bluuebunny/crossref_metadata_2025_split huggingface dataset:
A Diagnostic Sign in Migraine?
Authors: de Silva R N 
Published: November 2017

At the bedside it was noted that, after ocular fundoscopy, patients with migraine complained more often of an afterimage than did non-migraineurs. This phenomenon was then investigated in consecutive patients attending a general neurology outpatient clinic. The relative risk for the diagnosis of migraine in patients reporting an after-image was 2.91 (95% confidence interval 1.96 to 4.34), and the sensitivity, specificity and positive predictive value of this observation for the diagnosis of migraine were 0.63, 0.75 and 0.55 respectively. After-images were equally likely to be reported by migraineurs with and without aura, and by patients with migraine equivalents. The after-image phenomenon probably reflects the heightened sensitivity to visual stimuli of patients with migraine. Although a diagnosis of migraine is primarily established by the patient's history, the presence of an afterimage following ocular fundoscopy may support this diagnosis.
Off-the-Cuff Cellular Phone Consultations in a Family Practice
Authors: Peleg Roni 
Published: November 2017

In Israel the public tends to make use of informal medicine alongside organized health services, and cellular phones now allow contact with physicians at almost any time or place. For three months in 1999 a family physician documented all consultations on medical subjects conducted by cellular phone, the phone being available 24 hours a day. There were 94 cellular phone medical consultations, of mean duration 5.8 min (range 2-18). Only 11 took place over the weekend, and 63 took place while the clinic was open. The most common reasons for consultation were advice on treatment (29%) and a second opinion (28%). In 48 cases the consultation was for a close relative rather than the caller. In 42 cases the request for consultation came while the physician was busy with other patients. The results of this small personal study confirm that the practice of informal consultations now extends to the cellular phone. Technologies of this sort demand new rules of conduct, if we are to avoid the various hazards of off-the-cuff medicine.
Exploring the Causes of Adverse Events in NHS Hospital Practice
Authors: Neale Graham , Woloshynowych Maria , Vincent Charles 
Published: November 2017

In a previous paper we reported that 10.8% of patients admitted to two large hospitals in Greater London experienced one or more adverse events, of which half were deemed preventable. Here we examine the underlying causes of errors in clinical practice. Rather than identifying specific errors made by individuals, we have looked at possible faults in the organization of care. Adverse events were grouped according to stages in the care process: diagnosis, preoperative assessment and care, operative or invasive procedure (including anaesthesia), ward management, use of drugs and intravenous fluids and discharge from hospital. Less than 20% of preventable adverse events were directly related to surgical operations or invasive procedures and less than 10% to misdiagnoses. 53% of preventable adverse events occurred in general ward care (including initial assessment and the use of drugs and intravenous fluids) and 18% in care at the time of discharge. Probable contributory factors in these errors included dependence on diagnoses made by inexperienced clinicians, poor records, poor communication between professional carers, inadequate input by consultants into day-to-day care, and lack of detailed assessment of patients before discharge.
Nephrotoxicity in the Elderly Due to Co-Prescription of Angiotensin Converting Enzyme Inhibitors and Nonsteroidal Anti-Inflammatory Drugs
Authors: Adhiyaman Vedamurthy , Asghar Muhammad , Oke Anthony , White Anthony D , Shah Ikram U 
Published: November 2017

Both angiotensin converting enzyme inhibitors and nonsteroidal anti-inflammatory drugs can lead to functional renal insufficiency. In an observational study we assessed the frequency of this adverse effect in patients aged over 75 years receiving these drugs in combination. In one year, out of 1500 patients whose records were screened, 12 were prescribed this combination. 2 developed acute renal failure, of whom one died and the other recovered after discontinuation of both drugs. 4 patients showed deterioration in renal function, which returned to normal after one of the drugs was stopped. Renal function remained stable in 6 patients: patients with deterioration in renal function were older and more likely to be on diuretics. This drug combination is commonly nephrotoxic in the elderly and should be avoided, especially in those taking diuretics.
Inappropriate Admissions: Thoughts of Patients and Referring Doctors
Authors: Campbell John 
Published: November 2017

