bluuebunny/crossref_metadata_2025_split huggingface dataset:
General Practice Recruitment for People at Risk of Schizophrenia: The Buckingham Experience
Authors: Falloon Ian R. H. 
Published: March 2018

Objective The process of detecting people at high risk of schizophrenia from a community sample is a major challenge for prevention of psychotic disorders. The aim of this paper is to describe early detection procedures that can be implemented in primary care settings. Methods A selected literature review is supplemented by experiences and data obtained during the Buckingham Integrated Mental Health Care Project. Results General medical practitioners have been favoured as the agents most likely to prove helpful in detecting the key risk factors that predict the onset of schizophrenic disorders, as well as in recognising the earliest signs and symptoms of these conditions. However, the practical problems of screening for multiple and subtle risk factors in general practice are substantial, and general practitioners (GPs) often have difficulty recognising the earliest signs of a psychotic episode. A range of strategies to assist GPs detect early signs of psychosis in their patients are considered. Conclusions It is feasible to implement primary care setting early detection procedures for people at risk of schizophrenia. Implementation is aided by the use of a brief screening questionnaire, training sessions and case supervision; and increased collaboration with mental health services and other community agencies.
General Practice Recruitment for Schizophrenia Prevention Studies
Authors: Harris Mark 
Published: March 2018

Objective To examine the barriers and incentives that may exist for Australian general practitioners (GPs) to screen for and detect individuals at risk of developing schizophrenia and to participate in studies aimed at assessing screening procedures. Method Examination of literature, existing procedures in general practice, informed by experience in the GP Integration Support, Evaluation and Resource Unit during 1995–1999 and the General Practice Integration Research Programme and the reports arising from this. Results The attitudes and responses of GPs to research proposals and to working with researchers will be influenced by their overall relationship with mental health services. As the average GP will only have a small caseload of patients with schizophrenia, it is important to provide some incentive to encourage GP involvement in schizophrenia prevention studies. Key incentives include: the availability of specialist support from mental health practitioners; systems development in general practice; inclusion in the research team; and Quality Assurance points. Conclusions General practitioners have shown willingness to engage in a diversity of research projects, including mental health research. Divisions of General Practice are increasingly interested in evaluation and research and may be a useful entry point for approaching GPs as a group.
Evaluating the Importance of Reducing the Duration of Untreated Psychosis
Authors: McGorry Patrick D. 
Published: March 2018

Objective The concept of duration of untreated psychosis or DUP has been a strong candidate for intervention as part of the early intervention paradigm. However, its importance has been questioned. This paper aims to present selected issues concerning attempts to reduce DUP and evaluate the impact of these attempts. Method Current research designs are critiqued and alternatives considered. Results Evidence suggests that it is difficult to design studies that are both ethical and potent enough to determine the contribution of treatment delay to outcome. Conclusions Further research is justified but this should not obstruct commonsense service reforms.
Identification of Young People at Risk of Psychosis: Validation of Personal Assessment and Crisis Evaluation Clinic Intake Criteria
Authors: Phillips Lisa J. , Yung Alison R. , McGorry Patrick D. 
Published: March 2018

Objective To describe the development and validation of the criteria used at the Personal Assessment and Crisis Evaluation (PACE) Clinic to identify young people at ‘ultra-high’ risk of developing a psychotic disorder within a short follow-up period. Method The PACE Clinic criteria initially grew out of clinical observations and retrospective research describing the prodromal phase of first-episode psychosis. Early prospective research refined the criteria into the three intake groups for the Clinic. These criteria combine putative state and trait risk factors for psychosis. Whether or not a person meets criteria for one or more of these groups can usually be determined by a thorough psychological assessment interview. Two early studies are described that assess the validity of this screening protocol. Results The transition rate to acute psychosis of the ‘ultra-high’ risk group identified in the second study was 41%. Conclusions These results suggest that it is possible to accurately identify young people at imminent risk of psychosis. The PACE criteria have now been adopted (or adapted) by a number of other clinical research programs both in Australia (i.e. Psychological Assistance Service in Newcastle) and other programs in the United States and elsewhere. This research may lead the way to the development of preventive interventions for the ultra-high risk group.
Early Intervention and Sustaining the Management of Vulnerability
Authors: Birchwood Max 
Published: March 2018

