bluuebunny/crossref_metadata_2025 huggingface dataset:
Non-group A streptococci: are they pathogens in the throat?
Authors: Chowdhury M N H , Kambal A.M. , Al-Eissa Y.A. , Khaliq M R A , Al-Ayed I.H. , Al-Sanie A.M.
Published: September 2007

A total of 3,184 paediatric patients with sporadic pharyngitis was studied at King Khalid University Hospital in Riyadh, Saudi Arabia. In addition, 478 children without pharyngitis who were matched for age and sex were included as controls. Group A β-haemolytic streptococci (βHS) were detected significantly more often among the children with pharyngitis than among the controls (8.4% vs 2.3%; p <0.0001). In contrast, total non-group A and group C βHS were isolated at lower frequency from the sick than control children (0.9% vs 2.5% and 0.2% vs 1.2% respectively; p <0.01) while other non- group A βHS such as groups B, G and F were each isolated in similar frequency from both the sick and control children. We conclude that non-group A βHS appear not to be as important as aetiological agents of sporadic pharyngitis in these children.
Suicide and 'violent' death in a six-year cohort of male probationers compared with pattern of mortality in the general population: evidence of accumulative socio-psychiatric vulnerability
Authors: Pritchard Colin , Cox Malcolm , Dawson Adrian
Published: September 2007

The 'Health of the Nation' (Department of Health, 1992) suicide targets focus upon the mentally ill, but virtually ignore the mentally abnormal offender. Whilst forensic services deal with the severely disturbed, the majority of offenders remain in the community, despite long-standing psychosocial difficulties.

This study explores the mortality rates of a six-year cohort of male probationers (1990-1995) with males in the general population. Male offenders (aged 17-54) had double the death rate, five times the 'external death' rate and nine times the suicide rate of the general population.

This paper highlights the need to further improve the health-psychiatric-criminal justice collaboration.
Pica
Authors: Walker A.R.P. , Walker B.F. , Sookaria F.I. , Cannan R.J. , Cannan R.J.
Published: September 2007

Pica is the compulsive eating of non-food substances over a sustained period of time. It remains an intriguing, little understood occurrence, with a potential for both positive and negative outcomes. In this review information is given on the history of the phenomenon, its prevalence among children and women, and its relation to iron and zinc deficiency. A number of examples of pica practice are reported from Africa.
Roof water collection systems in some Southeast Asian countries: status and water quality levels
Authors: Appan A.
Published: September 2007

There is extensive use of simple and inexpensive roof water collection systems in some Southeast Asian countries. The collected runoff which flows off different types of roofs is affected not only by the inherent quality of the roofing material but also by the contamination of roofs by rodents, birds, etc. Consequently, bacteriological quality levels are excessive though the collected rainwater is still used extensively for potable purposes.

From samples collected in most locations, there were positive Total and Faecal Coliform counts though, in terms of physico-chemical parameters, roof water appears to be of a higher quality. Various causes have been attributed to the frequent presence of Faecal Coliform but, mostly, pollution is of animal origin as the Faecal Coliform/Faecal Streptococci ratio is less than unity.

It is proposed that the collected roof water be boiled, disinfected with household bleach or be subjected to radiation from sunlight which appears to have good potential to be an effective bactericide. It is recommended that simple testing methods be developed and health education imparted to the various aspects of utilising roof water collection systems.
Review : Bile acids, fibre and colon cancer: the story unfolds
Authors: Chaplin M.F.
Published: September 2007

Are the changes in faecal bile acid concentrations the cause of colorectal cancer or one of its effects? This is an area of controversy mainly due to the lack of a clear explanation as to how the bile acid concentrations are controlled under different circumstances. This review presents an outline of the evidence that bile acids are both a causal factor in colorectal cancer and that their concentrations are affected by it in a synergistic manner. It also offers an explanation of how some dietary fibre protects against colorectal cancer.
Health promotion in a hospital ward; reality or asking the impossible?
Authors: Coakley A.L.
Published: September 2007

The hospital ward environment poses challenges for health promotion which will require not only increased multiprofessional collaboration, but a new appreciation of the capabili ties of each member of the ward team. This paper discusses the application of one model of health promotion suitable for use in this setting and highlights the advantages of utilising such an approach.
Smoking habits of primary health care physicians in Bahrain
Authors: Hamadeh R.R.
Published: September 2007

A survey of the smoking habits of all primary health care physicians in Bahrain was carried out to determine their smoking habits and attitudes towards smoking. Sixty-four male doctors and fifty- eight female doctors returned a voluntary self completed questionnaire resulting in an 80.8% response rate. Male physicians were older than their female counterparts and had a higher proportion of ever-smokers (45.3%), smokers (26.6%), ex- smokers (18.8%) and daily smokers (18.8%). Cigarette smoking was the predominant type of smoking. The ratio of daily smoking prevalence (doctors/general population) among Bahraini citizens was 0.83 for males, 0.45 for females and 0.65 for both sexes combined. Of the smokers, 80% have considered quitting and 83.3% of them had made a serious attempt to quit. All the never- smokers perceived themselves as non-smokers in the coming five years compared to 83.3% of the ever- smokers. Among the perceived reasons for not smoking, primary health care physicians gave the highest importance to protecting their own health and setting a good example to children. Never- smokers gave more importance than ever-smokers to all the reasons for not smoking except for the occurrence of certain symptoms.
A methodology for setting practice criteria in healthcare
Authors: Zaenger Dennis , Al-Assaf A.F. , Al-Assaf A.F.
Published: September 2007

