bluuebunny/crossref_metadata_2025 huggingface dataset:
The Impact of Pump-Priming Funding on Genitourinary Medicine and Modernization of Services
Authors: Rogstad K E , Copas A J
Published: January 2017

Genitourinary (GU) medicine services are under increasing pressure due to increased workload. The Department of Health responded to this crisis by allocating pump-priming funding of £5 million direct to GU medicine clinics in 2002–03. A survey was performed of all clinics in England to determine if funding was received, its utilization and the extent of modernization of services. Response rate was 71% (147 of 206 clinics), with 95% (140) receiving their allocation. Additional clinics were instated by 54% (74/137) and of these 51% (35/69) had thus reduced their waiting times. Extensive modernization of services was under way, with 89% (130/146) reducing proportion of follow-up attendances, 87% (127/146) extending the nurse role and the majority of clinics looking at developing or extending their clinical networks. This study has shown the direct benefit of increased funding allocated to GU medicine and the extent of modernization under way.
A Case of Asymptomatic Gonorrhoea in a Male Using Illegal Steroids
Authors: Gokhale R , Dinardo L R B , Wylie F , Ghosh A K
Published: January 2017

Acute gonococcal urethritis is usually a symptomatic infection in males. Most men will present within one or two weeks after an exposure with symptoms of urethral discharge and dysuria. Early diagnosis is possible in genitourinary medicine clinics with typical signs and symptoms along with microscopy awaiting confirmation by culture and sensitivities. We report a case of gonorrhoea in which we believe the symptoms were masked due to regular use of steroids in a body builder.
Sentinel Testing for the Human Immunodeficiency Virus Antibody at the Murray Street Clinic, Perth, Western Australia
Authors: Kelly H , Sesnan K
Published: January 2017

Sentinel testing for human immunodeficiency virus (HIV) infection aims to monitor the HIV epidemic by testing subgroups of the population, and such testing has been carried out at the Murray Street Clinic in Perth, Western Australia since August 1989. This clinic is part of the State Health Department and is dedicated to the diagnosis, management and control of sexually transmitted diseases (STDs) in Western Australia. Sentinel testing at this clinic is both voluntary and confidential.

In the first 6 months of testing at the clinic, 2351 new patients were seen and 3000 HIV antibody tests were performed. The refusal rate for participation was 8%. No patient tested as a sentinel test or because of multiple heterosexual partners was HIV antibody positive. The first 6 months of sentinel testing at the Murray Street Clinic does not indicate a silent HIV infection in the self-selected sexually active group of people using the facilities of the clinic.
The Adolescent Female Prostitute and Sexually Transmitted Diseases
Authors: Markos A R , Wade A A H , Walzman M
Published: January 2017

Prostitution may be seen as an adolescent's cry for help. A review into the background of the problem, the groups and individuals involved and the incidence of sexually transmitted diseases amongst them is presented. Psychological analysis and behavioural trends, especially in relation to attitudes towards sex, sexually transmitted diseases and intravenous drug abuse are examined.
Inflammatory Cytology, Infection and Intraepithelial Neoplasia
Authors: Robinson A J , Mercey D E , Preston M , Bingham J S
Published: January 2017

The prognostic implications of minor grades of abnormality on cervical cytology are unclear. Women attending genitourinary medicine clinics who had cytology showing inflammatory changes with or without koilocytosis or borderline dyskaryosis have a high incidence of cervical intraepithelial neoplasia and genital infection. Of 119 patients who had a colposcopically directed cervical biopsy after one smear showing these changes, 46 (38%) had cervical intraepithelial neoplasia. Seventy-eight (57%) of 138 women had genital infection of whom 26 (33%) had a sexually transmitted disease. We recommend vigilant follow-up of borderline cytology including colposcopy if adequate facilities exist.
Strain Characteristics and Antibiotic Susceptibility of Isolates of Neisseria Gonorrhoeae Causing Disseminated Gonococcal Infection in Australia
Authors: Tapsall J W , Phillips E A , Shultz T R , Way B , Withnall K ,   Members of the Australian Gonococcal Surveillance Programme
Published: January 2017

The auxotype (A) and serovar (S) distribution and antibiotic and serum sensitivity of 22 strains of Neisseria gonorrhoeae isolated from blood and joints were determined. With one exception, these strains from disseminated gonococcal infections (DGI) belonged to one of 4 serovars of the IA serogroup and were resistant to killing by normal human serum. The auxotype distribution of these Australian strains differed significantly from that reported elsewhere in that 17 of the 22 isolates were proline requirers, but none were of the AHU auxotype. This lack of the AHU auxotype in the DGI strains in Australia was explained by the virtual absence of AHU requirers in a sample of 1560 mucosal strains isolated in Sydney and Darwin from 1987 to 1990. The A/S distribution of these mucosal isolates also helped to account for the low (0.12) percentage of DGI strains in isolates examined by the Australian Gonococcal Surveillance Programme (AGSP) from 1981 to 1991, and the differences in the rates of DGI in Sydney (0.08%) and Darwin (0.87%). There was a relative lack of the IA serogroup strains which are mostly responsible for DGI in the mucosal isolates from Sydney (15% of all strains) but a higher proportion of these serovars (40%) in the Darwin sample. There were 46 cases of DGI in data from the AGSP, 29 of these being women. Seven of the cases diagnosed in Australia were infected with penicillinase-producing gonococci suggesting that antibiotics other than the penicillins should now be used for this condition in this region.
Reduction in Needle Sharing among Community Wide Samples of Injecting Drug Users
Authors: Frischer M , Bloor M , Green S , Goldberg D , Covell R , McKeganey N , Taylor A
Published: January 2017