Objective The purpose of this article is to consider the issue of how long early intervention needs to be sustained to have a long-term impact on the course of psychosis. Method Factors relevant to the concept of secondary prevention in psychosis are discussed. The need for sustained intervention for long-term impact on psychosis is examined. Evidence concerning the length of time required for the maximal impact of early intervention services and interventions that have been demonstrated as effective in achieving long-term change is reviewed. The article discusses individuals of low and high vulnerability to schizophrenia and the interaction between this vulnerability and the length and type of treatment they require to change the deteriorating course of psychosis. Results There is increasing evidence for the concept of a ‘critical period’ lasting up to 5 years after first presentation, during which the long-term level of vulnerability to relapse and disability may be determined. Conclusions For many highly vulnerable patients, early intervention must be sustained for a minimum of 3 years to prevent or limit the potential for early decline. A core unanswered question is whether effective early intervention prevents potential long-term disability or merely delays it.
Problem Solving as a Core Strategy in the Prevention of Schizophrenia and other Mental Disorders
Authors: Falloon Ian R. H. 
Published: March 2018

ObjectiveTo outline the rationale for implementing training in structured problem solving as a primary prevention strategy for major mental disorders.MethodThe evidence that training people in a structured method of solving their personal problems is an effective strategy in the treatment of established cases of schizophrenic and major mood disorders, is selectively reviewed.ResultsMost of the relevant research focused on the prevention of major recurrent episodes of psychosis. There is some evidence to support the hypothesis that this strategy may assist many people to achieve a full and sustained recovery from the clinical and social impairments of these disorders, especially when patients are taught to use structured problem solving with members of their personal resource groups, and they continue to take optimal doses of psychoactive medication. There is support for the hypothesis that the key therapeutic factor associated with these benefits is the improved efficiency of the management of life stress.ConclusionsThe simplicity of problem solving, the educational methods used, and the widespread application to a person's lifestyle would appear to make this a possible candidate for a primary prevention program for major mental disorders. Guidebooks and teaching aids have been developed and show excellent consumer acceptance.
What Genetic Advances Might Mean for the Consumer in Mental Illness
Authors: Mitchell Marilyn 
Published: March 2018

Objective Increased research efforts into screening young people at risk of schizophrenia is anticipated. The aim of the present paper is to consider the ethical concerns raised by this research from a consumer's perspective. Method Insights into relevant ethical concerns obtained from personal experiences of psychotic illness are described. Results A range of salient ethical issues were identified that need to be addressed in research proposals regarding the screening of people for schizophrenia risk factors. Conclusions The importance of research into the development of screening procedures for schizophrenia risk factors suggests that the ethical issues identified need urgent attention. Consumer input is essential in this endeavour.
A prospective observational study of emergency department presentations following novel psychoactive substance use
Authors: Henshall David E , Innes Callum WD , Morrison Scott R , Wilson Blair , Brown Ryan A , McAllister Shannon M , Culshaw Seamus L , Reda Elaina 
Published: March 2018

