bluuebunny/crossref_metadata_2025_split huggingface dataset:
Some Observations on Diphtheria Carriers
Authors: McCartney J. E. , Harvey William C. 
Published: July 2019

The results of the clinical examination of 288 diphtheria carriers, 300 diphtheria patients, and 100 diphtheria convalescents ready for discharge are given. It is shown that the proportion of abnormal conditions in the nose and throat of the carriers (94·1 per cent.) is higher than in the diphtheria patient group (73 per cent.), and considerably higher than in the recovered convalescent cases (52 per cent.). This is particularly noticeable when the proportion of cases with nasal abnormalities is considered in the three groups, namely, in carriers 72·2 per cent.; in diphtheria patients 42·6 per cent.; while in negative convalescent cases the figure is only 7 per cent. Further, the departures from normal in the recovered convalescents are generally enlarged but healthy looking tonsils which do not appear to interfere with the natural elimination of diphtheria bacilli during convalescence. The greatest proportion of carriers is in the age group 1 to 5 years, and owing to the small size and anatomical complexities of the nasal passages, the pathological conditions tend to persist and make examination and treatment difficult. The figures indicate that the presence of pathological conditions in the nose and throat of diphtheria patients is conducive to the establishment of the carrier state. It has been shown during the investigation that the presence of diphtheria bacilli in carriers is intermittent, and that there may be failure to isolate the organisms over long periods of time although the patient may still be infective. It is emphasized that even three negative culture results are not sufficient to establish that a carrier is completely free from infection.
Note on Idiosyncrasies and Abnormalities in Human Beings
Authors: Weber F. Parkes 
Published: July 2019

Idiosyncrasies are the expression of abnormal mental or physical reaction towards “agents.” An attempt is made to indicate the position of idiosyncrasies in a classified scheme of all abnormalities; but bodily idiosyncrasies due to an “allergic” or hypersensitive response to agents are mainly considered in the present paper. Migraine and mucous colic (“colitis mucosa”) are discussed in connexion with Freeman's view of food idiosyncrasies, hay fever, asthma, urticaria, angioneurotic œdema, &c., as manifestations of an “immunological abnormality or defect.” The hypothesis that idiosyncratic hypersensitiveness towards physical agents, such as light, heat, cold and mechanical trauma, may in reality be the expression of reaction towards a histamine-like body, or protein of some kind (virtually a “foreign protein”) liberated in the tissues by the physical agent in question, is referred to, according to the works of W. W. Duke and Sir Thomas Lewis and his co-workers, and the writings of Sir Humphry Rolleston on the subject. A somewhat analogous explanation is suggested for the following conditions: an abnormally hypersensitive (eczema-like) reaction towards formalin lotions; epidermolysis bullosa; constitutional factitious urticaria in otherwise healthy individuals not suffering from ordinary urticaria; excessive liability to chilblains; so-called “erythrocyanosis” of the lower parts of the legs in girls and young women, and some cases of Raynaud's disease. The significance of eosinophilia in cases of dermatitis herpetiformis and pemphigus is also alluded to.
Electro-Therapy 1910–1935, Including Experiments in the Induction of Artificial Fever
Authors: Heald C. B. 
Published: July 2019

Recent advances in direct-current technique, especially the advantages of ionization with such drugs as histamine. Faradic-current improvements, especially in connexion with the grid-glow valve; oscillo-graphic tracings of various modifications of this current. Heat and electro-pyrexia examined in particular reference to the type of apparatus producing the most comfortable form of pyrexia in a one-hour's treatment. Advantages of inductothermy in producing hyperpyrexia. Scope of hyperpyrexia treatments, in particular reference to their beneficial effects in gonorrhœa, neurosyphilis, asthma, arthritis, &c. Necessity for hyperpyrexia treatment to be under the charge of a qualified practitioner. Progress in ultra-violet-light therapy. A new apparatus for treatment of lupus. Improved clinical results in cases of burns, pruritus, varicose ulcers and diseases of the lymphatic system. A strong band (about 10,000A°) not clinically recognized is present in a water-cooled Kromayer Lamp. Emphasis is laid upon the penetrative power of this beam and its powerful selective effect upon lymphatic tissues.
Some Recent Work on Barbiturates
Authors: Cameron G. R. 
Published: July 2019