Practice criteria are an important part of health care and have taken a new prominence in the trend to address quality-of-care issues. Once an organisation makes a commitment to addressing its quality-of- care, it must define 'quality' in operational terms. Practice criteria do just that. The organisation ensures consistent, high-quality services through the correct application of practice criteria. This paper outlines a methodology that has been used in at least three countries to date. Early indications are that it is useful for helping an organisation begin its quality improvement 'journey'.
MiRFinder: an improved approach and software implementation for genome-wide fast microRNA precursor scans
Authors: Huang Ting-Hua , Fan Bin , Rothschild Max F , Hu Zhi-Liang , Li Kui , Zhao Shu-Hong
Published: September 2007

Background

MicroRNAs (miRNAs) are recognized as one of the most important families of non-coding RNAs that serve as important sequence-specific post-transcriptional regulators of gene expression. Identification of miRNAs is an important requirement for understanding the mechanisms of post-transcriptional regulation. Hundreds of miRNAs have been identified by direct cloning and computational approaches in several species. However, there are still many miRNAs that remain to be identified due to lack of either sequence features or robust algorithms to efficiently identify them.

Results

We have evaluated features valuable for pre-miRNA prediction, such as the local secondary structure differences of the stem region of miRNA and non-miRNA hairpins. We have also established correlations between different types of mutations and the secondary structures of pre-miRNAs. Utilizing these features and combining some improvements of the current pre-miRNA prediction methods, we implemented a computational learning method SVM (support vector machine) to build a high throughput and good performance computational pre-miRNA prediction tool called MiRFinder. The tool was designed for genome-wise, pair-wise sequences from two related species. The method built into the tool consisted of two major steps: 1) genome wide search for hairpin candidates and 2) exclusion of the non-robust structures based on analysis of 18 parameters by the SVM method. Results from applying the tool for chicken/human and D. melanogaster/D. pseudoobscura pair-wise genome alignments showed that the tool can be used for genome wide pre-miRNA predictions.

Conclusion

The MiRFinder can be a good alternative to current miRNA discovery software. This tool is available at http://www.bioinformatics.org/mirfinder/.
Calponin is expressed by subpopulations of connective tissue cells but not olfactory ensheathing cells in the neonatal olfactory mucosa
Authors: Tomé Mercedes , Siladžic Edina , Santos-Silva Alessandra , Barnett Susan C
Published: September 2007

Background

Debate has been ongoing on the relative merits of olfactory ensheathing cells (OECs) and Schwann cells as candidates for transplant-mediate repair of CNS lesions. Both glial cells exhibit similar molecular and cellular properties and to date there has been no antigenic marker identified that can clearly distinguish the two cell types. This inability to distinguish between the two cells types prevents confirmation of a controversial statement that cultures of OECs are contaminated with Schwann cells. Recently, proteomic analysis of foetal OECs and adult Schwann cells identified an actin-binding protein, calponin, as a specific marker for OECs. However, at the same time a recent report suggested that adult OECs do not express calponin. It was not clear if this discrepancy was due to methodology, as cells had to be treated with proteinase K to maximize calponin staining or developmental differences with only foetal/neonatal OECs expressing calponin. For this reason we have examined calponin expression in the peripheral olfactory system of embryonic and neonatal rats in vivo and from cells in vitro to assess if calponin is expressed in a developmental manner.

Results

In this study we show that: i) proteinase K pretreatment had no effect on calponin staining in both OECs and Schwann cells. ii) calponin immunoreactivity was not expressed by embryonic or neonatal OECs in vitro and in vivo although connective tissue from the olfactory mucosa was strongly positive in neonatal rats but not embryonic rats, iii) calponin expression in the olfactory mucosa was heterogeneous, defining subpopulations of connective tissue cells iv) using functional confrontation assays between OECs or Schwann cells with astrocytes, calponin was expressed heterogeneously by astrocytes.

Conclusion

It is concluded that calponin is heterogeneously expressed by neonatal mucosal connective tissue but not expressed by neonatal OECs, embryonic OECs, and neonatal Schwann cells. Furthermore, we propose that calponin is not a specific marker for OECs generated from any developmental age.
Common TNF-α, IL-1β, PAI-1, uPA, CD14 and TLR4 polymorphisms are not associated with disease severity or outcome from Gram negative sepsis
Authors: Jessen Kristine Marie , Lindboe Sarah Bjerre , Petersen Anncatrine Luisa , Eugen-Olsen Jesper , Benfield Thomas
Published: September 2007

Background

Several studies have investigated single nucleotide polymorphisms (SNPs) in candidate genes associated with sepsis and septic shock with conflicting results. Only few studies have combined the analysis of multiple SNPs in the same population.