Background and aims Novel psychoactive substances are compounds intended to mimic the effects of illicit drugs. They provide a unique challenge to healthcare, as complications of their use and their impact on services are relatively unknown. This study aims to determine nature of presentations, patient demographics and impact on healthcare. Methods Novel psychoactive substances users who presented to a large urban emergency department over 4 weeks were prospectively identified and followed for 1 year. Patients over 13 years old were eligible for inclusion. Information regarding patient demographics and presentations was collected. Results During the study period, 53 patients (39 male), mean age 32.6 ± 8.9 (±standard deviation), presented 148 times with complaints relating to novel psychoactive substances use. Study population characteristics included history of illicit drug use (83.0%), intravenous drug use (64.2%), psychiatric diagnosis or symptoms (56.6%), methadone prescription (52.8%) and having no fixed abode (37.7%). Injection was the most common method of use (72.3%), Burst the most commonly named agent (19.6%) and behavioural change the most common presenting complaint (31.1%). Patients collectively spent 10,620 h in hospital over 1 year. Conclusion This study highlights differences between the young population targeted by government campaigns regarding novel psychoactive substances use and the presenting population to hospital, and the associated burden on the National Health Service.
Strangulation of giant rectal prolapse
Authors: El Moussaoui Imad , Limbga Augustin , Dika Manke , Mehdi Abdelilah 
Published: March 2018

Introduction Rectal prolapse is the complete protrusion of the rectum through the anal canal, incarceration rarely complicates rectal prolapse. Even more rarely, it becomes strangulated and gangrenous, necessitating emergency surgery. Case presentation We present the first reported case of strangulated acute rectal prolapse as the first manifestation of rectal prolapse. The patient was a 26-year-old man who presented with a 20×6 cm semi-spherical mass extra-anally. Rectosigmoidectomy with sacral rectopexy was performed, resecting 20 cm of the incarcerated rectum and sigmoid colon. The postoperative course was uneventful with a good final result after colostomy closure and continuity restoration. Conclusion The successful treatment of this patient illustrates the value of surgery in this difficult and unusual case scenario of rectal incarceration.
Military Significance of Q Fever: A Review
Authors: Spicer A J 
Published: March 2018

Q fever is undoubtedly a disease of military significance. Whilst so far it has only been described in troops operating in Mediterranean countries, the Balkans and southern Europe, it is a potential hazard for nonindigenous soldiers in at least 51 countries on 5 continents. Sheep and goats are the main source of infection, and the disease is almost entirely acquired by inhalation of dust-borne rickettsiae from an environment contaminated with infected placentae. The commonest vehicle of transmission is infected hay and straw. On the available evidence, Q fever is simply and largely preventible as a significant military disease by implementation of the following measures: (I) Education on the source and methods of infection. (2) Banning the use of hay and straw for bedding, and the clearing and burning of hay and straw fromfarm buildings prior to occupation. (3) The exclusion of sheep and goats from military areas. (4) Regular serological surveillance of flocks adjoining military areas for evidence of heavy infection by Coxiella burnet;’ (5) Vigilance for an unusually high incidence of abortion in flocks adjoining military areas, which should initiate an immediate serological survey to determine the possibility of gross environmental contamination by the Q fever organism. (6) The possible use of short term prophylaxis with tetracycline for limited exposures to Q fever.
Royal Naval Dockyards Asbestosis Research Project: Nine-Year follow-up Study of Men Exposed to Asbestos in Devonport Dockyard
Authors: Rossiter C E , Heath J R , Harries P G 
Published: March 2018

Progression of asbestos-related disease was assessed in a group of 253 dockyard workers examined in 1966 and 1975. Despite the almost complete protection from exposure to asbestos since 1966, radiographic parenchymal abnormalities increased and occurred more frequently during the next 9 years in those men who had been more heavily exposed to asbestos. Lung function values were lower in those most heavily exposed and were declining at a faster rate than in those with less dust exposure. The most sensitive lung function index was the transfer factor. Those men with persistent crackles in 1966 exhibited a restrictive pattern of lung function, whereas an obstructive pattern was seen in men with wheezes in 1966. The men with irregular small opacities of category 1/1 or more or with diffuse pleural change in 1966 and who survived to 1975 had worse lung functions than any other groups. Progression of disease was greater for smokers than non-smokers, with those who gave up smoking between 1966 and 1975 suffering the greatest changes. This latter group showed most increase in small opacities and included almost all new cases of diffuse pleural changes. They also showed the greatest declines in forced expiratory volume and forced vital capacity.
Foreign Bodies in the Rectum: A Review
Authors: Schofield Philip F 
Published: March 2018

