bluuebunny/crossref_metadata_2025_split huggingface dataset:
Valproic Acid Treatment of Agitation in Dementia
Authors: Herrmann Nathan 
Published: January 2017

Objective: Valproic acid, an anticonvulsant medication that enhances GABAergic neurotransmission, has been shown to be helpful in treating behavioural disturbances associated with dementia in several small case series. In an attempt to further document its effectiveness and safety, valproic acid was used to treat a group of elderly patients with dementia and severe agitation. Method: Sixteen patients, aged 68 to 95 years, who were previously unresponsive to other pharmacotherapeutic interventions, were treated prospectively with open-label divalproex sodium. Effectiveness was measured with the Behave AD (B-AD), the Cohen–Mansfield Agitation Inventory (CMAI), and the Clinical Global Impression Scale (CGIS). Doses ranged from 750 to 2500 mg, divided, per day, with levels of 184 to 742 µmol/L. Results: Scores on the CMAI declined from 68.8 to 61.0 (P < 0.005), and scores on the B-AD declined from 15.8 to 12.3 (P < 0.004). On the CGIS, 1 patient was rated as very much improved, 3 patients were much improved, 4 patients were minimally improved, and 8 patients were unchanged. The drug was prematurely discontinued in only 1 patient because of side effects. Conclusion: Valproic acid was shown to be well tolerated with modest effectiveness.
Creativity and Mental Illness: Is There a Link?
Authors: Waddell Charlotte 
Published: January 2017

Objective: To critically assess the scientific evidence for associating creativity with mental illness. Method: MEDLINE and secondary literature searches identified 29 studies and 34 review articles on creativity and mental illness. All studies were critically evaluated. Reviews were also assessed. Results: Of 29 studies that evaluated possible associations between creativity and mental illness, 15 found no evidence to link creativity and mental illness, 9 found positive evidence, and 5 had unclear findings. Most studies used flawed methodologies with weak (case series or case control) designs. There were no randomized or prospective cohort studies. Adequate criteria for determining causal association were not met. In 34 selective reviews, despite mixed evidence, many authors asserted that creativity and mental illness were positively or causally associated. Conclusions: There is limited scientific evidence to associate creativity with mental illness. Despite this, many authors promoted a connection. Explanations for this contradiction are explored, and social and research implications are discussed.
DSM-III-R Schizophreniform Disorder with Good Prognostic Features: A Six-Year Follow-up
Authors: Benazzi Franco 
Published: January 2017

Objective: To determine the outcome of DSM-III-R schizophreniform disorder with good prognostic features. Method: A 6-year follow-up of 20 cases was conducted with structured interviews (comprehensive assessment of symptoms and history) and assessments of functioning scales (global assessment of functioning, Strauss–Carpenter Scale). Results: Thirty-five percent of the cases had major affective disorders, 35% had schizophreniform episodes and major affective disorders, 5% had schizophreniform episodes only, 10% developed schizophrenia, and 15% had no disorders. Conclusion: The findings suggest an association between schizophreniform disorder with good prognostic features and affective illness.
Instruments d'évaluation de l'aptitude à subir son procès: Une recension de la documentation scientifique
Authors: Crocker Anne G , Ohayon Maurice , Caulet Malijaï 
Published: January 2017

Objectifs: Faire le point sur l'état des connaissances concernant les méthodes d'évaluation de l'aptitude à subir son procès (ASP). Établir le parallèle entre cet état des connaissances et les résultats d'études portant sur les facteurs associés aux décisions d'aptitude. Décrire les limites inhérentes au domaine de l'ASP. Méthode: Recension de la documentation pertinente à partir des bases de données Psychinfo et Medline, de 1967 à 1996 inclusivement. Résultats: Dix instruments permettant une collecte systématique d'information auprès des personnes faisant l'objet d'évaluation de l'ASP ont été recensés. Une description et une analyse des qualités psychométriques révèlent qu'ils sont cependant critiquables à certains égards. Conclusion: Bien que certaines recherches aient montré que le diagnostic soit le facteur le plus fortement associé à la décision d'aptitude, aucun instrument n'intègre une évaluation systématique de la psychopathologie. Or, si l'on tient compte des conséquences possibles des décisions, tant pour l'accusé que pour la société, ces évaluations et les recommandations qui en découlent sont d'une importance capitale.
Psychiatrists' Documentation of Informed Consent
Authors: Schachter Debbie , Kleinman Irwin 
Published: January 2017

