chapman Simon , Campbell Sharon
Published: November 2017

We analyse the portrayal of sex and drug use in the most popular movies of the last 20 years using the Internet Movie Database list of the top 200 movies of all time. Films released or set prior to the HIV era (pre 1983), animated, not about humans or G/PG rated, were excluded. Films were reviewed by one of two teams of two observers using a data extraction sheet tested for inter-rater reliability. Sexual activity, sexually transmitted disease (STD) prevention, birth control measures, drug use and any consequences discussed or depicted were recorded.

There were 53 sex episodes in 28 (32%) of the 87 movies reviewed. There was only one suggestion of condom use, which was the only reference to any form of birth control. There were no depictions of important consequences of unprotected sex such as unwanted pregnancies, HIV or other STDs. Movies with cannabis (8%) and other non-injected illicit drugs (7%) were less common than those with alcohol intoxication (32%) and tobacco use (68%) but tended to portray their use positively and without negative consequences. There were no episodes of injected drug use.

Sex depictions in popular movies of the last two decades lacked safe sex messages. Drug use, though infrequent, tended to be depicted positively. The social norm being presented is concerning given the HIV and illicit drug pandemics.
Cryptococcal Small-Bowel Obstruction in an Hiv-Positive Patient
Authors: Nawabi D H , Ffolkes L , O'Bichere A
Published: November 2017

Meningitis and pulmonary infections are common manifestations of cryptococcosis but gastrointestinal involvement is rare.
Delayed Diagnosis of HIV-Associated Thrombocytopenia in a Man of 70
Authors: Shavit Linda , Grenader Tal
Published: November 2017

HIV infection is commonly seen as a disease of young people, and failure to consider it in the over-50s can have damaging consequences. In the USA, at least 10% of AIDS cases now occur in this age group.1
Pierre-Charles-Alexandre Louis and the Evaluation of Bloodletting
Authors: Morabia Alfredo
Published: November 2017

Additional material for this article is available from The James Lind Library website [ www.jameslindlibrary.org ] where this paper was previously published.
The Doctor's PDA and Smartphone Handbook: Medical Records
Authors: Paton Chris , Al-Ubaydli Mohammad
Published: November 2017

This is the fifth in a series of extracts from a forthcoming book by M Al-Ubaydli and C Paton. The website [ www.rsmpress.co.uk/bkpda.htm ] includes video tutorials to accompany this text.
Al-Razi and Islamic Medicine in the 9th Century
Authors: Tibi Selma
Published: November 2017

Additional material for this article is available from The James Lind Library website [ www.jameslindlibrary.org ] where this paper was previously published.
Surgical Insights into Parkinson's Disease
Authors: Pereira Erlick A C , Aziz Tipu Z
Published: November 2017

Surgery for Parkinson's disease was popularized in the mid-twentieth century before the advent of effective medical therapies. Early lesioning treatments contributed to our understanding of the functional anatomy of Parkinson's disease. Observations of the limitations and long-term complications of established pharmacological therapies for Parkinson's disease, together with major contributions from animal research to elucidate the roles of the basal ganglia in movement disorders, inspired a recent renaissance in neurosurgical interventions for Parkinson's disease including deep brain stimulation; this continues to yield much neurophysiological information. The development of potentially restorative treatment modalities, such as gene therapy, neural transplantation and nanotechnology, hold much promise for surgery, both therapeutically and in revealing further insights into Parkinson's disease pathophysiology.
Adrenomyeloneuropathy in Patients with ‘Addison's Disease’: Genetic Case Analysis
Authors: Mukherjee Sagarika , Newby Elizabeth , Harvey John N
Published: November 2017

Objective

To review the clinical presentations and diagnostic issues in adrenomyeloneuropathy and adrenoleukodystrophy, which are different presentations of the same single gene disorder.

Design

Observational study.

Participants

Three generations of an affected kindred.

Intervention

None.

Main outcome measures

Neurological features suggestive of adrenoleukodystrophy or adrenomyeloneuropathy. Measurement of very long chain fatty acids. Molecular analysis of the adrenoleukodystrophy gene.