Methods

Clinical data and DNA from consecutive adult patients with culture proven Gram negative bacteremia admitted to a Danish hospital between 2000 and 2002. Analysis for commonly described SNPs of tumor necrosis-α, (TNF-α), interleukin-1β (IL-1β), plasminogen activator-1 (PAI-1), urokinase plasminogen activator (uPA), CD14 and toll-like receptor 4 (TLR4) was done.

Results

Of 319 adults, 74% had sepsis, 19% had severe sepsis and 7% were in septic shock. No correlation between severity or outcome of sepsis was observed for the analyzed SNPs of TNF-α, IL-1β, PAI-1, uPA, CD14 or TLR-4. In multivariate Cox proportional hazard regression analysis, increasing age, polymicrobial infection and haemoglobin levels were associated with in-hospital mortality.

Conclusion

We did not find any association between TNF-α, IL-1β, PAI-1, uPA, CD14 and TLR4 polymorphisms and outcome of Gram negative sepsis. Other host factors appear to be more important than the genotypes studied here in determining the severity and outcome of Gram negative sepsis.
Generating prior probabilities for classifiers of brain tumours using belief networks
Authors: Reynolds Greg M , Peet Andrew C , Arvanitis Theodoros N
Published: September 2007

Background

Numerous methods for classifying brain tumours based on magnetic resonance spectra and imaging have been presented in the last 15 years. Generally, these methods use supervised machine learning to develop a classifier from a database of cases for which the diagnosis is already known. However, little has been published on developing classifiers based on mixed modalities, e.g. combining imaging information with spectroscopy. In this work a method of generating probabilities of tumour class from anatomical location is presented.

Methods

The method of "belief networks" is introduced as a means of generating probabilities that a tumour is any given type. The belief networks are constructed using a database of paediatric tumour cases consisting of data collected over five decades; the problems associated with using this data are discussed. To verify the usefulness of the networks, an application of the method is presented in which prior probabilities were generated and combined with a classification of tumours based solely on MRS data.

Results

Belief networks were constructed from a database of over 1300 cases. These can be used to generate a probability that a tumour is any given type. Networks are presented for astrocytoma grades I and II, astrocytoma grades III and IV, ependymoma, pineoblastoma, primitive neuroectodermal tumour (PNET), germinoma, medulloblastoma, craniopharyngioma and a group representing rare tumours, "other". Using the network to generate prior probabilities for classification improves the accuracy when compared with generating prior probabilities based on class prevalence.

Conclusion

Bayesian belief networks are a simple way of using discrete clinical information to generate probabilities usable in classification. The belief network method can be robust to incomplete datasets. Inclusion of a priori knowledge is an effective way of improving classification of brain tumours by non-invasive methods.
The DNA binding parvulin Par17 is targeted to the mitochondrial matrix by a recently evolved prepeptide uniquely present in Hominidae
Authors: Kessler Daniel , Papatheodorou Panagiotis , Stratmann Tina , Dian Elke Andrea , Hartmann-Fatu Cristina , Rassow Joachim , Bayer Peter , Mueller Jonathan Wolf
Published: September 2007

Background

The parvulin-type peptidyl prolylcis/transisomerase Par14 is highly conserved in all metazoans. The recently identified parvulin Par17 contains an additional N-terminal domain whose occurrence and function was the focus of the present study.

Results

Based on the observation that the human genome encodes Par17, but bovine and rodent genomes do not, Par17 exon sequences from 10 different primate species were cloned and sequenced. Par17 is encoded in the genomes of Hominidae species including humans, but is absent from other mammalian species. In contrast to Par14, endogenous Par17 was found in mitochondrial and membrane fractions of human cell lysates. Fluorescence of EGFP fusions of Par17, but not Par14, co-localized with mitochondrial staining. Par14 and Par17 associated with isolated human, rat and yeast mitochondria at low salt concentrations, but only the Par17 mitochondrial association was resistant to higher salt concentrations. Par17 was imported into mitochondria in a time and membrane potential-dependent manner, where it reached the mitochondrial matrix. Moreover, Par17 was shown to bind to double-stranded DNA under physiological salt conditions.

Conclusion

Taken together, the DNA binding parvulin Par17 is targeted to the mitochondrial matrix by the most recently evolved mitochondrial prepeptide known to date, thus adding a novel protein constituent to the mitochondrial proteome of Hominidae.
Simultaneous integrated boost of biopsy proven, MRI defined dominant intra-prostatic lesions to 95 Gray with IMRT: early results of a phase I NCI study
Authors: Singh Anurag K , Guion Peter , Sears-Crouse Nancy , Ullman Karen , Smith Sharon , Albert Paul S , Fichtinger Gabor , Choyke Peter L , Xu Sheng , Kruecker Jochen , Wood Bradford J , Krieger Axel , Ning Holly
Published: September 2007

Background

To assess the feasibility and early toxicity of selective, IMRT-based dose escalation (simultaneous integrated boost) to biopsy proven dominant intra-prostatic lesions visible on MRI.