Research on inappropriate hospital admissions has tended to neglect the views of the referring doctors and the patients. In this study, the Appropriateness Evaluation Protocol was applied to a random sample of 102 emergency medical admissions. The patients and doctors were then presented with a list of possible alternatives to admission that might have been used at the point of referral. Case notes were available for 88 patients. As judged by these, 28% of admissions were inappropriate, the commonest reason being the potential for treatment or tests to have been performed as outpatient procedures; next commonest was the possibility of lower level care. The response rate to the questionnaires was about two-thirds, for both doctors and patients. Of the general practitioners and casualty doctors who responded, 60% specified alternatives to admission that they would have considered, and the equivalent figure for patients was 70%. For both groups the major preferences were same-day outpatient assessment and admission to a community hospital. Referring doctors and patients, in this survey, favoured alternatives to acute medical care in proportions much higher than that of supposedly inappropriate admission.
Can Homeopaths Detect Homeopathic Medicines by Dowsing? A Randomized, Double-Blind, Placebo-Controlled Trial
Authors: McCarney R , Fisher P , Spink F , Flint G , van Haselen R 
Published: November 2017

Dowsing is a method of problem-solving that uses a motor automatism, amplified through a pendulum or similar device. In a homeopathic context, it is used as an aid to prescribing and as a tool to identify miasm or toxin load. A randomized double-blind trial was conducted to determine whether six dowsing homeopaths were able to distinguish between Bryonia in a 12c potency and placebo by use of dowsing alone. The homeopathic medicine Bryonia was correctly identified in 48.1% of bottle pairs (n=156; 95% confidence interval 40.2%, 56.0%; P=0.689). These results, wholly negative, add to doubts whether dowsing in this context can yield objective information.
The Danger of Wearing an Anorak
Authors: Cheung Chui M G , Durrani Omar M , Lim Ming S , Ramchandani Mahesh , Banerjee Somnath , Murray Philip I 
Published: November 2017

Campaigns to reduce road traffic accidents have paid little attention to the way headgear could interfere with vision. Binocular visual field measurement was undertaken in six healthy volunteers wearing four different types of anorak. All four anoraks greatly reduced the horizontal and superior field of vision. The anorak producing the worst reduction resulted in a width of vision of 99° and only 15° of vision above eye level, versus 167° and 52° respectively without an anorak. Anorak wearers should turn their heads to look sideways before crossing the road.
Suspected Testicular Torsion: A Survey of Clinical Practice in North West England
Authors: Pearce I , Islam S , Mcintyre I G , O'Flynn K J 
Published: November 2017

Several aspects of the management of suspected testicular torsion are controversial. A questionnaire was mailed to all 33 consultant urologists in the North West region of England to elicit their policies for routine clinical management. 29 of 33 questionnaires were returned (2 incomplete). As regards radiological investigation, 4 consultants always request ultrasound examination; the others do not favour routine imaging. When the diagnosis of testicular torsion is confirmed at operation, all consultants would perform bilateral testicular fixation, although with considerable variations in technique; most use Vicryl sutures (66%) and three-point fixation (57%). One-third would do an ipsilateral orchidopexy if there was no clear evidence of testicular torsion at operation. The variation revealed by this survey prompted an attempt to formulate a protocol for management. A review of the published work indicates that, in cases of proven testicular torsion, treatment should include bilateral fixation with delayed-absorption or nonabsorbable sutures; fixation should be at three points. When torsion is not found at operation, there is no evidence of benefit from orchidopexy.
Self-Regulation in Hospital Waiting Lists
Authors: Smethurst D P , Williams H C 
Published: November 2017