Objective: The present study was undertaken to determine current attitudes and behaviour toward informed consent for antipsychotic medication and documentation of the informed consent process in patient charts. Method: Thirty psychiatrists treating a minimum of 10 patients on antipsychotic medication were selected from teaching and nonteaching hospitals. Clinicians completed questionnaires on their behaviour and attitudes regarding documentation of informed consent and antipsychotic medication. Physicians' charts were reviewed to ascertain documentation. Results: Psychiatrists reported sometimes documenting the informed consent process. The chart review revealed that, on average, each psychiatrist had documentation in 23% of charts. Physicians who either were affiliated with a teaching hospital or spent more time reading medical journals were more likely to document the informed consent process. Conclusions: Physicians who use antipsychotic medication as a treatment in their practice are not routinely documenting the informed consent process in patient records. Physicians should pay more attention to this aspect of record keeping because it is their only record of the consent process.
L'abus de substances psychoactives et l'adaptation sociale chez les psychotiques
Authors: Lépine Annie , Côté Gilles 
Published: January 2017

Objectif: Chez les sujets psychotiques, l'abus de substances psychoactives est-il associé à l'adaptation sociale? Méthode: Cinquante-cinq hommes psychotiques provenant d'un centre de détention ou d'un hôpital psychiatrique ont été évalués à l'aide de l'Échelle d'adaptation sociale (EAS-II) et d'une version française de la Phillips Rating Scale of Premorbid Adjustment in Schizophrenia (l'échelle d'évaluation de l'adaptation prémorbide de la schizophrénie de Phillips). Résultats: Chez les sujets psychotiques, l'abus de substances psychoactives est associé à certains indices d'adaptation sociale et d'adaptation sexuelle prémorbide. Conclusion: Des différences sont observées dans certains aspects du fonctionnement social, mais il est difficile de porter un jugement global sur l'adaptation sociale.
Dissecting a Waiting List
Authors: Pope C. J. , Roberts J. A. , Black N. A. 
Published: January 2017

This study examines a list of 1,283 patients waiting for general and orthopaedic surgery in an outer London borough. In general surgery varicose vein and hernia surgery accounted for 60% of those waiting more than one year. Of those who had waited more than a year on the orthopaedic list 25% were waiting for knee replacement surgery. The average length of time spent waiting was 10 months, with some people waiting over 5 years. The impact of the numbers waiting a long time on aggregate waiting time was highlighted by weighting the numbers waiting by the months spent waiting. Analysis of urgency codes indicates that although there was a statistically significant relationship between urgency and the length of waiting time there were some anomalies. There was considerable inter-consultant variation in list size, waiting times and the case mix. Analysis of the flows onto the list and work done in one month showed that it would take a considerable time to clear some lists at present rates of activity. Disaggregated information such as this which explores the flows of patients on to and off of the lists is essential for the management of waiting lists and will become increasingly important as waiting lists become a feature of — ‘contracts’ — service agreements, in the reformed NHS.
Factors and Perspectives Affecting Nursing Resource Consumption in Community Hospitals
Authors: Shukla Ramesh K. 
Published: January 2017