Methods

Patients with localized prostate cancer and an abnormality within the prostate on endorectal coil MRI were eligible. All patients underwent a MRI-guided transrectal biopsy at the location of the MRI abnormality. Gold fiducial markers were also placed. Several days later patients underwent another MRI scan for fusion with the treatment planning CT scan. This fused MRI scan was used to delineate the region of the biopsy proven intra-prostatic lesion. A 3 mm expansion was performed on the intra-prostatic lesions, defined as a separate volume within the prostate. The lesion + 3 mm and the remainder of the prostate + 7 mm received 94.5/75.6 Gray (Gy) respectively in 42 fractions. Daily seed position was verified to be within 3 mm.

Results

Three patients were treated. Follow-up was 18, 6, and 3 months respectively. Two patients had a single intra-prostatic lesion. One patient had 2 intra-prostatic lesions. All four intra-prostatic lesions, with margin, were successfully targeted and treated to 94.5 Gy. Two patients experienced acute RTOG grade 2 genitourinary (GU) toxicity. One had grade 1 gastrointestinal (GI) toxicity. All symptoms completely resolved by 3 months. One patient had no acute toxicity.

Conclusion

These early results demonstrate the feasibility of using IMRT for simultaneous integrated boost to biopsy proven dominant intra-prostatic lesions visible on MRI. The treatment was well tolerated.
A fatal case of bupropion (Zyban) hepatotoxicity with autoimmune features: Case report
Authors: Humayun Fawwaz , Shehab Thomas M. , Tworek Joseph A. , Fontana Robert J.
Published: September 2007

Background

Bupropion is approved for the treatment of mood disorders and as an adjuvant medication for smoking cessation. Bupropion is generally well tolerated and considered safe. Two randomized controlled trials of bupropion therapy for smoking cessation did not report any hepatic adverse events. However, there are three reports of severe but non-fatal bupropion hepatotoxicity published in the literature.

Case Presentation

We present the case of a 55-year old man who presented with jaundice and severe hepatic injury approximately 6 months after starting bupropion for smoking cessation. Laboratory evaluation demonstrated a mixed picture of hepatocellular injury and cholestasis. Liver biopsy demonstrated findings consistent with severe hepatotoxic injury due to drug induced liver injury. Laboratory testing was also notable for positive autoimmune markers. The patient initially had clinical improvement with steroid therapy but eventually died of infectious complications.

Conclusion

This report represents the first fatal report of bupropion related hepatotoxicity and the second case of bupropion related liver injury demonstrating autoimmune features. The common use of this medication for multiple indications makes it important for physicians to consider this medication as an etiologic agent in patients with otherwise unexplained hepatocellular jaundice.
Epidermal growth factor receptor (EGFR) is transcriptionally induced by the Y-box binding protein-1 (YB-1) and can be inhibited with Iressa in basal-like breast cancer, providing a potential target for therapy
Authors: Stratford Anna L , Habibi Golareh , Astanehe Arezoo , Jiang Helen , Hu Kaiji , Park Eugene , Shadeo Ashleen , Buys Timon PH , Lam Wan , Pugh Trevor , Marra Marco , Nielsen Torsten O , Klinge Uwe , Mertens Peter R , Aparicio Samuel , Dunn Sandra E
Published: September 2007

Introduction

Basal-like breast cancers (BLBCs) are very aggressive, and present serious clinical challenges as there are currently no targeted therapies available. We determined the regulatory role of Y-box binding protein-1 (YB-1) on epidermal growth factor receptor (EGFR) overexpression in BLBC, and the therapeutic potential of inhibiting EGFR. We pursued this in light of our recent work showing that YB-1 induces the expression of EGFR, a new BLBC marker.

Methods

Primary tumour tissues were evaluated for YB1 protein expression by immunostaining tissue microarrays, while copy number changes were assessed by comparative genomic hybridization (CGH). The ability of YB-1 to regulate EGFR was evaluated using luciferase reporter, chromatin immunoprecipitation (ChIP) and gel shift assays. The impact of Iressa on monolayer cell growth was measured using an ArrayScan VTI high-throughput analyser to count cell number, and colony formation in soft agar was used to measure anchorage-independent growth.

Results

YB-1 (27/37 or 73% of cases, P = 3.899 × 10-4) and EGFR (20/37 or 57.1% of cases, P = 9.206 × 10-12) are expressed in most cases of BLBC. However, they are not typically amplified in primary BLBC, suggesting overexpression owing to transcriptional activation. In support of this, we demonstrate that YB-1 promotes EGFR reporter activity. YB-1 specifically binds the EGFR promoter at two different YB-1-responsive elements (YREs) located at -940 and -968 using ChIP and gel shift assays in a manner that is dependent on the phosphorylation of S102 on YB-1. Inhibiting EGFR with Iressa suppressed the growth of SUM149 cells by ~40% in monolayer, independent of mutations in the receptor. More importantly anchorage-independent growth of BLBC cell lines was inhibited with combinations of Iressa and YB-1 suppression.