Results

Three adults presented with adrenomyeloneuropathy and two children with adrenoleukodystrophy. Circulating concentrations of long chain fatty acids were raised consistent with clinical features. A mutation in exon 6 of the adrenoleukodystrophy gene (P543L) was identified. This had not previously been identified but has subsequently been reported by other groups.

Conclusions

Adrenomyeloneuropathy should be considered in the differential diagnosis in male patients presenting with adrenal failure. Early diagnosis allows genetic counselling in such families and may become more important as treatment strategies evolve.
Meckel's Diverticulum: a Systematic Review
Authors: Sagar Jayesh , Kumar Vikas , Shah D K
Published: November 2017

Meckel's diverticulum is the most common congenital malformation of gastrointestinal tract. It can cause complications in the form of ulceration, haemorrhage, intussusception, intestinal obstruction, perforation and, very rarely, vesicodiverticular fistulae and tumours. These complications, especially bleeding, are more common in the paediatric age group than in adults; however it is not uncommon to miss the diagnosis of Meckel's diverticulum in adults. Here, we reviewed the literature regarding the complications of this forgotten clinical entity in adults with potential diagnostic difficulties and management strategies.
Interventions for the Treatment, Management and Rehabilitation of Patients with Chronic Fatigue Syndrome/ Myalgic Encephalomyelitis: An Updated Systematic Review
Authors: Chambers Duncan , Bagnall Anne-Marie , Hempel Susanne , Forbes Carol
Published: November 2017

Objectives

To determine whether any particular intervention or combination of interventions is effective in the treatment, management and rehabilitation of adults and children with a diagnosis of chronic fatigue syndrome / myalgic encephalomyelitis (CFS/ME).

Design

Substantive update of a systematic review published in 2002. Randomized (RCTs) and non-randomized controlled trials of any intervention or combination of interventions were eligible for inclusion. Study participants could be adults or children with a diagnosis of CFS/ME based on any criteria. We searched eleven electronic databases, reference lists of articles and reviews, and textbooks on CFS/ME. Additional references were sought by contact with experts.

Results

Seventy studies met the inclusion criteria. Studies on behavioural, immunological, pharmacological and complementary therapies, nutritional supplements and miscellaneous other interventions were identified. Graded exercise therapy and cognitive behaviour therapy appeared to reduce symptoms and improve function based on evidence from RCTs. For most other interventions, evidence of effectiveness was inconclusive and some interventions were associated with significant adverse effects.

Conclusions

Over the last five years, there has been a marked increase in the size and quality of the evidence base on interventions for CFS/ME. Some behavioural interventions have shown promising results in reducing the symptoms of CFS/ME and improving physical functioning. There is a need for research to define the characteristics of patients who would benefit from specific interventions and to develop clinically relevant objective outcome measures.
Appraisal, Assessment and Career Development for Doctors in Training: The Mersey Deanery Personal Development Portfolio
Authors: Sprigge J S , Higgins J , Rice B , Tofield L , Graham D
Published: November 2017

Objectives

To develop a robust valid and exportable appraisal and assessment process for doctors in training which is portfolio based and works at all hospitals within the deanery. It is called the personal development portfolio.

Design

For every senior house officer, there was a recorded meeting with his or her supervisor, at the beginning, midterm and at the end of the post. An outside assessor witnessed the exit assessment meeting.

Setting

The Wirral Hospital, a District General Hospital with 72 senior house officers in 10 different specialties was used as a pilot site to develop the process. Then the process was exported and implemented at the other 12 trusts of the deanery.

Main outcome measures

Records were kept of the induction, midterm and exit assessment meetings. A record was kept of the number of senior house officers succeeding and failing at their exit assessments. Also, the number promoted to the specialist registrar grade was recorded.

Results

The process was performed every 6 months on 11 occasions between 2000 and 2005. It involved 72 senior house officers in 10 different specialties. On each occasion, participation usually exceeded 70%: 623 were appraised and assessed and 609 of them (97.8%) had satisfactory exit assessments. For 14 doctors (2.2%), the process identified a cause for concern, which was usually accepted by the doctor and sometimes allowed remedial action to be taken. Twenty-six (4.2%) were promoted to the specialist registrar grade in this period. The process also identified the strengths and weaknesses of the senior house officer posts in the 10 different specialties that had such posts, and was used to encourage good medical teaching practice in them. Over 4 years, we exported the process to all the other 12 Trusts in the Mersey Deanery. Once established, the process was easy to use for both trainees and trainers, although it was time consuming.