Foreign bodies which lodge above the anal sphincter mechanism may arrive from one of two portals of entry, the mouth or the anal canal. Ingestion of a foreign body is usually unknown to the patient, who presents with symptoms due to impaction and minor injury to the rectal ampulla or anal canal. The patient may have severe anal pain or sepsis associated with the foreign body. The diagnosis is usually obvious on examination under an anaesthetic, but before this there may be a difficult diagnostic problem. Foreign bodies passed into the rectum through the anal sphincter are more common and show an extreme variety. The reasons for insertion are discussed. Management of the problem includes extraction of the foreign body and the recognition and treatment of any associated injury, both extraperitoneal and intraperitoneal. Minor extraperitoneal injuries may be treated expectantly, but in all intraperitoneal and major extraperitoneal injuries laparotomy and colostomy are required. It is stressed that most foreign bodies can be removed transanally, and laparotomy to remove the foreign body is rarely required.
Collagenase Inhibition in the Healing Colon
Authors: Young Howard L , Wheeler Malcolm H 
Published: March 2018

A randomized controlled trial was performed to assess the effect of intravenous aprotinin (Trasylol) on the healing of experimental colonic anastomoses in the rabbit following a standard left colonic resection anastomosis. Assessment of tensile strength was by means of both bursting pressure and breaking strength. Those animals subjected to bursting pressure assessment received intravenous aprotinin 80 000 KIU (kallikrein inhibitory units) at the time of anaesthesia, and postoperatively 160000 KIU per day given in divided doses for three days. Control animals received saline placebo. A further group of animals received a lower loading and maintenance aprotinin dose (40 000 KIU and 60000 KIU per day respectively) with control animals receiving saline. Breaking strength was employed as the means of assessment. The mean bursting pressures were 47.7 ∓ 2.9 mmHg and 37.5 ∓ 3.4 mmHg for aprotinin and controls respectively (P≤0.05). The mean difference in collagen content of the anastomosis compared to the resected specimen was +1.25 ∓0.50 μg/mg and −1.02 ∓ 0.47 ug/mg for aprotinin and placebo groups (P ≤ 0.005). The mean breaking strength in the aprotinin group was 169.6 ∓74.5 g and 110.0 ∓65.9 g for the saline group (P≤0.02). The mean difference in collagen content of the anastomosis compared to the resected specimen was +0.95 ∓0.69 ug/mg and −1.5 ∓0.78 ug/mg for the aprotinin and saline groups respectively (P≤0.05). The significant elevation of both bursting pressure and breaking strength assessments, with a significant improvement in the collagen content of the anastomoses, may be the result of collagenase inhibition following the use of intravenous aprotinin in the experimental model.
Femoral Neck Fracture Fixation: Rigidity of Five Techniques Compared
Authors: Mackechnie-Jarvis A C 
Published: March 2018

Artificial cadaveric femoral neck fractures were internally fixed with five different devices and subjected to cyclical loading of 0–1.0 kilonewtons (approximately one body weight) whilst in an anatomical position. Displacement of the proximal fragment was detected by a transducer and charted. Bone strength was assessed by a preliminary control loading phase on the intact bone. Efficiency of each fracture fixator could then be directly compared by the relative movement in each case. Five specimens each were tested with Moore's Pins, Trifin Nail, Garden Screws and a sliding screw-plate (OEC Ltd). By the criteria of the experiment, which put a severe shearing load on the implant, none of these devices reliably bore the representative body weight. An extended barrel-plate, which supported the sliding screw almost up to the fracture line, was then made. This device, employing some of Charnley's concepts, tolerated body weight in four cases out of five.
Weight control in university students
Authors: Salmons Paula H 
Published: March 2018