Evidence of reduced levels of needle sharing among injecting drug users (IDUs) has largely been confined to IDUs attending needle exchanges or receiving treatment. In this paper we present the results of a serial cross-sectional study of needle sharing conducted in Glasgow using a multisite sampling strategy. Of the estimated 9400 IDUs in the city, 503 were interviewed in 1990 and 535 in 1991. The proportion of IDUs reporting injecting with, or passing on used needles and syringes in the last 6 months fell significantly as did the number of individuals from whom equipment was received or passed on to. The impact of this level of sharing has been limited in terms of HIV transmission; the prevalence of HIV among the 1990 sample was 2.0% and 1.1% for the 1991 sample. However, the fact that a third of IDUs in Glasgow continue to inject, even occasionally, with used equipment gives cause for concern in view of the other pathologies known to be associated with poor injecting hygiene.
How Should an AIDS Diagnosis Be Given? The Views of Patients
Authors: Pergami Andrea , Catalan Jose , Hulme Nick , Burgess Adrian , Gazzard Brian
Published: January 2017

The report aimed at obtaining information about patients' experience of how the diagnosis of AIDS was given to them by their doctors, and about patients' satisfaction with the consultation. Thirty people with AIDS completed a self-report questionnaire enquiring about their views and satisfaction with the process of communication of the diagnosis. Results showed that about two-thirds of patients were satisfied, while almost a quarter were definitely not satisfied with the consultation. Satisfaction was associated with the general attitude of the person giving the diagnosis and with the quality of the information given. The relevance of the findings for the training of doctors is discussed.
The Impact of Lubricants on Latex Condoms during Vaginal Intercourse
Authors: Steiner M , Piedrahita C , Glover L , Joanis C , Spruyt A , Foldesy R
Published: January 2017

The objective was to evaluate the impact of additional lubricant on condom breakage and slippage. Two hundred and sixty-eight couples used 6 new and 6 aged condoms during vaginal intercourse and were instructed to use 2 of each type with either water-based lubricant, oil-based lubricant or no additional lubricant.

The use of either oil-based or water-based lubricant increased slippage rates of new and aged condoms, although only one pairwise comparison (oil-based lubricant vs. no additional lubricant) was statistically significant (8.5% vs. 3.8%, P=0.004). The use of oil-based lubricant increased breakage, although not statistically significantly, in both new and aged condoms. Water-based lubricant did not impact the breakage rate of the new condoms and decreased the breakage rate of the aged condoms (no additional lubricant 4.5% vs. water-based lubricant 2.1%, P=0.029).

From a functional perspective, this study suggests that condom users should be told not to use oil-based lubricants. The negative impact of water-based lubricant on slippage may be outweighed by the protective influence on breakage, especially for aged condoms.

Over three-quarters of the couples (76%) had at least some incorrect knowledge, according to current condom instructions, of the type of lubricant that should be used with condoms.
Experience of HIV Prevention Interventions among Female Sex Workers in Delhi, India
Authors: Singh Yadu Nath , Malaviya Anand Narayan
Published: January 2017

This paper describes the effect of HIV prevention intervention among female sex workers in Delhi. Over a 2-year period we found a marked increase in condom use with little increase in HIV seroprevalence. The prevalence of HIV infection did not increase during the study period (1 positive among 701 in 1988 vs 1 positive in 600 in 1990).
Disseminated Aspergillosis in the Acquired Immunodeficiency Syndrome
Authors: Singh G , Wijesurendra C S , Green J T
Published: January 2017

The relationship of disseminated aspergillosis with human immunodeficiency virus (HIV) infection is unclear. In the initial case definition of acquired immunodeficiency syndrome (AIDS) developed by the Centres for Disease Control (CDC), Atlanta, aspergillosis was included as an AIDS-defining opportunistic infection1. In view of the primary relationship of aspergillosis with neutropenia rather than with lymphocyte depletion, as well as the lack of aspergillar infections among reported AIDS cases, aspergillosis was later deleted from the CDC case definition of AIDS2. We describe a case of disseminated aspergillosis in a patient with AIDS, with an extensive literature review of the subject.
Gynaecological Disorders and Human Immunodeficiency Virus Infection
Authors: Shah P N , Kell P D , Barton S E
Published: January 2017