Conclusion

We have identified for the first time a causal link for the expression of EGFR in BLBC through the induction by YB-1 where it binds specifically to two distinguished YREs. Finally, inhibition of EGFR in combination with suppression of YB-1 presents a potential opportunity for therapy in BLBC.
Alveolar instability caused by mechanical ventilation initially damages the nondependent normal lung
Authors: Pavone Lucio , Albert Scott , DiRocco Joseph , Gatto Louis , Nieman Gary
Published: September 2007

Background

Septic shock is often associated with acute respiratory distress syndrome, a serious clinical problem exacerbated by improper mechanical ventilation. Ventilator-induced lung injury (VILI) can exacerbate the lung injury caused by acute respiratory distress syndrome, significantly increasing the morbidity and mortality. In this study, we asked the following questions: what is the effect of the lung position (dependent lung versus nondependent lung) on the rate at which VILI occurs in the normal lung? Will positive end-expiratory pressure (PEEP) slow the progression of lung injury in either the dependent lung or the nondependent lung?

Materials and methods

Sprague–Dawley rats (n = 19) were placed on mechanical ventilation, and the subpleural alveolar mechanics were measured with an in vivo microscope. Animals were placed in the lateral decubitus position, left lung up to measure nondependent alveolar mechanics and left lung down to film dependent alveolar mechanics. Animals were ventilated with a high peak inspiratory pressure of 45 cmH2O and either a low PEEP of 3 cmH2O or a high PEEP of 10 cmH2O for 90 minutes. Animals were separated into four groups based on the lung position and the amount of PEEP: Group I, dependent + low PEEP (n = 5); Group II, nondependent + low PEEP (n = 4);Group III, dependent + high PEEP (n = 5); and Group IV, nondependent + high PEEP (n = 5). Hemodynamic and lung function parameters were recorded concomitant with the filming of alveolar mechanics. Histological assessment was performed at necropsy to determine the presence of lung edema.

Results

VILI occurred earliest (60 min) in Group II. Alveolar instability eventually developed in Groups I and II at 75 minutes. Alveoli in both the high PEEP groups were stable for the entire experiment. There were no significant differences in arterial PO2 or in the degree of edema measured histologically among experimental groups.

Conclusion

This open-chest animal model demonstrates that the position of the normal lung (dependent or nondependent) plays a role on the rate of VILI.
Role of the complement in experimental sepsis
Authors: Ward Peter A
Published: September 2007

At the Trauma, Shock, Inflammation and Sepsis 2007 conference, the roles of complement activation products and relevant receptors were stressed in the setting of experimental sepsis [cecal ligation and puncture (CLP)] in mice and rats. In addition, some limited evidence was presented related to humans with septic shock (requiring vasopressor support). Collectively, the data suggested that events found in CLP also occur in human sepsis. Experimental sepsis (CLP) in rodents is associated with robust complement consumption and appearance of activation products (C3a, C5a) in plasma. During sepsis, there is up-regulation of C5a receptors (C5aR, C5L2) on blood polymorphonuclear neutrophils (PMNs) and in lungs, liver, kidneys, and heart. CLP also leads to dramatic reductions of C5aRs on blood PMNs, the intensity of which correlates with lethality. Interception in vivo of C5a or C5aR dramatically improves survival after CLP, preserves innate immune functions of blood PMNs, and greatly attenuates the intensity of consumptive coagulopathy and activation of the fibrinolytic system after CLP. In humans with septic shock, there is evidence of complement activation products in plasma along with loss of C5aRs on blood PMNs. These data suggest that in septic humans, interception of C5a or C5aR might be clinically efficacious.
Advances in the practice of electroconvulsive therapy
Authors: Lock Toni
Published: September 2007

The first electroconvulsive treatment was administered by Cerletti and Bini in 1938. The event was essentially an experiment, carried out like a military operation (Endler, 1988). The patient was stimulated three times, each time increasing the intensity of the stimulus before a generalised seizure was induced. He had been suffering from an acute psychosis with a poor prognosis, but responded to a course of 11 treatments and was discharged free of symptoms two months later. The first paper on electroconvulsive therapy (ECT) in English was published in theLancet(Kalinowski) in 1939. At that time, somatic treatment alternatives for the severely ill in large mental institutions included lobotomy and insulin coma therapy. In comparison, unmodified ECT (albeit associated with a significant risk of serious physical morbidity) was predictable, efficient, quick and effective. It is understandable why the treatment became widely and fairly indiscriminately adopted before systematic objective evidence of its efficacy was collected.
How consultants manage their time
Authors: Creed Francis
Published: September 2007

One of the most valuable commodities in the NHS is the individual consultant's time. This is what patients, their relatives, and other staff want most, and they complain that it is not sufficiently available. We increasingly examine the use of our resources and the quality of our service but do not pay sufficient attention to this variable. This article aims to highlight the importance of the clinician's time and suggests that it should be subjected to periodic audit, along with other aspects of the service, and that the duration of face-to-face contact with patients should be introduced as one of a series of quality measures.
Prevention of depression: psychological and social measures
Authors: Scott Jan
Published: September 2007

