bluuebunny/crossref_metadata_2025_split huggingface dataset:
Health Care Rationing: Can we Afford to Ignore Euthanasia?
Authors: Ward P. R. 
Published: January 2017

Explicit rationing decisions are being made to encompass a wide range of health care issues. Voluntary euthanasia has largely been excluded from this debate due to, in my view, the emotive nature of the issue. Euthanasia is an issue in which economists have been largely excluded and in which ethicists and philosophers dominate. It is the purpose of this paper to review the economic and ethical literature on euthanasia and to discuss their compatibility within the debate on euthanasia. The potential cost savings by the use of advance directives, do-not-resuscitate orders, and futile care withdrawal are then reviewed, as are the potential cost savings created by hospice care. As a conclusion, the ethical and economic arguments are then balanced to assess their compatibility. It is the contention of this paper that reducing medical care costs near the end of life should not be a taboo subject, and that rationing decisions could focus on an exploration of this area and the approaches to it, which are ethically justifiable and economically worthwhile. The introduction of a policy of voluntary euthanasia could have a large impact on the rationing of health care resources whilst also promoting patient choice and an arena for a more dignified death.
Blood-Taking Practices and Needle-Stick Injuries in House Officers
Authors: Woolley P D , Palfreeman A J , Patel R , Talbot M D , Samarasinghe P L 
Published: January 2017

The blood-taking practices and prevalence of needle-stick injuries were recorded for 46 house officers working at the two largest teaching hospitals in Sheffield and 38 house officers working at three hospitals in London. Wearing gloves when performing venesection or inserting an intravenous cannula was generally perceived as making the procedure more difficult and no house officer in either centre wore gloves when performing routine venesection. Twenty-five (54.3%) of the house officers from Sheffield resheathed needles by hand, while a further 14 (28.3%) placed the sheath onto a work surface before attempting to manoeuvre the needle back into its sheath. Only 7 (17.4%) house officers denied resheathing needles after performing venesection. Twenty-seven (58.7%) admitted to having had a needle-stick injury within 3 months of commencing their first house officer post. Twenty-seven (71.1%) of the house officers from London resheathed needles, the remainder disposing of the needle by placing it straight into an appropriate container. Twenty-five (66%) admitted to having had a needle-stick injury the first 6 months of being a house officer. Training in the correct techniques of venesection with emphasis on either avoiding resheathing needles or resheathing safely is essential early in the medical student curriculum and needs regular repetition.
Meatoscopy: A Simple Technique to Examine the Distal Anterior Urethra in Men
Authors: Thin R N 
Published: January 2017

A common problem is to determine the site of the base of meatal warts in men and if the lesions will be suitable for the treatments available in genitourinary medicine (GUM) or sexually transmitted diseases (STD) clinics. Formal endoscopy requires sterile conditions and is therefore an expensive procedure. A simple safe cheap alternative is meatoscopy using an auroscope with inflation. This allows inspection of the anterior urethra to a depth of 5 or 6 cm. With this technique 175 examinations were performed on 153 patients. Warts were confined to the lips in 27 (56%) of 48 patients with meatal warts; in an additional 5 patients with meatal warts the warts arose from deep in the fossa navicularis and in 16 patients with meatal warts there were additional warts in the fossa navicularis invisible on clinical examination. No urethral warts were seen in 103 patients without meatal warts, comprising 47 patients with external genital warts and 56 without any warts. It is concluded that meatoscopy should be undertaken in all patients with meatal warts to determine the site of their base and to assess if there are any more proximal warts. This should be done as soon as the meatal warts are seen, and urethritis has been excluded, so that appropriate treatment can be planned.
Prevalence of Urogenital Chlamydia Trachomatis Infection in El Salvador I. Infection during Pregnancy and Perinatal Transmission
Authors: Posada Ana Berta Cañas , Jonasson Jon , de Linares Leonor , Bygdeman Solgun 
Published: January 2017

One-hundred and twenty-nine pregnant women in labour (age range 15–46 years; median age 23) and 42 infants born to chlamydia-positive mothers (age range 5–15 days; median age 10) were investigated to estimate the prevalence and incidence, respectively, of Chlamydia trachomatis infection in San Salvador, El Salvador. Urethral and cervical samples were obtained from all women and conjunctival specimens were taken from both eyes of each child. The chlamydial antigen was detected with the commercial Pharmacia Chlamydia EIA kit. Direct immunofluorescence (DFA) (Syva MicroTrak) was used for confirmation. In the newborns both EIA and DFA tests on direct preparations from ocular smears were performed on all the samples. The prevalence of chlamydial infection in pregnant women was 44% (57/129). The incidence of chlamydial infection in neonates was 64% (27/42), and the majority of the infected children (56%) had conjunctivitis. Referring to individuals rather than specimens the sensitivity of EIA tests on conjunctival samples from the infants was low (37%) as compared with 91% on urethral and cervical specimens from the pregnant women.
Sample Size Determination for a Trial of-Breast Cancer Screening under Age 50: Population versus Case Mortality Approach
Authors: Peer Petronella G M , Verbeek André L M , Straatman Huub 
Published: January 2017