It is increasingly apparent that the differences in the prevalence and severity of various gynaecological conditions are a function of immunosuppression and differences in behavioural factors, rather than a direct effect of HIV itself. Women infected with HIV will present with their gynaecological disorders initially to their carers in both primary care and genitourinary medicine clinic settings. It is therefore essential that all those involved in the management of these women are aware of the interactions between HIV infection, immunosuppression and various gynaecological conditions so that they may be appropriately managed.
The Syndrome of Thrombosis, Thrombocytopenia, and Recurrent Spontaneous Abortions Associated with Antiphospholipid Antibodies: Hughes Syndrome
Authors: Gharavi AE , Wilson WA
Published: January 2017

aPL-associated thrombosis (Hughes syndrome) is widely recognized as a major cause of organ damage in autoimmune diseases. Beginning with the first symposium in 1984, international aPL symposia have facilitated research on aPL antibodies, and the clinical standardization of aPL tests. It is hoped that the present symposium will continue this tradition, because much remains to be learnt about the origin and pathogenicity of aPL antibodies. In addition, new insights are needed for more effective therapies to be developed.
Anti-β2-glycoprotein I Antibody: Specificity and Clinical Significance
Authors: Koike T , Matsuura E
Published: January 2017

Cardiolipin binding of IgG-class anticardiolipin antibody (aCL) depends on the existence of β2-glycoprotein I (β2-GPI). We developed an EIA system that enables detection of antibodies against β2-GPI, without the presence of cardiolipin. This system involves use of irradiated polystyrene plates, in which oxygen atoms are introduced onto the surfaces of the plates. β2-GPI bound to the surface of these plates is assumed to undergo a conformational change that exposes normally cryptic epitopes. Anti-β2-GPI antibody measured using this EIA system showed good correlation with aCL measured by conventional EIA methods and may prove useful in evaluating the risk of thrombosis and monitoring the clinical course in patients with SLE. Utilizing this EIA system and β2-GPI-deleted mutants, we found that the fourth domain of β2-GPI is involved in expression of one of the cryptic epitopes recognized by aCL. We also found that oxidized LDL are sequentially targeted by β2-GPI and aCL.
Treatment of Neurologic Complications of Antiphospholipid Antibody Syndrome
Authors: Brey RL , Levine SR
Published: January 2017

Thrombosis associated with antiphospholipid antibodies (aPL) occurs in both venous and the arterial circulation. The most common arterial thrombo-occlusive event is cerebral infarction. We briefly review treatment strategies aimed at patients with cerebrovascular disease and aPL. Besides general treatment issues, we discuss primary prevention and secondary prevention. Most regimens include antithrombotics or immune modulation. Prospective studies (currently underway) are required to better estimate the rate of recurrent thrombo-occlusive events on standardized therapy before one therapy can be recommended over another with reasonable evidence.
Dame Muriel Powell (1914–1978): Role Model of a Hospital Matron and Leader of Nursing
Authors: Scott Elizabeth J C
Published: January 2017

Muriel Powell was for 22 years matron of St George's Hospital, London, and for a brief period Chief Nursing Officer in the Scottish Home and Health Department in Edinburgh. She was an influential role model, an influential leader of and spokesperson for her profession, and a member of the government committee that recommended the removal of the title “matron” from the National Health Service in 1968. The title is now being reintroduced and one of the purposes of this paper is to highlight the lack of any consideration having been given to the historical background of the title and the reasons why it was removed.
William Osier and Jacob Mendez Da Costa: Philadelphia Medicine, 1884–1889
Authors: Wooley Charles F
Published: January 2017

When William Osier (1849–1919), at the age of 35, moved from Montreal to Philadelphia (the leading medical centre in the United States) in 1884, Jacob Mendez Da Costa (1833–1900) was 51, and Chair of Practice at Jefferson Medical College. During Osier's five frenetic years in Philadelphia, he and Da Costa shared medical and professional experiences, interactions with friends and colleagues, and participation in the leading medical organizations in the United States. The shared experiences reflect Philadelphia in the 1880s, the traditions, the times and the individuals. Although Da Costa was considered the greatest clinical teacher of his day, his career embodied Quaker Philadelphia and his legacy does not reflect the stature of the clinician and the man. In time, Osier became Sir William Osier, a man for the ages.
William James West (1794–1848): Abdominal Surgeon and Distraught Father
Authors: Ford John M T
Published: January 2017

William West was an early-nineteenth-century successful small-town surgeon-apothecary who took a major role in the local movement for medical reform. He published the first series of ovariotomies in England in 1837. His son suffered from a type of infantile spasm which West described in the Lancet in 1841, and which is now known as West's syndrome.
Erasmus of Rotterdam (1466–1536): Renaissance Advocate of the Public Role of Medicine
Authors: Albury W R , Weisz G M
Published: January 2017

The great Renaissance scholar Erasmus of Rotterdam was a pioneering advocate of the importance of medicine for social as well as individual welfare. Erasmus' “Oration in praise of the art of medicine” (1518) illustrates his literary approach to this topic. Although the original version of his text did not address the state's role in promoting the health of the populace, Erasmus inserted new material on this topic into the “Oration” for a 1529 edition. This new material and references in some of his other writings from the same period indicate that it was in the 1520s that Erasmus first became a strong advocate of government intervention in public health matters. It is suggested that medical events in Erasmus' own life — his experiences both as a patient and as an observer of diseases — may explain why his interest in public health legislation increased significantly around this time.
Joseph Towne (1806–1879), Master Modeller of Wax
Authors: Mendis D , Ellis H
Published: January 2017