There is evidence that hospital waiting lists in the UK are resistant to shortening because reductions in length generate increases in referrals. We explored this concept by examining outpatient data for eight specialties in a large hospital centre over 17 months. Correlation coefficients were calculated by regressing waiting list density (numbers waiting more than 26 weeks) against referral rate. In three of the eight specialties, with the longest waiting lists, referral rates were significantly related, after one month's delay, to waiting list density (P<0.01)—dermatology, R=0.68; ear-nose-throat R=0.78; trauma/orthopaedics (R=0.64). These were the three with the longest lists. These results help to explain why initiatives to shorten waiting lists are commonly ineffective in the long term.
Effect of Breaking Bad News on Patients’ Perceptions of Doctors
Authors: Barnett Mandy M 
Published: November 2017

The breaking of bad news is a routine but difficult task for many health professionals. There are numerous anecdotes of insensitive practice but the subject has attracted little systematic research. We therefore interviewed 106 patients with advanced cancer (from an original sample of 195) to assess their perceptions of the doctors involved in their care. Aspects of the ‘breaking bad news’ event were recorded during discussion of the illness history and were subsequently rated. Participants were also asked to nominate doctors under the headings ‘most helpful’ and ‘less helpful’, and completed standardized psychological screening questionnaires. In 94 of the 106 cases the bad news had been given by a doctor, usually a surgeon. Of the 13 doctors categorized as ‘most helpful’ when breaking bad news, 8 were general practitioners; of the 7 categorized as ‘less helpful’ all were surgeons. 69% of patients were neutral or positive about the bad-news consultation, but 20% were negative and 6% very negative. Doctors in surgical specialties were significantly more likely to be rated poorly than non-surgical specialists or general practitioners. Surgeons were the group of doctors most likely to break bad news, but non-surgical doctors were rated more positively in performance of the task. This finding has implications for training.
Wet Combing for Head Lice: Feasibility in Mass Screening, Treatment Preference and Outcome
Authors: Stichele R H Vander , Gyssels L , Bracke C , Meersschaut F , Blokland I , Wittouck E , Willems S , De Maeseneer J 
Published: November 2017

There is no scientific consensus on the best way to control head louse infestation in schoolchildren. A study was conducted to test the feasibility and acceptability of a screening campaign by wet combing and a community approach to head-louse control with home visits, and to explore parents’ treatment preferences and treatment outcomes. A non-controlled intervention (advice on treatment options offered to all positive children) was nested within an epidemiological prevalence study. All children in three primary schools in Ghent, Belgium, were invited to take part in screening by wet combing (n=677, 3–11 years). Positive children were offered structural treatment advice, a home visit on day 7, and a check by wet combing on day 14. 83% of the children were screened. The prevalence of active infestation (living moving lice) was 13.0% in school 1 and 19.5% in school 3. In school 2, prevalence of signs of active and past infestation was 40.7%. A home visit was made to 58% of the positive children. 85% of the positive children were screened again on day 14. Wet combing was the most widely used treatment, followed by chemical treatment and a combination of the two. In school 1 and 3 51% were cured, and in school 2 24% became nit-free. A wet combing screening campaign and a community-oriented approach to head-louse control is feasible though resource-intensive. The prevalence of head lice was high and the cure rate was low, with either topical treatments or wet combing.
Delay in Diagnosis of Slipped Upper Femoral Epiphysis
Authors: Ankarath S , Ng A B Y , Giannoudis P V , Scott B W 
Published: November 2017

Treatment of slipped upper femoral epiphysis (SUFE) is directed at preventing progressive slippage, minimizing deformity and avoiding avascular necrosis and chondrolysis. Delay in treatment adversely affects long-term outcomes. In a retrospective study we assessed delays between symptom onset and evaluation of the patient in an orthopaedic department. 27 patients aged 10–16 years were grouped by source of referral (general practitioner or accident and emergency department), and hips were classified as stable or unstable according to ability to bear weight. The 27 children had 37 affected hips, 31 stable and 6 unstable. In the 20 patients referred by general practitioners, mean delay from symptom onset to orthopaedic evaluation was 119 days (range 2–504); in the 7 referred from accident and emergency departments it was 95 days (1–482). In the latter group the slips were more likely to be acute and unstable. 9 (45%) of the patients in the general-practitioner group had hip radiography before referral, all correctly diagnosed though not all the examinations included the recommended frog-lateral views. Long delays between onset and diagnosis of SUFE are most likely in patients with mild symptoms, able to bear weight on the hip. Any adolescent with undiagnosed hip or knee pain that has lasted more than a week should undergo radiological investigation of the hip, with frog-lateral as well as anteroposterior views.
Cardiovascular Autonomic Dysfunction in Africans Infected with Human Immunodeficiency Virus
Authors: Nzuobontane Divine , Ngu Blackett Kathleen , Christopher Kuaban 
Published: November 2017