The role of pharmacotherapy in the management of depressive disorders is well-established and frequently reviewed. This paper focuses on the prospects for reducing the incidence, prevalence and morbidity of depression through psychosocial interventions. A central requirement in prevention is a knowledge of the epidemiology of the disorder being investigated. This data can be used to identify high-risk groups. By comparing the number of known cases with population levels of morbidity, it allows comment on help-seeking behaviour and accessibility of services. Also, differences in incidence and prevalence rates give some indication of the chronicity of the disorder.
Chronic depression and anxiety in primary care: approaches to liaison
Authors: Lloyd Keith , Jenkins Rachel
Published: September 2007

Much attention has focused on prompt, accurate identification and treatment of depression and anxiety in primary care settings. Less is known about what to do when treatment is unsuccessful or the initial opportunity to intervene is missed. The long-term prognosis of depression and anxiety in primary care settings is not good: half of sufferers experience a relapsing remitting course and a quarter become chronic. There is also a relationship between chronicity and high service utilisation. The label “heartsink” has sometimes been applied to these patients, often pejoratively.
Bridging primary and secondary care for people with learning disabilities
Authors: Simpson Neill J.
Published: September 2007

Definitions for learning disability vary depending on the context in which they are used (Box 1), as does the terminology (Box 2). In the UK, the term ‘learning disability’ was adopted in 1991 by the Department of Health. The term ‘mental retardation’ is used in the ICD-10 (World Health Organization, 1992). Fryers (1991) has commented on the need for different definitions in order to distinguish the context in which the term is used.
A managerial perspective on consultant psychiatrists
Authors: Joyce Lionel , Perkins Rod
Published: September 2007

This paper explores the range of expectations of psychiatrists held by those in general management in the health service.

In most Western countries, including the UK, comprehensive mental health services are predominantly funded from State resources. The role of the psychiatrist has changed in the past 20 years and will without doubt change further in the next 20 years. Expectations of psychiatrists have changed and will continue to do so. We take the position that psychiatrists should continue to have the major leadership role in mental health and in so doing must become increasingly responsive to the changes taking place in health care planning and provision.
Risk assessment. “A word to the wise”?
Authors: Vinestock Morris
Published: September 2007

Risk assessment is in vogue clinically and politically. The term is used in two ways. It refers to a method of balancing probable consequences of decisions which formalises the decision-making process. In psychiatry, it usually refers to the same method focused on the current clinical practice of assessing the risks of harm to self or others.
Behaviour therapy and drug treatments for obsessive–compulsive disorder
Authors: Duggan C.
Published: September 2007

Three recent advances have increased the importance of obsessive–compulsive disorder (OCD) for the general psychiatrist. It is a more common disorder than previously realised, there are effective treatments, and the basic neurobiological substrate for the condition is being identified. This review will consider these advances but focus mainly on the practical aspects of assessing the condition and planning treatment.
New psychological treatments in schizophrenia
Authors: Haddock Gillian , Lewis Shôn
Published: September 2007

The first line of treatment for patients with psychotic disorders such as schizophrenia is neuroleptic medication. Neuroleptics have provided substantial benefits to patients with this type of severe mental illness since their discovery as a treatment for psychosis in the 1950s. Despite this, there are still a large number of patients who do not respond fully to neuroleptic medication or who are not able to tolerate it. For example, although as many as 70% of patients are substantially improved following drug treatment, a considerable proportion continue to experience persistent, distressing and recurrent symptoms. In a survey of patients in a London psychiatric hospital, Cursonet al(1988) found that just under half of the patients continued to experience hallucinations and delusions despite the prescription of medication. In addition, many patients experience intolerable side-effects or do not wish to comply with neuroleptic medication, yet look for some effective alternative. Depression, anxiety and a high rate of suicide are additional problems faced by patients with schizophrenia.
Misuse of amphetamines and related drugs
Authors: Seivewright Nicholas , McMahon Charles
Published: September 2007

This article discusses the misuse of drugs which act as stimulants, an effect mainly produced by enhancement of the central transmission of catecholamines, particularly dopamine. Stimulant misuse is extremely widespread in the UK and elsewhere, but primary users of such drugs present relatively rarely for treatment at drug services. At present such services mainly see heroin users, not only because the greater addictiveness of heroin produces generally higher levels of problems, but because a substitute treatment can be used in that group in the form of methadone.
The management of released hostages
Authors: Fletcher Keron
Published: September 2007

Hostage situations differ greatly – in the aims and goals of the hostage-takers, the frequency and intensity of maltreatment, the type and quality of conditions, the duration of captivity, and the processes by which they are ultimately resolved and concluded. Although there is a paucity of research-based data about hostage reactions, clinical management, and outcome, there are general descriptive accounts in the medical and popular literature. A number of key texts are highlighted in the references, and examples of different conditions are briefly summarised in Box 1.
Assertive community treatment for the severely mentally ill in West Lambeth
Authors: Craig Tom , Pathare Soumitra
Published: September 2007