Toxic effects are sometimes seen after the administration of quite small amounts of barbiturates. Factors concerned in their production are discussed under the following heads:— Barbiturates can produce liver damage, even hepatitis. Barbiturates may become toxic in the presence of liver damage, as shown by:— Clinical and post-mortem experience. Experimental evidence—the work of Pratt and Koppanyi in America and our own experiments showing that certain barbiturates may exert toxic effects not only when there is severe liver damage but also in the early stages of liver injury. Other factors also seem to be concerned:— Cold. Hæmorrhage. Fasting. Sepsis. Tight bandage around upper abdomen. Castration. The experimental evidence for this statement is given.
Radiation Therapy in Tumours of Bone
Authors: Fulton J. Struthers 
Published: July 2019

Radiation can be shown to produce satisfactory results in the treatment of simple bone cyst, chondroma, angioma, and benign giant-cell tumour. It is of particular value in benign giant-cell tumour where there are grounds for the opinion that it should largely replace surgical methods. Surgery remains the methods of choice in the treatment of osteogenic sarcoma but where the lesion is inaccessible growth restraint may be obtained by the use of X-ray therapy. Radiation, as a palliative measure, is of definite value in the treatment of bone metastases. Myelomata are uniformly responsive to X-ray therapy, which is capable of prolonging life and relieving pain in these cases. It is probable that radiation therapy is superior to surgery in treatment of Ewing's tumour if the diagnosis be made at an early stage of the disease. Direct invasion of the bone by tumour should not be considered a contra-indication to radiation therapy, particularly if the tumour is of a type known to be radio-sensitive.
Discussion on the Therapeutic Value of Transfusion of Derivatives of Blood
Authors: Whitby L. E. H. 
Published: July 2019

Transfusion may be performed for a large number of reasons wvhich must be clearly defined because almost all derivatives of blood lack one or more of properties of fresh blood and have, therefore, only a limited therapeutic value. The convenience of blood derivatives must not lead to improper use. War has led to the development of durable blood derivatives suitable for the blood volume restoration essential for the treatment of secondary shock. Stored blood over a certain age must be included in this category. Experimental evaluation has placed the order of preferment for blood derivatives used for blood volume restoration as citrated plasma, serum, hoemoglobin-Ringer, gum saline, red cells in saline suspension, isotonic saline and glucose. Clinical evaluation of the advantages of plasma over serum and vice versa has not yet been fully decided. Serum preparation, dry or fluid, is technically much easier than plasma. For blood volume restoration in secondary shock there is required an innocuous protein fluid which is retained in the circulation. The amount that needs to be transfused is often incredibly large and must be at least 5o% of the volume lost; the effect requires to be carefully controlled by blood-pressure observations and clinical judgment. Rate also is important. Extensive experience has shown that though citrated plasma is eminently satisfactory it is an advantage to use a proportion of blood when the volume restoration needs to be large.
The Nature of Herpes Zoster: A Long-Term Study and a New Hypothesis
Authors: Hope-Simpson R Edgar 
Published: July 2019

Dr Hope-Simpson presents a study of all cases of herpes zoster occurring in his general practice during a sixteen-year period. The rate was 3·4 per thousand per annum, rising with age, and the distribution of lesions reflected that of the varicella rash.It was found that severity increased with age, but that the condition did not occur in epidemics, and that there was no characteristic seasonal variation. A low prevalence of varicella was usually associated with a high incidence of zoster.Dr Hope-Simpson suggests that herpes zoster is a spontaneous manifestation of varicella infection. Following the primary infection (chickenpox), virus becomes latent in the sensory ganglia, where it can be reactivated from time to time (herpes zoster). Herpes zoster then represents an adaptation enabling varicella virus to survive for long periods, even without a continuous supply of persons susceptible to chickenpox.
Should Antibiotic-Impregnated Cement Be Used During Primary Total Ankle Arthroplasty (TAA)?
Authors: Richter Jens 
Published: July 2019