The effects of human immunodeficiency virus (HIV) on cardiovascular autonomic function have been little investigated in African patients. We performed standard heart-rate and blood pressure tests on 75 consecutive consenting patients referred for an HIV test in Yaounde, Cameroon. 54 patients proved to be HIV-infected (30 having progressed to AIDS). Cardiovascular autonomic dysfunction was present in 8 (28%) patients with AIDS and in 1 (4%) HIV-positive patient without AIDS; no HIV-negative individuals had abnormal results. If borderline results are included, over 80% of HIV-positive patients had cardiovascular autonomic dysfunction. In HIV-infected patients, simple tests such as blood pressure responses to standing or handgrip can warn of cardiovascular autonomic dysfunction, thus signalling the need for added precautions when invasive procedures are proposed.
Can Hospital Transfusion Committees Change Transfusion Practice?
Authors: Torella Francesco , Haynes Sarah L , Bennett Joanne , Sewell Darreul , Mccollum Charles N 
Published: November 2017

Blood and blood products are commonly over-used in hospital practice. We investigated whether the introduction of a red-cell transfusion trigger (haemoglobin <8 g dL–1) influenced transfusion practice in surgery. Coronary artery bypass grafts (CABGs, n=400), total hip replacements (n=107), colectomies (n=85) and transurethral prostatectomies (TURPs, n=158) were reviewed over two periods of six months, before and after the introduction of the policy by the local hospital transfusion committee. After introduction of the policy, the proportion of patients transfused fell from 57% to 45% with CABGs (P=0.02) and from 52% to 26% with hip replacements (P=0.006); for colectomies and TURPs there was no change. Hospital stay did not increase in any of the groups. In the second period, haemoglobin concentration on discharge was lower after total hip replacement, by a mean (95% CI) of 0.7 (0.3–1.2) g dL–1 (P=0.002) and after colectomy, by a mean of 0.6 (0.1–1.1) g dL–1 (P=0.03). Although other factors cannot be excluded, we suggest that the reductions in red-cell transfusion were in large part attributable to the new transfusion policy.
Health Status and Clinical Diagnoses of 3000 UK Gulf War Veterans
Authors: Lee Harry A , Gabriel Roger , Bolton J Philip G , Bale Amanda J , Jackson Mark 
Published: November 2017

Up to June 2001, 3000 British veterans of the Gulf War had sought advice from a special medical assessment programme established because of an alleged Gulf War syndrome. After assessment those attending were classified as completely well, well with symptoms, well with incidental diagnoses treated or controlled, or unwell (physically or mentally). Mental illness was confirmed by a psychiatrist. The first 2000 attenders have been reported previously. The present paper summarizes findings in all 3000. 2252 (75%) of those attending were judged ‘well’, of whom 303 were symptom-free. Medical diagnoses were those to be expected in such an age-group (mean age 34 years, range 21–63). No novel or unusual condition was found. In 604 of the 748 unwell veterans, a substantial element of the illness was psychiatric, the most common condition being post-traumatic stress disorder. The healthcare requirements of the Gulf veterans seen in this programme can therefore be met by standard National Health Service provision.
How Much do Doctors know about Consent and Capacity?
Authors: Jackson Elizabeth , Warner James 
Published: November 2017