The consumption of professional and non-professional nursing resources on medical/surgical nursing units varies sharply among community hospitals. In an effort to explain the variation, this study examines several factors: socio-economic characteristics of the population; supply of registered nurses; hospital characteristics such as size, complexity and diversity of services; patient characteristics such as case mix index and nursing care acuity index; and production system characteristics such as efficiency of technical support systems and the structure of nursing care delivery. Nursing skill mix varies more than the staffing levels among hospitals. The research suggests that factors associated with a clinical-rational model such as nursing acuity index and the efficiency of clinical/support systems explains little, whereas factors associated with economic-rational model of hospital revenues – like case mix, number of hospital services, poverty (through Medicaid program) and age distribution (through Medicare program) – do significantly affect nursing resource consumption. The results point to the presence of resource allocation to nursing based on hospital revenues rather than patient care needs.
Introduction of Hip Ultrasonography to the Neonatal Services of a Fife District General Hospital
Authors: Dean B. , Coid Donald R. 
Published: January 2017

Ultrasonography of the hip is a new technique which is said to assist in the diagnosis of neonatal hip disorders. The authors were unaware of any reports of formal evaluation of the introduction of this new technology into a District General Hospital. This study outlines several aspects of patient care before and after the introduction of neonatal hip ultrasonography to a Fife hospital as an adjunct to a neonatal orthopaedic clinic. After introduction of ultrasound the proportion of patients where the consultant was ‘very confident’ in the diagnosis increased by 29% (95% confidence intervals 9% to 49%); the proportion of children requiring three or more x-rays in the year following referral fell by 46% (95% confidence intervals 27% to 65%) and the proportion of children requiring five or more follow up attendances in the year following referral fell by 56% (95% confidence intervals 38% to 74%). Introduction of this technology has benefited patients by reducing their need to attend clinics and reducing their overall exposure to ionising radiation. There is a continuing need for ultrasonography to be provided in Fife neonatal orthopaedic outpatient clinics.
Further Flexing? Issues of Employment Contract Flexibility in the UK Nursing Workforce
Authors: Buchan J. 
Published: January 2017

This paper, based on research commissioned by the Royal College of Nursing (Buchan, 1995), reports on the changing working patterns and flexibility in the employment of nursing staff in the National Health Service (NHS) in the UK. It reviews relevant literature, examines official data and draws information from 12 case study NHS trusts. Flexibility is invariably portrayed as a good thing, and as a means to a positive end, yet is rarely defined in detail, if at all. The aim of this paper is to consider flexibility not as a slogan or panacea, but in terms of the rationales for, and likely effects of, changing patterns of nursing work. It examines the reasons why NHS employers have been attempting to increase the flexibility of their nursing workforce.
Transfusion-Associated HIV Infection in Mexico Related to Paid Blood Donors; HIV Epidemic
Authors: Volkow Patricia , Velasco Silvia Ruiz , Mueller Nancy , de Leon Samuel Ponce , Sierra-Madero Juan Gerardo , Sada Eduardo , Soto José Luis , Perez-Ancona Franz , Ruiz-Palacios Guillermo , Castillo José Ramón , Mohar Alejandro 
Published: January 2017

The objective of the study was to describe the clinical, epidemiological profile and conditional incubation period in a group of transfusion-associated HIV-infected (TAHI) patients seen in five national tertiary care centres in Mexico from 1983 to April 1998. Date of transfusions, AIDS diagnoses, opportunistic infections and malignancies were collected. The incubation period was estimated through a non-parametric conditional analysis. One hundred and fifty-seven TAHI cases were analysed. The frequency of TAHI by year of transfusion was: 0.6% in 1980 and 1981, 4.5% in 1984, 22.4% in 1985, 54.5% in 1986, 10.3% in 1987, 0.6% in 1988, 1.9% in 1989 and 1990, 1.3% in 1993 and 0.6% in 1994 and 1996. The median incubation period was 4.3 years. A well-defined epidemic period of HIV-infection among blood-recipients was identified that coincided with the HIV-epidemic among paid donors. TAHI patients in Mexico developed AIDS in a shorter time than that described for other populations.
Asymptomatic Herpes Simplex Virus Shedding from the Genital Tract Whilst on Suppressive Doses of Oral Acyclovir
Authors: Bowman C A , Woolley P D , Herman S , Clarke J , Kinghorn G R 
Published: January 2017