Recommendation: Unknown. There is insufficient evidence for the routine use of antibiotic-impregnated cement during primary total ankle arthroplasty (TAA). Level of Evidence: Consensus. Delegate Vote: Agree: 100%, Disagree: 0%, Abstain: 0% (Unanimous, Strongest Consensus)
Should Treatment of Diabetic Foot Osteomyelitis Be Based on Bone Biopsies?
Authors: Heidari Nima , Kwok Iris , Vris Alexandros , Charalambous Alexander 
Published: July 2019

Recommendation: Yes. Bone biopsies play both a crucial diagnostic and interventional role in the management of diabetic foot infection. Although bone biopsies are not required in every case of diabetic foot infection, their most important role is in guiding accurate antibiotic treatment, as they provide more accurate microbiological information than superficial soft tissue samples in patients with diabetic foot osteomyelitis. Level of Evidence: Moderate. Delegate Vote: Agree: 100%, Disagree: 0%, Abstain: 0% (Unanimous, Strongest Consensus)
Functional Capacity Evaluation for Injuries to the Foot and Ankle
Authors: Idarraga Alexander J. , Wright-Chisem Adam , Bohl Daniel D. , Lee Simon , Lin Johnny , Holmes George B. , Hamid Kamran S. 
Published: July 2019

Background: The functional capacity evaluation (FCE) is used to determine physical ability after treatment of a workplace-related injury. This evaluation is a determinant in the administration of benefits and the decision to return to work (RTW). The purpose of this study was to characterize FCE results and ability to RTW after treatment for workplace-related orthopedic injuries to the foot or ankle. Methods: A retrospective medical record review from the practices of 4 orthopedic foot and ankle surgeons was conducted. Inclusion criteria were a workplace-related injury to the foot or ankle, at least 2 years of follow-up, and an associated FCE. The FCE report and clinic notes were used to determine the patient’s preinjury job requirement, postinjury FCE-determined ability, specific FCE- or physician-imposed work restrictions, and clearance to RTW. A total of 188 patients met inclusion criteria. Results: In total, 74.4% of patients had FCE-determined work abilities at or above their preinjury job requirements, and 63.3% of patients were cleared to RTW. The mean time from injury to FCE was 1.9 ± 1.5 years, and the mean time to clearance for RTW was 2.0 ± 1.3 years. A less strenuous preinjury job requirement was positively associated with both the FCE-determined ability meeting the preinjury job requirement ( P < .001) and clearance to RTW ( P = .034). Conclusion: Two in 3 patients were cleared to RTW following workplace-related injuries to the foot or ankle culminating in an FCE. However, it took a mean of 2 years to achieve this clearance. Patients with more strenuous jobs were less likely to be able to RTW after injury. Level of Evidence: Level III, retrospective comparative study.
Determinants of caregiver burden in heart failure: does caregiver contribution to heart failure patient self-care increase caregiver burden?
Authors: Durante Angela , Greco Andrea , Annoni Anna Maria , Steca Patrizia , Alvaro Rosaria , Vellone Ercole 
Published: July 2019