To assess knowledge of capacity issues across different medical specialties we conducted a cross-sectional survey with a structured questionnaire at academic meetings, lectures and conferences. Of 190 individuals who received the questionnaire 129 (68%) responded-35 general practitioners, 31 psychiatrists, 29 old-age psychiatrists and 34 final year medical students. Correct answers on capacity to consent to or refuse medical treatment were given by 58% of the psychiatrists, 34% of the geriatricians, 20% of the general practitioners and 15% of the students. 15% of all respondents wrongly believed that a competent adult could lawfully be treated against his or her will, with no obvious differences by specialty. As judged by this survey, issues of capacity and consent deserve more attention in both undergraduate and postgraduate medical education.
Symptom Severity in Advanced Cancer, Assessed in Two Ethnic Groups by Interviews with Bereaved Family Members and Friends
Authors: Koffman Jonathan , Higginson Irene J , Donaldson Nora 
Published: November 2017

Little research has been reported on the experience of cancer among minority ethnic communities in the UK. As part of a wider survey in inner London we interviewed bereaved family members or close friends of 34 first-generation black Caribbeans and of 35 UK-born white patients about symptoms and symptom control in the year before death with cancer. They were drawn from population samples in which the response rates were equal at about 46%. Symptoms in the two ethnic groups were similar. However, multivariate logistic regression indicated greater symptom-related distress in black Caribbeans for appetite loss, pain, dry mouth, vomiting and nausea, and mental confusion. Respondents were also more likely to say, in relation to black Caribbean patients, that general practitioners (though not hospital doctors) could have tried harder to manage symptoms. The findings suggest a need for better assessment and management of cancer symptoms in first-generation Caribbean Londoners, guided by a deeper understanding of cultural influences on their responses to advanced illness.
Fast-Track Surgical Referral in a Population Displaced by War and Conflict
Authors: Ryan J M , Fleggson Matthew , Beavis John , Macnab Cara 
Published: November 2017

After the 1988–1994 conflict between Armenia and Azerbaijan, fought over the territory of Nagorno-Karabakh, large numbers of people were resettled in camps in southern Azerbaijan. Healthcare in the camps was generally good but there was no access to hospitals. The Leonard Cheshire Centre of Conflict Recovery (LCC) organized a ‘fast-track’ system of surgical care in the southern camps by securing the help of still-functioning hospitals in the distant capital, Baku. Regular clinics were held in the camps for visiting specialists; and, by arrangement with the Government of Azerbaijan and various non-governmental organizations, treatment was offered to those who fell within strict selection criteria. After a pilot study yielded clear benefits, the scheme was transferred to a local nongovernmental organization, which successfully operated an expanded version. The hidden cost of war often includes the neglect of chronic medical conditions that require secondary and tertiary care. The ‘fast-track’ system illustrates the potential of existing facilities to meet these needs at modest cost, given sufficient support.
Homeopathic Arnica for Prevention of Pain and Bruising: Randomized Placebo-Controlled Trial in Hand Surgery
Authors: Stevinson C , Devaraj V S , Fountain-Barber A , Hawkins S , Ernst E 
Published: November 2017

Homeopathic arnica is widely believed to control bruising, reduce swelling and promote recovery after local trauma; many patients therefore take it perioperatively. To determine whether this treatment has any effect, we conducted a double-blind, placebo-controlled, randomized trial with three parallel arms. 64 adults undergoing elective surgery for carpal tunnel syndrome were randomized to take three tablets daily of homeopathic arnica 30C or 6C or placebo for seven days before surgery and fourteen days after surgery. Primary outcome measures were pain (short form McGill Pain Questionnaire) and bruising (colour separation analysis) at four days after surgery. Secondary outcome measures were swelling (wrist circumference) and use of analgesic medication (patient diary). 62 patients could be included in the intention-to-treat analysis. There were no group differences on the primary outcome measures of pain ( P=0.79) and bruising ( P=0.45) at day four. Swelling and use of analgesic medication also did not differ between arnica and placebo groups. Adverse events were reported by 2 patients in the arnica 6C group, 3 in the placebo group and 4 in the arnica 30C group. The results of this trial do not suggest that homeopathic arnica has an advantage over placebo in reducing postoperative pain, bruising and swelling in patients undergoing elective hand surgery.