The prime duty of specialist mental health services is to provide effective care to often non-compliant and unstable severely mentally ill (SMI) patients. Society expects such care to be humane and effective, but also demands that the severely ill are closely supervised to minimise risk to the public. Sadly, specialist services all too often fail on both counts. In part, this is due to the sheer complexity of care that is needed, going far beyond purely medical or therapeutic interventions. SMI patients have profound difficulties accessing and using everyday services and opportunities. Negative symptoms of apathy, self-neglect and low motivation, coupled with irrational beliefs and compounded by inadequately resourced and tightly rationed provision of social care, require mental health care services to be constantly active across areas of both medical and social provision. Services that ignore the importance of long-term, integrated care do so at their peril. A steady stream of disasters has been blamed on a lack of communication and coordination between agencies (Spokes, 1988; Ritchie et al, 1994), and follow-up studies of SMI patients managed by traditional hospital out-patient services repeatedly note a mismatch between levels of need and service uptake, with the least needy consuming the greater amount of service (Goering et al, 1984; Melzer et al, 1991).
Pharmacotherapy for anxiety disorders: drugs available
Authors: Cowen P. J.
Published: September 2007

The human search for tranquillity has embraced the use of numerous substances of which alcohol is probably the most widely used. Alcohol acts in part by facilitating neurotransmission at γ-aminobutyric acid (GABA) synapses and until recently the pharmacological treatment of anxiety was based principally on drugs that produce similar actions on this neurotransmitter and its receptor complex (Cowen & Nutt, 1982) (Box 1).
Interventions for people with autism: recent advances
Authors: Howlin Patricia
Published: September 2007

Autism is a pervasive and life-long disorder that is characterised by profound deficits in communication and social understanding, together with ritualistic and obsessional behaviours and a general resistance to change. Although usually associated with additional cognitive impairments (approximately 50% of those affected have an IQ below 50) the condition can occur in individuals of all levels of ability, and around 20% of cases have an IQ within the normal range. Estimates of prevalence vary from 3.3 to 16.0 per 10 000 and rates may be even higher if children within the autistic wider spectrum are included (Wing, 1993, 1996). Understanding of causation is still limited, although genetic factors are now known to play a major role (Lord & Rutter, 1994).
The Cochrane Collaboration and the process of systematic reviewing
Authors: Adams Clive , Soares Karla
Published: September 2007

In 1979 Archie Cochrane, a British epidemiologist, stated that:

“it is surely a great criticism of our profession that we have not organised a critical summary, by specialty or subspecialty, adapted periodically, of all relevant randomized controlled trials.”

Cochrane, 1979
Prevention and treatment of impairment in doctors
Authors: Wilhelm Kay , Diamond Michael , Williams Anthony
Published: September 2007

This paper will concentrate on some of the practical contributions that consultant psychiatrists can make in the prevention and treatment of psychiatric impairment in doctors. We will illustrate this with case material from programmes in which there has been a good deal of psychiatrist participation.
Health of tomorrow's doctors: obstacles to appropriate help-seeking
Authors: Wrate Robert M. , Baldwin Pamela J.
Published: September 2007

During the research interviews for Isobel Allen's prospective studies of medical careers (Allen, 1994), many young doctors voiced concerns about their working conditions. Although a relationship between doctors' health impairment and their arduous working conditions has only recently been empirically established (Baldwinet al, 1997a), concern about sick doctors, at all stages of their careers, has been growing for many years. There are very few empirical data on sick doctors' help-seeking, but the enlightened self-interest of trusts and health boards may become an important new driving force, because of the more clearly defined responsibilities of National Health Service (NHS) senior staff for the well-being of their colleagues and possible liability for colleagues' impaired clinical practice (General Medical Council, 1995;British Medical Journal, 1997). The anticipated UK shortage of doctors may also act as a stimulus for measures designed to encourage the retention of a healthy medical workforce.
Seasonal affective disorder
Authors: Rodin I. , Thompson C.
Published: September 2007

Seasonal affective disorder (SAD) is a recurrent depressive disorder in which episodes occur at a particular time of year. The most frequent variant is winter SAD in which patients become depressed during the autumn or early winter, with remission or conversion to hypomania the following spring. Recognition of winter SAD is important because the diagnosis predicts a good response to the novel treatment of phototherapy. One other variant, summer SAD, has also been described and we will discuss this condition separately. Otherwise, we will confine our discussion to the winter variant which we will refer to as SAD.
Atypical antipsychotics and the negative symptoms of schizophrenia
Authors: King David J.
Published: September 2007

The concept of positive and negative symptoms in schizophrenia can be traced back to Hughlings Jackson (1889) who taught that disease does not create, it sets free, and accordingly positive symptoms could be seen as ‘release’ phenomena resulting from ‘dissolution’ of the highest cerebral centres of the nervous system. Crow (1980) revived the dichotomy and proposed a Type I syndrome, characterised by positive symptoms, and a Type II syndrome, characterised by negative symptoms. He thought the latter was due to cortical atrophy and responded poorly to antipsychotic medication. In their review of the distinction, Walker & Lewine (1988) found a stronger relationship between premorbid dysfunction and negative symptoms than with positive symptoms. They also found there was a stronger influence of genetic factors on negative symptoms than positive symptoms.
Group therapy for victims and perpetrators of incest
Authors: Welldon Estela
Published: September 2007