Background: The burden is high in caregivers of heart failure patients, but the literature on patient and caregiver predictors of caregiver burden is inconsistent. Also, it is unknown if caregiver contribution to heart failure self-care maintenance (i.e. helping patients to maintain heart failure stable) and self-care management (i.e. helping patients to act in case of heart failure worsening) increases caregiver burden. Aims: To identify caregiver and patient predictors of caregiver burden in heart failure; and to evaluate if caregiver contribution to heart failure self-care maintenance and management increases caregiver burden. Methods: A cross-sectional study with the enrolment of 505 caregivers of heart failure patients. We used the caregiver burden inventory and the caregiver contribution to self-care of heart failure index. We analysed the data using hierarchical regression. Results: Heart failure caregivers, mostly women (52.5%), with a mean age 56.5 (±14.9) years, cared for heart failure patients, mostly men (55.2%), with a mean age of 75.9 (±10.4) years. Caregiver predictors of higher caregiver burden were older age, female gender, fewer caregiving hours and poor social support. Patient predictors of higher caregiver burden were older age, better education, taking fewer medications and higher quality of life. Caregiver contribution to self-care maintenance and management were not significant predictors of caregiver burden. Conclusions: Our results could help providers to identify heart failure caregivers who are more exposed to burden. As caregiver contribution to heart failure self-care improves patient outcomes and seems not burdensome for caregivers, providers may consider educating caregivers about self-care as a viable option for improving patient outcomes without increasing caregiver burden.
Factors influencing self-management priority setting and decision-making among Chinese patients with acute coronary syndrome and type 2 diabetes mellitus
Authors: Liu Xian-Liang , Willis Karen , Fulbrook Paul , Wu Chiung-Jung (Jo) , Shi Yan , Johnson Maree 
Published: July 2019

Background: Priority setting and decision-making in relation to self-management of multiple conditions is particularly challenging for both patients and health professionals. The aim of this study was to validate a conceptual model of self-management priority setting and decision-making in multimorbidity and confirm factors that influence self-management prioritizing and decision-making in a sample of patients with acute coronary syndrome and type 2 diabetes mellitus. Methods: This was a qualitative study using deductive directed content analysis. A purposive sample of 21 participants with acute coronary syndrome and type 2 diabetes mellitus that were admitted to a Shanghai hospital were interviewed. Results: Participants provided evidence to confirm all but one of the factors from the conceptual model. Internal factors influencing self-management predominated. Agreement with recommended treatment, functional capacity and perceived synergies, antagonistic effects, or interactions among the conditions and prescribed treatments, was emphasized. The facilitators and barriers to priority setting and decision-making were related to available resources, provider communication and, to a lesser extent, confusion about recommendations, and treatment complexity. Some participants were also concerned about treatment side effects. Conclusions: Internal factors (personal beliefs, preferences, and attitudes) and facilitators and barriers (knowledge, finances, social support, and transportation) were related to changes in priority setting and decision-making and self-management behavior in this sample. Health education, which includes case studies with shifting self-management priorities is recommended, rather than a unique disease-specific focus. Further research, exploring the relationship between these factors and changes in the dominant condition and related management, using valid and reliable instruments that capture these key factors, is recommended.
Sociodemographic Factors and Stage of Cancer at Diagnosis: A Population-Based Study in South India
Authors: Mathew Aleyamma , George Preethi Sara , Ramadas Kunnambath , Mathew Beela Sarah , Kumar Aswin , Roshni Sivasevan , Jayakumar Krishnan Nair Lalithamma , Booth Christopher M. 
Published: July 2019

PURPOSE Lower socioeconomic status is associated with inferior cancer survival in high-income countries, but whether this applies to low- and middle-income countries is not well described. Here, we use a population-based cancer registry to explore the association between educational level and stage of cancer at diagnosis in South India. METHODS We used the Trivandrum District population-based cancer registry to identify all cases of breast and cervical cancer (women) and oral cavity (OC) and lung cancer (men) who were diagnosed from 2012 to 2014. Educational status—classified as illiterate/primary school, middle school, or secondary school or higher—was the primary exposure of interest. Primary outcome was the proportion of patients with advanced stage disease at diagnosis defined as stage III and IV (breast, cervix, or OC) or regional/metastatic (lung). RESULTS The study population included 4,547 patients with breast (n = 2,283), cervix (n = 481), OC (n = 797), and lung (n = 986) cancer. Educational status was 22%, 19%, and 26% for illiterate/primary, middle, and secondary school or higher, respectively. Educational status was missing for 33% of patients. The proportion of all patients with advanced stage disease was 37% (breast), 39% (cervix), 67% (OC), and 88% (lung). Patients with illiterate/primary school educational status were considerably more likely to have advanced breast cancer (50% v 39% v 36%; P < .001), cervix cancer (46% v 43% v 24%; P = .002), and OC cancer (77% v 76% v 59%; P < .001) compared with patients with higher educational levels. The proportion of patients with advanced lung cancer did not vary across educational levels (89% v 84% v 88%; P = .350). CONCLUSION A substantial proportion of patients in South India have advanced cancer at the time of diagnosis. This is particularly true among those with the lowest levels of education. Future health awareness and preventive interventions must target less-educated communities to reduce delays in seeking medical care for cancer.
Microcosting Analysis of Diffuse Large B-Cell Lymphoma Treatment in Malawi
Authors: Painschab Matthew S. , Kohler Racquel E. , Kasonkanji Edwards , Zuze Takondwa , Kaimila Bongani , Nyasosela Richard , Nyirenda Ruth , Krysiak Robert , Gopal Satish 
Published: July 2019