Joseph Towne (1806–1879) was a pioneer in the art of wax modelling of anatomical and dermatological material. He began his career at the age of 17, at Guy's Hospital, London, where he spent the whole of his professional life. He was a secretive, self-taught individual, and the finer points of his technique died with him. His brilliant works are on view at the Gordon Museum at Guy's, and are still used for teaching.
Robert Hooke (1635–1703), in His Own Words
Authors: Breathnach C S
Published: January 2017

The diaries and other writings of Robert Hooke (1635–1703), as well as those of his contemporaries, are drawn upon to sketch his social and scientific life. An account is presented of his involvement with the Royal Society from its earliest days, and of his relations with notable scientists. In exploring the similarity between combustion and respiration, he established that air is composed of different gases, and that it is not motion of the lungs but a supply of fresh air that is necessary for life.
Medical Street Names in Paris
Authors: Sykes A H
Published: January 2017

In Paris, the blue enamel signs for streets named after a person also bear the dates of birth and death, and a word or two to designate the person's field of activity. In this paper an alphabetical listing is given of 166 Parisian streets that have been named after medically qualified men who achieved distinction in medicine or elsewhere.
William Marsden's Yorkshire Family, 1749–1922
Authors: McIntyre Neil
Published: January 2017

William Marsden (1796–1867), a Yorkshireman, founded two major London hospitals. We know little of his family background, about which his only biography gives a highly inaccurate account. It suggests his family were landowners and gentlemen farmers. Although their origins were more humble, some at least of his Yorkshire relatives prospered — through gardening, banking, manufacturing and even medicine. This paper presents information on four generations of Yorkshire Marsdens.
Factors Affecting Cervical Screening Uptake in Prisoners
Authors: Plugge E , Fitzpatrick R
Published: January 2017

Imprisoned women are at increased risk of cervical cancer but less likely to have been screened for this disease. There is very little information on the situation in prisons in the UK but this study indicates that, as anticipated, these women are less likely to have been screened in the last five years than women generally. Whilst there are no ethnic differences, it appears that women who had been in prison longer than three months were more likely to have had a smear in the last five years compared with those who had been in for three months or less (79.2% vs 37.5%, Chi-squared=9.7, p=O.002) suggesting that the prison health services had been able to use this opportunity to screen this disadvantaged population.
Screening for Abdominal Aortic Aneurysms: The Effects of Age and Social Deprivation on Screening Uptake, Prevalence and Attendance at Follow-Up in the MASS Trial
Authors: Kim L G , Thompson S G , Marteau T M , Scott RAP
Published: January 2017

Objectives/setting:

The effectiveness of screening programmes may be improved by knowledge of factors affecting screening uptake, disease prevalence and attendance for follow-up. Data from the Multicentre Aneurysm Screening Study (MASS) are used to examine the influences of age and social deprivation in the context of screening for abdominal aortic aneurysms (AAAs).

Methods:

In the MASS trial, a population-based sample of 34,000 men aged 65 to 74 received an invitation to screening. The associations of attendance at screening with age, social deprivation and season of the year when invited to attend were investigated using logistic regression analysis. Similar analyses were performed for AAA prevalence and attendance at recall scans.

Results:

Compared with men aged 65–69, those aged 70–74 were less likely to attend screening (79% vs 81 %), had increased prevalence of AAA (6% vs 4%) and were less likely to attend for followup (79% vs 84%). Compared with those in the least deprived quartile, those in the most deprived quartile also were less likely to attend (75% vs 85%), had increased prevalence (6% vs 4%) and were less likely to attend for follow-up (80% vs 83%). Season showed no significant association with attendance at initial screening.

Conclusions:

Higher age and social deprivation are associated with both poorer attendance at screening and follow-up, and having an AAA. This highlights the importance of promoting screening programmes, particularly to the more deprived populations.
Commissioning Diabetic Eye Screening by Optometrists: A Local Initiative at the Primary-Secondary Care Interface
Authors: Harris Andrew , Bonell Christopher , Evans Tyrrell , Roberson Geoffrey
Published: January 2017

The rationale behind the decision of a London family health services authority (Lambeth, Southwark, and Lewisham) to embark on a programme for diabetic eye screening by optometrists is outlined, discussing the way in which the scheme was set up and its possible future development. This family health services authority brought together a range of professionals across primary and secondary care to reach agreement on development of the service, and a consensus on clinical guidelines for operation of the scheme. This was particularly difficult in an area served by four hospitals which provide care to diabetics. Development of the scheme identified key questions about quality which have promoted a separate research agenda.
Reliability of the Barlow and Ortolani Tests for Neonatal Hip Instability
Authors: El-Shazly M , Trainor B , Kernohan W G , Turner I , Haugh P E , Johnston A F , Mollan R A B
Published: January 2017

To investigate if those responsible for screening for neonatal hip instability are using acceptable manual hip stress tests as described by Ortolani and Barlow.

A video camera was used to record the technique of 35 personnel who were responsible for screening. They examined both a baby and a simulator. The study comprised five groups, classified by experience and practice: senior orthopaedic surgeons, senior paediatric staff, junior paediatric staff, nurses, community staff.

The seven authors together with six independent expert observers viewed the video and marked the performance with the aid of a specially designed proforma. Although there was some variation between these expert observers, the results showed differences in the scores obtained by the different groups of examiners over all aspects of the test procedure.