Abuse is an inter-generational problem. Abusers have been damaged in childhood by abusive action perpetrated on them, usually by their parents but sometimes by other significant adults. At times, in becoming adults, the early emotional damage can manifest into psychopathological features, including perversions or paraphilias and perpetration of abuse against children.
Cognitive therapy in the treatment of low self-esteem
Authors: Fennell Melanie J. V.
Published: September 2007

Beck's cognitive therapy originally developed as a short-term treatment for depression (Beck et al, 1979). It has been shown to be effective with a range of other disorders including panic disorder, generalised anxiety disorder, social phobia, eating disorders and sexual dysfunction (Roth et al, 1996). It is promising in the treatment of yet more disorders, many of which have traditionally been thought relatively impervious to psychotherapy, for example, bipolar disorder, chronic fatigue and psychosis (Clark & Fairburn, 1997). However, not everyone responds well to short-term cognitive therapy. In particular, it has been proposed that people with multiple, chronic problems that are apparently expressions of personality, rather than temporary responses to adverse life experiences, require more extended therapy (Beck et al, 1990).
Puerperal disorders
Authors: Brockington Ian
Published: September 2007

Childbearing, from the standpoint of psychological medicine, is the most complex event in human experience (Brockington, 1996). Pregnancy and childbirth involve major biological, social and emotional transitions and expose the mother to a range of psychological and medical complications. There are about 20 psychiatric disorders occurring in the post-partum period (see Table 1).
Expert evidence and the courts 2. Proposals for reform, expert witness bodies and ‘the model report’
Authors: Rix Keith J. B.
Published: September 2007

In response to what are regarded as the two principal evils of the civil justice system, costs and delay, Lord Woolf, now Master of the Rolls, has presided over an inquiry which has resulted in some proposed reforms which should change radically the administration of civil justice. The implications for experts are best considered against the background of a brief overview of the proposed reforms. This paper then considers the role of the expert witness organisations and the medical version of ‘the model expert report’.
Management of alcohol Korsakoff syndrome
Authors: Smith Iain David , Hillman Audrey
Published: September 2007

“Contrary to popular belief, partial recovery from Korsakoff's Psychosis is the rule and 21% recover more or less completely. However the extent to which the patient will recover cannot be predicted with confidence during the acute stages of the illness. Failure to appreciate these facts about the natural history of the mental illness may result in the premature confinement of the patient to a mental hospital” (Victoret al, 1971).
Cognitive and behavioural approaches to medication adherence
Authors: Scott Jan
Published: September 2007

“The desire to take medication is perhaps the greatest feature which distinguishes man from animals.” (Sir William Osler)

Medication non-adherence is a major obstacle to translating treatment efficacy in research settings into effectiveness in clinical practice (Dickson & Kendall, 1986; Scott, 1995). Randomised controlled trials indicate that brief interventions such as cognitive-behavioural educational packages for depression, cognitive therapy for lithium clinic attenders and compliance therapy for people with schizophrenia may be beneficial (Cochran, 1984; Katon et al, 1995; Kemp et al, 1996). However, clinical psychiatry has been surprisingly slow to investigate individual risk factors for medication non-adherence or to use strategies to enhance adherence that have been used extensively in other chronic illness populations.
Identification of Patients With Prostate Cancer Who Benefit From Immediate Postoperative Radiotherapy: EORTC 22911
Authors: Van der Kwast Theodorus H. , Bolla Michel , Van Poppel Hein , Van Cangh Paul , Vekemans Kris , Da Pozzo Luigi , Bosset Jean-Francois , Kurth Karl H. , Schröder Fritz H. , Collette Laurence
Published: September 2007

Purpose

The randomized controlled European Organisation for Research and Treatment of Cancer (EORTC) trial 22911 studied the effect of radiotherapy after prostatectomy in patients with adverse risk factors. Review pathology data of specimens from participants in this trial were analyzed to identify which factors predict increased benefit from adjuvant radiotherapy.

Patients and Methods

After prostatectomy, 1,005 patients with stage pT3 and/or positive surgical margins were randomly assigned to a wait-and-see (n = 503) and an adjuvant radiotherapy (60 Gy conventional irradiation) arm (n = 502). Pathologic review data were available for 552 patients from 11 participating centers. The interaction between the review pathology characteristics and treatment benefit was assessed by log-rank test for heterogeneity (P < .05).

Results

Margin status assessed by review pathology was the strongest predictor of prolonged biochemical disease-free survival with immediate postoperative radiotherapy (heterogeneity, P < .01): by year 5, immediate postoperative irradiation could prevent 291 events/1,000 patients with positive margins versus 88 events/1,000 patients with negative margins. The hazard ratio for immediate irradiation was 0.38 (95% CI, 0.26 to 0.54) and 0.88 (95% CI, 0.53 to 1.46) in the groups with positive and negative margins, respectively. We could not identify a significant impact of the positive margin localization.

Conclusion

Provided careful pathology of the prostatectomy is performed, our results suggest that immediate postoperative radiotherapy might not be recommended for prostate cancer patients with negative surgical margins. These findings require validation on an independent data set.