Conclusions

It was possible to develop and implement a portfolio based appraisal and assessment process, which was accepted by senior house officers and their trainers in all specialties at all hospitals within the deanery. Now that the senior house officer grade has been superceded by the Foundation and the training grade years, the principles of the personal development portfolio are being used to appraise and assess doctors in these grades too.
Sexual Activity among Patients in Psychiatric Hospital Wards
Authors: Warner James , Pitts Nicola , Crawford Mike J , Serfaty Marc , Prabhakaran Pramod , Amin Rizkar
Published: November 2017

In psychiatric hospitals, sexual activity between patients raises special difficulties regarding consent. We undertook a questionnaire survey of inpatients in the mental health units of three hospitals to identify the nature and frequency of sexual activity. A contemporaneous staff questionnaire was used in an attempt to validate the patient reports.

Of the 100 patients who participated (response rate 60%), 30 reported engaging in some form of sexual activity including 10 who had sexual intercourse. All sexual intercourse was consensual, but only 2 respondents used condoms. Staff questionnaires suggested levels of sexual activity congruent with patient reports.

This survey underlines the conflict between an individual's right to sexual expression and the need to protect vulnerable patients.
Spatio-temporal dynamics of cerebral capillary segments with stalling red blood cells
Authors: Erdener Şefik Evren , Tang Jianbo , Sajjadi Amir , Kılıç Kıvılcım , Kura Sreekanth , Schaffer Chris B , Boas David A
Published: November 2017

Optical coherence tomography (OCT) allows label-free imaging of red blood cell (RBC) flux within capillaries with high spatio-temporal resolution. In this study, we utilized time-series OCT-angiography to demonstrate interruptions in capillary RBC flux in mouse brain in vivo. We noticed ∼7.5% of ∼200 capillaries had at least one stall in awake mice with chronic windows during a 9-min recording. At any instant, ∼0.45% of capillaries were stalled. Average stall duration was ∼15 s but could last over 1 min. Stalls were more frequent and longer lasting in acute window preparations. Further, isoflurane anesthesia in chronic preparations caused an increase in the number of stalls. In repeated imaging, the same segments had a tendency to stall again over a period of one month. In awake animals, functional stimulation decreased the observance of stalling events. Stalling segments were located distally, away from the first couple of arteriolar-side capillary branches and their average RBC and plasma velocities were lower than nonstalling capillaries within the same region. This first systematic analysis of capillary RBC stalls in the brain, enabled by rapid and continuous volumetric imaging of capillaries with OCT-angiography, will lead to future investigations of the potential role of stalling events in cerebral pathologies.
The Parent Perceptions of Overall School Experiences Scale: Initial Development and Validation
Authors: Ball Annahita , Bates Samantha , Amorose Anthony , Anderson-Butcher Dawn
Published: November 2017

Parent engagement in schools is often precipitated by a thorough and genuine assessment of parents’ needs, priorities, and perceptions of their children’s schools. This study reports on the development and validation of the Parent Perceptions of Overall School Experiences Scale. Confirmatory factor analyses (CFAs) examined the factorial validity of the measure using cross-sectional survey data from 2,643 parents. In addition, a series of CFAs was conducted to explore the language invariance of the measurement model across Spanish and English versions of the scale. Predictive validity also was determined using correlational analyses. Results revealed that the five-item Parent Perceptions of Overall School Experiences Scale is a brief, universal measure of parents’ perceptions of their overall experiences with their children’s schools. Schools, parents, and community members may use this measure to assess parents’ needs and to advocate for necessary programmatic changes that serve parents and their children.
Internal Capsule Elevation (ICE Procedure)
Authors: Yune Marc
Published: November 2017