Video recording for criticalanalysis and feedback is a useful technique in this situation. Overall, the results suggest that testing for neonatal hip instability was inadequate. A variety of hip stress manoeuvres were being performed. The ability of each subject to perform satisfactory tests seemed to depend on their experience and education. More “hands on” training and experience of testing might provide the necessary competency for screening.
Feasibility Study of a Randomised Trial of Ovarian Cancer Screening among the General Population
Authors: Parkes C A , Smith D , Wald N J , Bourne T H
Published: January 2017

To determine the feasibility of a randomised trial of ovarian cancer screening among women attending a breast cancer screening centre.

Randomised controlled trial of ovarian cancer screening using transvaginal ultrasonography as a primary screening test and colour Doppler imaging as a secondary screening test in the screened group and no intervention in the control group.

Reading breast cancer screening centre (United Kingdom).

8678 women, without a bilateral oophorectomy or hysterectomy, aged between SO and 64 attending for NHS breast cancer screening between September 1989 and February 1993.

Uptake of ovarian cancer screening among eligible women and the screening false positive rate (considered as the referral rate to a gynaecologist for surgical intervention).

−82% (7124/8678) of eligible women agreed to join the trial and were randomly allocated in equal numbers to each arm of the trial. 3280 women had an initial scan. The false positive rate after ultrasonography alone was 2·9% (86/2952), but this dropped to 0·5% after colour Doppler as a secondary screening test. One stage I primary ovarian cancer was detected at screening in a 58 year old women.

A randomised trial of ovarian cancer screening using ultrasonography and colour Doppler imaging is feasible and acceptable among women attending a breast cancer screening centre. The results indicate that the expected odds of being affected given a positive result in the general population would be about 1:12. A full randomised trial of ovarian cancer screening with mortality as the end point is needed to assess whether screening reduces mortality from this disease. A multicentre European trial is currently in progress.
Prevalence of Abdominal Aortic Aneurysm Associated with Hypertension in an Urban Population
Authors: Grimshaw G M , Thompson J M , Hamer J D
Published: January 2017

Since 1989 13 000 invitations to screening for abdominal aortic aneurysm have been offered to men aged 60 to 7 5 living within the Birmingham conurbation.

The overall attendance was 76·1% (52–99%). The prevalence of aneurysms greater than 29 mm in the whole male population aged 60 to 75 was 7·2%. For those aged 60 to 64 the prevalence was 3·8%. For those aged between 60 and 64 with hypertension, however, the prevalence of abdominal aortic aneurysm was 7·7%. The relative risk of hypertension associated with aneurysm disease is 2·7.

This paper suggests that all men over 65 should be screened for aortic aneurysm, but that those men over 60 with hypertension should be added to the screened cohort.
Neonatal Screening for Sickle Cell Disease in a Metropolitan University Hospital: Efficacy and Problems
Authors: Ballas Samir K , Park Deborah , Wapner Ronald J
Published: January 2017

To determine the effectiveness of a screening programme to identify infants with sickle cell anaemia.

A metropolitan university hospital.

4845 (73·3%) newborn cord blood samples from 6271 infants born in the Thomas Jefferson University Hospital over a two year period were tested for the presence of haemoglobinopathies. The patient group comprised approximately 44% white Americans and 51% African Americans. Diagnoses of haemoglobinopathies were established by cellulose acetate (pH 8·6) and citrate agar (pH 6·2) electrophoresis, and thin layer isoelectric focusing.

17 African American infants were suspected of having sickle cell anaemia and their families were notified and called for retesting to confirm the diagnosis. Fourteen of these families responded; retesting confirmed the diagnosis of sickle cell anaemia in 12 (86%), and the remaining two (14%) had sickle cell trait The other three families never responded and all efforts to reach them were unsuccessful so the diagnosis could not be confirmed. The infants for whom the diagnosis of sickle cell anaemia was confirmed were treated prophylactically with penicillin and enrolled in sickle cell programmes. Of 398 infants with an abnormal haemoglobin (Hb), 170 (3·5% of all infants tested) showed sickle trait, 63 (1·3%) showed Hb C trait, and 165 samples (3·4%) showed Hb Bart's. Letters of notification were sent to those families whose infants had sickle trait or Hb C trait. Thirty three (16%) families responded and asked for additional information, counselling, or testing of other family members. Three of these families (about 0–1% of all white subjects tested) were white subjects of Italian, English, and Polish ancestry, and all of their infants had sickle trait. Additional testing on other family members showed that one black parent had Hb SC disease that had not previously been diagnosed as the subject was asymptomatic.

A screening programme for newborns in a metropolitan hospital ( a) was effective in identifying and treating infants with sickle cell anaemia with prophylactic penicillin, ( b) was associated with difficulties in tracking infants and their families in about 30% of suspected cases of sickle cell disease, ( c) found that sickle trait is not uncommon in white subjects, and ( d) found that “silent” sickle cell disorders do occur among American black subjects.
Screening Status in Relation to Biological and Chronological Characteristics of Breast Cancers: A Cross Sectional Survey
Authors: Alexander Freda E , Anderson Thomas J , Hubbard Alexandra L
Published: January 2017

Objective—

To determine the pathological and biological characteristics of breast cancers diagnosed by screening and examined at the Edinburgh University pathology department.