PURPOSE To describe the cost of treating diffuse large B-cell lymphoma (DLBCL) in Malawi under the following circumstances: (1) palliation only, (2) first-line cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP), (3) salvage etoposide, ifosfamide, and cisplatin (EPIC), and (4) salvage gemcitabine and oxaliplatin (GEMOX). METHODS We conducted a microcosting analysis from the health system perspective in the context of a prospective cohort study at a national teaching hospital in Lilongwe, Malawi. Clinical outcomes data were derived from previously published literature from the cohort. Cost data were collected for treatment and 2-year follow-up, reflecting costs incurred by the research institution or referral hospital for goods and services. Costs were collected in Malawian kwacha, inflated and converted to 2017 US dollars. RESULTS On a per-patient basis, palliative care alone cost $728 per person. Total costs for first-line treatment with CHOP chemotherapy was $1,844, of which chemotherapy drugs made up 15%. Separate salvage EPIC and GEMOX cost $2,597 and $3,176, respectively. Chemotherapy drugs accounted for 30% of EPIC and 47% of GEMOX. CONCLUSION To our knowledge, this is among the first published efforts to characterize detailed costs of cancer treatment in sub-Saharan Africa. The per-patient cost of first-line treatment of DLBCL in Malawi is low relative to high-income countries, suggesting that investments in fixed-duration, curative-intent DLBCL treatment may be attractive in sub-Saharan Africa. Salvage treatment of relapsed/refractory DLBCL costs much more than first-line therapy. Formal cost-effectiveness modeling for CHOP and salvage treatment in the Malawian and other low-resource settings is needed to inform decision makers about optimal use of resources for cancer treatment.
Models of Pediatric Palliative Oncology Outpatient Care—Benefits, Challenges, and Opportunities
Authors: Brock Katharine E. , Snaman Jennifer M. , Kaye Erica C. , Bower Kimberly A. , Weaver Meaghann S. , Baker Justin N. , Wolfe Joanne , Ullrich Christina 
Published: July 2019

PURPOSE: Although the bulk of current pediatric palliative care (PPC) services are concentrated in inpatient settings, the vast majority of clinical care, symptom assessment and management, decision-making, and advance care planning occurs in the outpatient and home settings. As integrated PPC/pediatric oncology becomes the standard of care, novel pediatric palliative oncology (PPO) outpatient models are emerging. The optimal PPO model is unknown and likely varies on the basis of institutional culture, resources, space, and personnel. METHODS: We review five institutions’ unique outpatient PPO clinical models with their respective benefits and challenges. This review offers pragmatic guidance regarding PPO clinic development, implementation, and resource allocation. RESULTS: Specific examples include a floating clinic model, embedded disease-specific PPC experts, embedded consultative or trigger-based supportive care clinics, and telehealth clinics. CONCLUSION: Organizations that have overcome personnel, funding, and logistical challenges can serve as role models for centers developing PPO clinic models. In the absence of a one-size-fits-all model, pediatric oncology and PPC groups can select, tailor, and implement the model that best suits their respective personnel, needs, and capacities. Emerging PPO clinics must balance the challenges and opportunities unique to their organization, with the goal of providing high-quality PPC for children with cancer and their families.