Forty-eight patients were recruited into a study of continuous oral acyclovir therapy for the suppression of recurrent genital herpes simplex virus (HSV) infection. Seven of these patients were shown to shed HSV in the absence of clinical signs or symptoms whilst on medication. The asymptomatic shedders did not differ significantly from the rest of the group in terms of age, interval from first attack to enrolment or number of recurrences prior to enrolment. Only one patient admitted to poor compliance as a trigger to asymptomatic HSV shedding. Failure to suppress asymptomatic shedding during prophylactic acyclovir therapy may have implications for sexual transmission to partners and vertical transmission to neonates and requires further study.
Prevention of Fetal Death in the Antiphospholipid Antibody Syndrome
Authors: Cowchock S 
Published: January 2017

The first treatment of pregnant women with antiphospholipid antibody syndrome (APLS) employed high doses of corticosteroids, plus low dose aspirin, with the goal of suppressing production of the autoantibody. Corticosteroids (usually prednisone), even when much lower doses are used, and even when tapered after midpregnancy, have been associated with significant maternal and obstetric risks and side effects: the most important are osteomalacia and preterm delivery (often precipitated by premature rupture of the membranes). Since the publication of a randomized trial demonstrating equivalent live birth rates of about 75% whether heparin or prednisone was used for treatment (plus low dose aspirin), the use of adjusted doses of heparin, together with low dose aspirin, has replaced prednisone for treatment of pregnant women; although prednisone may still be needed to treat manifestations of associated autoimmune disorders. A recent randomized trial has shown that the addition of heparin to aspirin is probably superior to treatment with aspirin alone. To achieve prophylactic levels of plasma heparin equivalent to those measured in patients who are not pregnant and are treated with the usual dose of standard heparin of 5000 IU every 12 h, the heparin dose required for treatment of pregnant women is usually higher. For that reason, heparin doses should be adjusted using the nadir APTT, or better plasma heparin measured by a factor Xa inhibition assay at the 2 h post-injection peak. Although low molecular weight heparin has been shown to be useful in prevention of fetal resorption in a mouse model, and appears to be equally safe for treatment of pregnant women, we still have no published data to show therapeutic equivalency, with respect to treatment of APLS-complicated pregnancy, to standard heparin preparations, and none that demonstrate any lower risk for the complication of most concern when heparin is given to pregnant women—osteopenia. Similarly, intravenous infusion of gamma globulins (IVG) appears on the basis of case reports to be effective additional treatment in cases where standard therapy has failed. Gamma globulin preparations contain anti-idiotypic antibodies that have been shown to bind to patient antiphospholipid antibodies. The place for the addition of IVG to standard therapy has not been defined, but clinically significant and corticosteroid-resistant thrombocytopenia complicating antiphospholipid antibody syndrome might be one indication for primary treatment with IVG ± low dose aspirin. Overall, live birth rates in most treatment studies are in the range of 70–80%. The reported birth rate information, however, cannot be compared between studies. None of the studies reported have used tools such as logistic regression analysis to allow for such significant predictors of live birth as the number of prior miscarriages, maternal age, medical history, or a history of fetal death (loss of a viable and chromosomally normal fetus after the 10th gestational week).
Self-Sampling in Screening to Reduce Mortality from Colorectal Cancer: A Qualitative Exploration of the Decision to Complete a Faecal Occult Blood Test (FOBT)
Authors: O'Sullivan I , Orbell S 
Published: January 2017