Methods—

These cancers were classified by screening status: never screened (n=111), prevalence screen detected (n=105), and previously screened (n=74). The last category arose in women who had been regularly screened during the trial; the cancers were diagnosed as interval cases before the first invitation to service screening (n=33) or were incidence screen detected at that time (n=41).

Results—

Association (for operable invasive cancers, n=250) of cancer characteristics with screening status reflects influences of biology (aggressiveness) or chronology (time of diagnosis), or both. The prognostic indicators tumour grade, histological type, and oestrogen receptor status were found in a smaller percentage of the patients with poor prognosis among the prevalence screen detected cases (9%, 77%, 18%) than among those previously screened (29%, 84%, 35%). The chronological factors size and node status were found in a smaller percentage of patients with poor prognosis among women previously screened (31%, 24%) than among those never screened (62%, 39%)). Apart from these two, no other factors improved the diagnosis in the previously screened group compared with the never screened group.

Conclusions—

These results suggest that favourable characteristics of screen detected cases are often due to the effects of length bias on “biological factors” and fail to show that current local screening practice has succeeded in advancing the diagnosis of breast cancers to a less aggressive phase.
Globalization and Economic Convergence
Authors: Kenworthy Lane
Published: January 2017

Convergence among national economies is viewed by a growing number of observers as an inevitable result of increasing global integration of product and financial markets. Yet there is reason to doubt that globalization has yet brought about, or will in the future bring about, the degree of convergence assumed by some. First, markets require effectiveness, not optimality. This allows considerable space for continued differences in national economic policy choices, institutional structures, and performance patterns. Second, domestic institutions mediate the impact of international market forces. Institutions differ markedly across countries, generating substantial cross-national variation in the preferences and capacities of economic actors (firms, unions, policy makers, and so on). To assess the convergence thesis empirically, I examine developments in the 17 richest industrialized nations from 1960 to 1994. There is some indication of convergence in a few areas, but it is limited. This appears to owe partly to the fact that globalization itself remains limited and in part to the fact that globalization's convergence-generating effects are limited.
Emerging Forms of Industrial Governance: Promoting Cooperation between Small and Large Firms in Brazil
Authors: Addis Caren
Published: January 2017

This article analyzes the emergence and diffusion of industrial governance arrangements in Brazil that promote cooperation among small and large firms that previously had conflictive relations. The core of the arrangements were quadripartite: Large firms implicitly promised small suppliers rewards for increased productivity; small firms, working in groups, collectively set goals and discussed their experiences to spur on each other; consulting firms devised restructuring programs and played the role of facilitator in the groups; the quasi-government agency subsidized the costs of consultants. Contrary to the assumptions of producer-driven commodity chains literature (Gereffi), the principal actors were local and not in the headquarters of multinational corporations. Unlike the predictions of the transactions-cost literature (Williamson), opportunism was mitigated even though there were no new contractual safeguards. Despite instability in macroeconomic indicators, policy making, and production, which meant that the payoffs from cooperation were uncertain (game theory), firms and other institutions managed to devise new governance arrangements. Although the concept of bootstrapping (Sable) captures the dynamics of groups of small firms, it needs to be amended to take into account the variety and flexibility of mediators. The success of these arrangements has important implications for the future of Brazil's corporatist groups and its economic survival.
Export Processing Zones in Africa: Implications for Labour
Authors: Romero Ana Teresa
Published: January 2017

For many developing countries export processing zones (EPZs) are vital investment-promotion strategies. Even though most African EPZs have not attracted much investment, interest in developing them continues to grow. Over the years EPZs have acquired a bad image because of widespread reports of violations of national and international labour standards. The experiences of countries in other regions show that labour problems arise from an underestimation of the need to address the labour-related aspects of activities in EPZs, the non-observance of national labour standards, lack of social dialogue and weak supervisory institutions. There are signs that the conditions that have led to labour problems in other regions are being replicated in Africa, causing tensions in certain zones. The article argues that on-going efforts in different regions to deal with these problems hold useful lessons for EPZ host countries in Africa.
Prospective Trial on Captopril-Related Cough
Authors: Lefebvre Jean , Poirier Luc , Lacourcière Yves
Published: January 2017

OBJECTIVE:

Quantify and characterize cough as an adverse reaction secondary to captopril.

DESIGN:

Cohort analytic study: six-month prospective trial including two-week, placebo, run-in period; five-month, single-blind, active treatment; and two-week, dechallenge period.

SETTING:

Outpatient clinic.

PATIENTS:

199 previously treated or newly diagnosed untreated patients with mild to moderate hypertension.

INTERVENTIONS:

Captopril 50 mg/d during five months.

OUTCOME MEASURES:

Self-questionnaires, interviews, dechallenge, and rechallenge periods, Naranjo's algorithm.