The internal capsule elevation (ICE) procedure is a new operation designed to reposition an inferiorly or laterally displaced or misplaced breast implant. The distinct advantage of this procedure is the ease of the operation because it is essentially a suture-free capsulorrhaphy. The premise of this procedure was derived from the simple observation that replacing a deflated saline implant after a significant delay (1 month) required a fairly vigorous dissection to reopen the periphery of the original pocket. This is due to the fact that the peripheral pocket that is no longer kept open by the inflated implant adheres to itself through the body’s normal healing processes. This natural phenomenon may be enhanced by lightly cauterizing in a fractionated pattern, the area of desired closure inferiorly or laterally in an arc like fashion. By opening the opposite superior and/or medial pocket with an electrocautery capsulotomy and minimal blunt dissection, this allows the repositioned implant to be more easily relocated in the more desirable position. Suture capsulorrhaphy is a procedure that requires extreme accuracy in placement of the sutures to avoid dimpling or irregular contours of the inferior and lateral breast. In experienced hands, it can be a very reliable procedure.1-3 In my experience, many patients have presented with misshapen breasts after suture capsulorrhaphy in inexperienced hands. Many of the patients have expressed regret and are displeased with their outcomes. The ICE procedure offers a technically easier alternative for repositioning the minimally inferiorly and or laterally displaced implant as compared with more traditional suture capsulorrhaphy.
Evaluation of antimicrobial activity and cytotoxicity of pegylated aminoglycosides
Authors: Ahmadi Zeba , Verma Geeta , Jha Diksha , Gautam Hemant Kumar , Kumar Pradeep
Published: November 2017

Here, in this study, we have investigated the antibacterial activity and cytotoxicity of pegylated aminoglycosides (gentamicin, kanamycin, and neomycin). The antibacterial activity of pegylated aminoglycosides, prepared in two different ratios (1:1 and 1:2, aminoglycoside:polyethylene glycol), was determined against some common pathogens, namely, Gram-positive ( Bacillus cereus, Staphylococcus aureus) and Gram-negative ( Escherichia coli, Pseudomonas aeruginosa), by zone of inhibition and minimum inhibitory concentration assays. The activity of pegylated aminoglycosides was found to be decreased as compared to their respective native aminoglycosides. Moreover, aminoglycoside:polyethylene glycol (1:1) derivatives showed much higher activity as compared to aminoglycoside:polyethylene glycol (1:2) derivatives, that is, an increase in the content of polyethylene glycol decreased the activity considerably. This decrease in antibacterial activity was found to be the most prominent in Gram-positive bacteria, S. aureus. On the other hand, pegylation significantly decreased the cytotoxicity as determined by hemolysis and MTT assays. These results advocate exploration of different types of crosslinkers consisting of a small degree of amphiphilicity, which could facilitate better interactions with the bacterial cell membranes and inhibit induction of bacterial resistance.
Women’s Experiences of Social Reactions From Informal and Formal Supports: Using a Modified Administration of the Social Reactions Questionnaire
Authors: DePrince Anne P. , Dmitrieva Julia , Gagnon Kerry L. , Srinivas Tejaswinhi
Published: November 2017

A growing literature links social reactions to disclosures of intimate violence to posttraumatic outcomes. The Social Reactions Questionnaire (SRQ), a widely used measure developed to assess social reactions, asks about reactions received from people generally. The ability to examine the impact of social reactions from specific groups of people—such as criminal justice personnel versus community-based providers—has become increasingly more important from both research and practice perspectives. For example, as sexual assault responses nationally have relied on community-coordinated models that involve both criminal justice and community-based systems, tools are lacking to systematically assess the impact of social reactions from criminal justice personnel and community-based providers on survivors. Using the SRQ, the current study asked women to report separately on reactions received from criminal justice personnel, community-based providers, and informal supports. We recruited a diverse community sample of women ( N = 228, ages 18-63, 19% lesbian/bisexual, 44% ethnic minority) who experienced a sexual assault in the previous year and disclosed to the criminal justice system and/or a community-based provider. Multilevel analyses revealed considerable variability in the social reactions reported by women across criminal justice personnel, community-based providers, and informal supports. Analyses supported a seven-factor structure for the SRQ when the measure is yoked to particular experiences of disclosure, in this case to criminal justice personnel, community-based providers, or informal supports. The utility of this modified administration and scoring of the SRQ and the importance of considering reactions across different groups are described.