Objective: To explore beliefs that might impact upon public reactions to a proposed population level faecal occult blood test (FOBT) screening invitation and acceptability of completing an FOBT home self sampling kit. Methods: Four focus groups were conducted to explore men and women's beliefs about colorectal cancer risk, their understanding of screening and reactions to an FOBT kit. Participants were shown a kit and permitted to examine it during the focus groups. Results: Colorectal cancer is viewed as having severe quality of life impacts and is commonly regarded as being caused by diet. Faecal blood is an expected symptom. A home self-sampling kit is viewed as highly acceptable, but some concerns were raised about collecting and storing faecal matter. Conclusions: The main implications for public education arising from the analysis were firstly, that communications regarding the potential to avoid quality of life impacts of colorectal cancer may motivate participation; secondly, that public education might address the ability of the test to detect asymptomatic abnormalities, in particular occult (as opposed to visible) blood; thirdly, in order to prevent avoidance responses to fear, communications need to emphasise that many abnormal test outcomes will not be cancer and early treatment may prevent cancer and associated adverse quality of life impacts; fourthly, that uptake may be promoted by emphasising messages that the test kit is very convenient; and finally, that instruction leaflets might minimise procedural concerns by suggesting simple and easy methods to collect and store faecal samples.
Overdiagnosis in Screening: Is the Increase in Breast Cancer Incidence Rates a Cause for Concern ?
Authors: Paci E , Warwick J , Falini P , Duffy S W 
Published: January 2017

Objectives: To estimate the degree of overdiagnosis of breast cancer in a mammographic screening programme. Setting: A mammography service screening programme in Florence, Italy. Methods: We studied the incidence of breast cancer in Florence between 1990 and 1999, following the introduction of screening in 1990. Incidence of breast cancer in this period was compared with incidence between 1985 and 1989, before the introduction of screening. It was necessary to estimate the number of cancers that would have arisen in the absence of screening, but after the end of followup (31 December 1999), so that these were not misclassified as overdiagnosed tumours. Around 60,000 women aged 50–69 were invited for screening during the period of study. Results: There were 2780 breast cancers diagnosed during the period of study (2626 were invasive). There was no significant evidence of overdiagnosis of invasive cancers. When invasive and in situ cancers were considered together, around 5% of cases were overdiagnosed. Conclusions: There is a small amount of overdiagnosis of ductal carcinoma in situ in mammography screening; however, this should not deter women from being screened. Training and practice in mammographic screening should emphasise detection of small, invasive lesions. Research into the natural history and treatment of the disease should aim at minimising overtreatment of those in situ lesions that are less likely to progress to invasive disease.
Cost Analysis in a Population Based Screening Programme for Colorectal Cancer: Comparison of Immunochemical and Guaiac Faecal Occult Blood Testing
Authors: Castiglione G , Zappa M , Grazzini G , Sani C , Mazzotta A , Mantellini P , Ciatto S 
Published: January 2017

Objective— To compare the costs of colorectal cancer (CRC) screening by two faecal occult blood tests (FOBT)—namely, Hemoccult (guaiac based) and reversed passive haemagglutination (RPHA) tests. RPHA was interpreted according to two positivity thresholds (+ or +/-). Methods— Attenders performed both tests. Subjects with a positive FOBT test were invited to have a complete exploration of the colon. The total costs for every 10 000 screened subjects and costs for each unit of result (screened subject, or patient with adenoma/s or cancer detected) were calculated for both tests. Results— 8353 subjects were enrolled. A total of 2109 repeated screening after two years. RPHA(+ and +/-) showed the highest and RPHA(+) the lowest positivity rate at first screening. The Hemoccult positivity rate was highest at repeat screening. Total costs of screening by RPHA(+ and +/-) were highest as this method had the highest recall rate. Screening by RPHA(+) was the least costly. Costs for each screened subject were highest for RPHA(+ and +/-) and lowest for RPHA(+). Costs for each cancer detected were lowest for RPHA(+) and highest for Hemoccult or RPHA(+ and +/-) in subjects aged > 49 or < 50, respectively. Costs for subjects with detected adenoma/s of > 9 mm were lowest for RPHA(+ and +/-) and highest for Hemoccult. At repeat screening total costs of RPHA(+ and +/-) were lower than at first screening, whereas for each subject with cancer or adenoma/s costs were increased. Conclusions— Our data confirm that screening by RPHA is more cost effective than by Hemoccult.