RESULTS AND CONCLUSIONS:

(1) Cumulative incidence of captopril-induced cough over a five-month period was 7.1 percent (95 percent C.I., 6.8–7.4 percent). Incidence of drug withdrawal secondary to severe cough was 1.0 percent; this figure is somewhat similar to first reports about the reaction. (2) Cough was a generally mild to moderate symptom, present day and night in 71.4 percent of patients and resistant to antitussive agents. Cough was not statistically related to sex, age, or smoking habit; however, the female gender and the development of a common cold may be predisposing factors.
Lovastatin-Induced Rhabdomyolysis in the Absence of Concomitant Drugs
Authors: Wallace Carla S. , Mueller Bruce A.
Published: January 2017

OBJECTIVE:

Presentation of a case of lovastatin-induced rhabdomyolysis in the absence of other medications known to potentiate this adverse effect.

METHODOLOGY:

Case report.

RESULTS:

A 60-year-old black man developed rhabdomyolysis after receiving lovastatin for 14 months. Rhabdomyolysis developed in the absence of other medications previously reported to cause this adverse effect when administered concomitantly with lovastatin. Adverse drug reaction causality algorithms categorized this reaction as either possible or probable.

CONCLUSIONS:

Rhabdomyolysis is an uncommon adverse effect associated with lovastatin therapy. Although reported cases of lovastatin-induced rhabdomyolysis were associated with the coadministration of cyclosporine, erythromycin, gemfibrozil, or nicotinic acid, this adverse effect may occur in the absence of these agents.
Predictive Performance of Equations to Estimate Creatinine Clearance in Hospitalized Elderly Patients
Authors: O'Connell Mary Beth , Dwinell Andrea M. , Bannick-Mohrland Susan D.
Published: January 2017

OBJECTIVE:

To ascertain the clinical accuracy of equations that estimate creatinine clearance to predict the correct drug doses in hospitalized elderly patients

DESIGN:

Single 24-hour creatinine clearance measurement compared with estimated creatinine clearances derived from eight equations using total and modified ideal body weight

SETTING:

Nonintensive care medical and surgical units at a county hospital

PATIENTS:

15 patients with urethral catheters were enrolled in each of three age groups: 65–75, 76–85, and ≥86 years

MAIN OUTCOME MEASUREMENTS:

Drug–dose predictions, bias, precision, and absolute errors

RESULTS:

The bias for all equations was −4.0−42.0 mL/min (–0.07–0.70 mL/s) and the precision was 10.8−47.4 mL/min (0.18–0.88 mL/s). The Jelliffe 1973, Hull et al., and Mawer et al. equations were the least biased and the Jelliffe 1973 was the most precise, followed by the Mawer et al., Hull et al., and Cockcroft-Gault equations. The percent of patients with absolute percent errors >20 percent were 38 percent for Jelliffe 1973, 36 percent for Mawer et al., 40 percent for Hull et al., and >50 percent for the other equations. The percent of patients receiving correct drug doses was 67 percent for Jelliffe 1973, 58 percent for Gates, 51 percent for Mawer et al. and Hull et al., and <50 percent for the other equations. Within various age, renal function, serum creatinine, and albumin subgroups, the Jelliffe 1973 estimates were least biased and most precise, followed by the Cockcroft-Gault estimates. Generally, estimates using modified lean body weight performed better than did those using total body weight.

CONCLUSIONS:

The Jelliffe 1973 equation with modified lean body weight was the best equation, followed by the Cockcroft-Gault equation. Even with the best equation, 33 percent of the patients would have received an incorrect drug dose. Therefore, some elderly patients may still require a measured creatinine clearance.
A Nationwide Investigation of a Possible Protamine Drug-Product Defect
Authors: Herrera Carlos R. , Grasela Thaddeus H. , Walawander Cynthia A.
Published: January 2017

OBJECTIVE:

To follow-up a report submitted to FDA Spontaneous Reporting System, we investigated the hypothesis that there was not a striking increase in unexpected deaths within four hours after elective coronary artery bypass surgery associated with protamine sulfate use.

DESIGN:

Surveys were mailed to clinical pharmacists at 521 hospitals participating in the Drug Surveillance Network. Questionnaires were to be completed with the assistance of cardiac surgeons and anesthesiologists. Hospitals responding with a suspected problem with protamine were contacted via telephone.

RESULTS:

Surveys were received from clinical pharmacists at 380 hospitals (73 percent response rate) and 29 hospitals reported the occurrence of potential problems associated with protamine during coronary artery bypass graft surgery. Telephone interviews of the positive responders yielded six cases of possible myocardial decomposition potentially associated with protamine. There was no association with a specific distributor, however, and none of the hospitals reported a dramatic increase in serious adverse events around the time of index cases.

CONCLUSIONS:

There was no evidence of a widespread public health problem with protamine and a product recall was not necessary. The high response rate and the ability to follow-up with telephone interviews suggests that the Drug Surveillance Network is an effective mechanism for investigating possible outbreaks of serious adverse events in the hospital setting.
The Effect of Physician Education on Knowledge of Drug Therapeutics and Costs
Authors: Sumpton Janice E. , Frewen Timothy C. , Rieder Michael J.
Published: January 2017

OBJECTIVE:

To determine if a clinical pharmacist-sponsored education program regarding physician knowledge of drug costs and therapeutics would change drug utilization and costs for specific high-cost groups of drugs in a pediatric critical care unit (PCCU).