A total of 1858 students of United Kingdom origin aged between 18 and 20 years of age completed questionnaires which investigated present weight, bingeing, vomiting and weight control. Men were significantly more likely than women to be overweight, while women were significantly more likely to be underweight. One-third of the women were actively controlling weight, with dieting as the preferred method, while over half had attempted weight control in the past three years. Daily or more frequent bingeing was reported by 1.9% of men and 1.2% of women. There was a statistically significant relationship between weight control and bingeing. Eleven percent of men and 24% of women thought they had a problem with weight control, although amongst both men and women the proportion who felt they were overweight was in excess of the proportion who actually were overweight. It is suggested that health education programmes should take account of the pressures upon young women to conform to predetermined ideals in terms of body weight.
Interviewing and Examination Skills in Paediatric Medicine: Videotape Analysis of Student and Consultant Performance
Authors: Menahem Samuel 
Published: March 2018

Taking an adequate history and competently examining a patient remain essential prerequisites for making a diagnosis. Four 5th year medical students who had completed 18 months of clinical teaching were assessed at the start and end of their ten-week paediatric term and compared with 4 experienced consultants. A videorecording was made of each patient encounter. The students’ history was often incomplete, at times inaccurate and imprecise, despite earlier provision of a framework to obtain the necessary information. The students spent a great proportion of their time examining the child, yet their findings were questionable particularly if the child was uncooperative. The second recording made at the end of the student's paediatric term revealed a general improvement in their confidence and knowledge, though similar deficiencies were observed. The consultants, as expected, did better. They also showed a greater awareness of understanding the child within the context of his family. They spent more time interviewing the parent and child, offered a fuller explanation of the diagnosis and carefully reviewed the management. These findings further emphasize the need to improve and assess the clinical performance of students.
Cost-Effectiveness of Investigations for Invasive Bladder Cancer
Authors: Hunt M T , Woodhouse C R J 
Published: March 2018

The results of diagnostic and staging investigations in consecutive cases of invasive transitional cell carcinoma of the bladder are reviewed. Urine culture, urine cytology and intravenous urography had positive results in a high percentage of cases. As diagnostic investigations they are cost-effective but certainly do not remove the obligation to perform cystoscopy and examination under anaesthetic. Isotopic bone scan and liver scan showed metastases in 4 and one cases respectively and only when there were clinical signs of disseminated disease. Chest X-ray showed metastases in one case. These investigations are not cost-effective. Lymphangiography was positive in 12 of the 94 cases and, although expensive (£70), is still a staging investigation of value in planning treatment.
ANCA Associated with Behçet's Disease
Authors: Burrows N P , Zhao H M , Norris P G , Lockwood C M 
Published: March 2018

Behçcet's disease is a multisystem disorder affecting primarily mucocutaneous and ocular sites although the gastrointestinal, cardiovascular, central nervous and respiratory systems may also be involved. Hulusi Behçet, a Turkish dermatologist, first described Behçet's disease in 1937 and suggested a possible infectious aetiology1. The pathogenesis of this condition still remains unclear although it is likely that infection acts as a trigger in genetically susceptible individuals. We report a patient with unusual cutaneous manifestations of Behçet's disease and antineutrophil cytoplasmic antibodies (ANCA) directed against the cytotoxic protein, bactericidal/permeability-increasing protein (BPI). This is the first report of Behçet's disease associated with this autoantibody.
Congenital Gingival Granular Cell Tumour
Authors: Anderson P J , Kirkland P , Schafler K , Moss A L H 
Published: March 2018

Congenital gingival granular cell tumours are rare lesions which have only occasionally been reported in the UK. Clinical features are of a benign lesion which occurs almost exclusively in newborn, Caucasian females and the anterior maxilla is the commonest site. Treatment consists of local excision and is curative. The terminology concerning this condition has been rather confused because of uncertainty regarding the histogenesis of these tumours and the similar histological appearance to adults granular cell myoblastoma occurring at other intraoral sites. The exact histogenesis of these tumours remains unresolved and they may be hamartomata. We describe a new case occurring within the UK, which illustrates many of the common clinical features of the condition, with an accompanying literature review.