STUDY DESIGN:

Prescribers within the PCCU completed a questionnaire addressing drug costs and therapeutic issues. Subsequent to the questionnaire the PCCU liaison pharmacist implemented a visual display of monthly drug costs, an education program that included the presentation of questionnaire results, and drug information lectures discussing controversial therapeutic issues. After the education program participants again completed the questionnaire.

SETTING/PARTICIPANTS:

The study was conducted in a 13-bed PCCU in a regional children's hospital. The participants were postgraduate trainees in pediatrics and critical care medicine as well as attending staff in the PCCU.

OUTCOME MEASURES:

The main outcome measure was the score on a test addressing drug costs and therapeutic issues.

RESULTS:

The mean overall posteducation score (52.5 percent) improved significantly from the preeducation score (46.4 percent). The preeducation questionnaire results indicated increased knowledge of costs by residents and increased knowledge of therapeutics by attending physicians. The number of educational sessions attended appeared to be associated with improvement in overall questionnaire scores.

CONCLUSIONS:

There was improvement in knowledge of drug costs and therapeutics associated with the educational program. Although this relationship did not reach statistical significance, this may be related to the relatively small sample size of our study. Our results suggest that clinical pharmacists can positively influence physicians' knowledge on drug costs and therapeutics.
Treatment of Type I Diabetes with a Combination of Glyburide and Insulin
Authors: Gums John G. , Curry R. Whitney , de Oca Gelcys Montes , Skluth Hilary A. , Reynolds L. Raymond
Published: January 2017

OBJECTIVE:

To assess the ability of a combination of insulin and an oral hypoglycemic agent (glyburide) to improve the overall glycemic control in a population of patients with type I diabetes.

DESIGN:

Randomized, placebo-controlled, double-blind trial.

SETTING:

Community-based, university-affiliated, family medicine group.

PATIENTS:

Men and women between 18 and 68 years of age with type I diabetes.

INTERVENTIONS:

Subjects were observed and titrated on an insulin only regimen for 12 weeks (phase I). Subjects were then randomized to receive either placebo or glyburide 10 mg/d for an additional 12 weeks (phase II).

MAIN OUTCOME MEASURES:

Glucose measurements were taken at breakfast, lunch, supper, and bedtime. Each patient also was followed sequentially for serum lipids, glycosylated hemoglobin, (Hb A1c) and daily insulin utilization.

RESULTS:

Average fasting blood glucose (FBG) measurements were significantly lower in the glyburide-treated group during phase II (9.22 ± 0.55 mmol/L) compared with baseline (10.27 ± 0.93 mmol/L) and phase I (10.41 ± 0.55 mmol/L). A decrease in the average Hb A1c concentration in the glyburide group was evident by week 4 and was sustained for the duration of the study. The average daily insulin dose rose significantly in the glyburide but not the placebo group compared with baseline. Total cholesterol, triglycerides, and low-density lipoprotein cholesterol did not change significantly in either group over the course of the study. High-density lipoprotein cholesterol increased significantly over baseline in the glyburide group during phase II. Several patients experienced dramatic improvements in glycemic parameters after the addition of glyburide to their insulin regimens.

CONCLUSIONS:

Improvements were observed in the FBG and Hb A1c measurements of this heterogeneous population of patients with type I diabetes after the addition of glyburide to their insulin regimens. The study failed to find consistent trends in glycemic control when evaluating mean changes in FBG measurements.
Isradipine—Another Calcium-Channel Blocker for the Treatment of Hypertension and Angina
Authors: Lopez Larry M. , Santiago Tamara M.
Published: January 2017

OBJECTIVE:

To review the pharmacology, pharmacokinetic disposition, dose recommendations, adverse effects, drug interactions, and efficacy of isradipine in patients with hypertension or ischemic heart disease.

DATA SOURCES:

Data from scientific literature were extracted, evaluated, and summarized for presentation. A MEDLINE search was conducted using the following indexing terms: isradipine, calcium-channel blockers, hypertension, and angina pectoris. Experiences from studies evaluating isradipine reported in the form of articles, abstracts, or proceedings involving patients or healthy subjects were considered for inclusion.

STUDY SELECTION:

Special consideration was given to clinical studies that had been designed in a blind, randomized fashion. Studies that compared the effectiveness and safety of isradipine with another antihypertensive or antianginal agent or placebo were included.

DATA EXTRACTION:

Data from human studies published in the English language were evaluated. Trials were evaluated according to sample size, design, and adequacy of description of therapeutic response.

DATA SYNTHESIS:

Isradipine is a new dihydropyridine calcium-channel blocker that appears to exert less negative inotropic activity than nifedipine and to selectively inhibit sinoatrial conduction. Pharmacokinetic parameters are quite variable and considerably more work is needed to better describe the kinetic disposition of isradipine. Antihypertensive efficacy has been demonstrated extensively in a number of short-term trials. Antianginal efficacy also has been observed in a few short-term trials and is comparable to that of isosorbide dinitrate and nifedipine. Extensive experience with isradipine is minimal and no clear-cut advantages over existing compounds have been noted thus far.

CONCLUSIONS:

The place of isradipine in the therapy of hypertension and myocardial ischemia is unclear and its routine use cannot yet be recommended based solely on clinical grounds.