Objective — To determine the efficacy of screening for breast cancer in women aged 40 to 49. Methods — A large number of women will have to be enrolled to ensure adequate statistical power. Attention will be restricted to the deaths from breast cancer that occur among comparable groups of patients with breast cancer rather than to an analysis in which all women entering into the trial are considered at risk of dying from breast cancer (population mortality analysis). As the new trial is likely to be conducted in regions where screening has been established for all women from age SO onward, comparability may be reached by including the breast cancers detected at the routine screening examination at age 50. Conclusions — When comparability of cases can be reached, such a case mortality analysis requires 15–30% fewer women to be enrolled than a population approach.
Setting Standards for Cervical Screening Fail-Safe Mechanisms: A Target Based on an Audit of Cytopathology Laboratory Records
Authors: Roberts Emilie , Barrow Steve , Cook G A , Walsworth-Bell J P 
Published: January 2017

Objective — To examine the efficacy of cytopathology laboratories in monitoring action following an abnormal cervical smear. Setting — 11 screening laboratories serving 19 districts in the former North Western region of the United Kingdom. Method — 944 validated cases were identified at 11 laboratories. The screening history for each abnormal smear was obtained from the screening laboratory and compared with the records from the relevant family health services authority (FHSA) database. Results — Laboratories held complete follow up records in 740 (78·4%) cases; the FHSA records extended this to 910 (96·4%) cases. Poor communication was the main problem; computerisation was not necessary to improve fail-safe procedures. Conclusions — Audit of fail-safe procedures is a valuable purchasing tool, identifying weaknesses and strengths, setting and maintaining standards.
Diagnostic Accuracy of Immunochemical Faecal Occult Blood Test for Gastric Cancer
Authors: Nakama Hidenori , Kamijo Noboru , Fujimori Kazuya , Fattah A S M Abdul , Zhang Bing 
Published: January 2017

Objectives –Toinvestigate the accuracy of the immunochemical occult blood test in screening for gastric cancer and to evaluate whether or not the upper digestive tract should be examined when the occult blood test is positive but there is no abnormal sign in the colorectum. Methods –In a case-control study an occult blood test was carried out on 150 subjects with gastric cancer, ISO subjects with colorectal cancer, and on 300 healthy subjects. Data were analysed from 44 996 persons attending a population screening programme who underwent both radiological gastric cancer screening (barium meal) and colorectal cancer examination by occult blood test. Results –In the case—control study the occult blood test was positive in 27/150 (18%) subjects with gastric cancer, in 112/150 (75%) subjects with colorectal cancer, and in 24/300 (8%) healthy controls. In the population screening programme the occult blood test was positive in 4/50 (8%) persons with gastric cancer and 3232/44 950 (7%) persons without gastric cancer,- indicating no difference between them. Conclusions –These data show that the immunochemical faecal occult blood test is worthless as a screening test for gastric cancer, and that examination of the upper digestive tract is unnecessary in cases where the faecal occult blood test is positive but there is no sign of colorectal disease.
Organic Farming: Ex Post Strategy or Ex Ante Business Analysis?
Authors: Leaver Adam 
Published: January 2017

Recent strategy debates have emphasised the importance of skilled management to build core competencies within the firm and thus nurture competitive advantage. For some, the competency of management is so crucial that market maturity is simply just a state of mind. This paper critically reviews this claim through an investigation of the structure and dynamics of the organic food sector. This paper argues that “resource-based” arguments are less strategy discourses and more histories of successful or failed companies. As such they are difficult to apply to ex ante situations such as agriculture, where the market is mature yet there are no obvious solutions. The organic sector offers one way out for farmers, but it too is constrained or governed by its sectoral environment and operating ratios. In conclusion this paper argues that market maturity is therefore not a stale of mind because sectoral pressures create real economic and financial problems which individual managers alone cannot solve.
Internationalization Strategies, Networking and Functional Discretion
Authors: Jaklič Marko 
Published: January 2017

International networking seems to be a very useful concept especially for internationalization of small and medium-sized companies (SMEs) in (small) catching-up economies, since it is possible to overcome some of the problems of knowledge and technology as well as capital accumulation. However, an important set of questions pertains to the position of a partner within a network of relationships. I will argue that a functional discretion or a “freedom of business functions” and their development, especially the marketing and R&D functions, should be a strategic goal for a company striving to be well positioned in a network. For introductory purposes three models describing internationalization strategies of firms are distinguished: the theory of internalization, the model of the internationalization process, and the network approach to internationalization.1 The latter describes industrial markets as networks of relationships between companies. Then I describe the nature of cooperation and competition in networks, discuss problems and management of networks and introduce the concept of the positioning of companies in networks. Based on internationalization and networking concepts I develop a “3-Phase Internationalization” model, which helps to develop a pattern of thinking about the functional discretion of a company in various stages of the internationalization process. In effect, this model may be seen as a means of integrating the main theories of internationalization. In the last part of the article we present two Slovenian cases of networks in internationalization as illustrations of the theoretical discussion. I conclude that functional discretion may well be a development issue for states or regional economies as well as a critical strategic issue for companies.
Comparative Studies on the in Vitro Drug Dissolution Profiles for Hydroxyzine Hydrochloride Tablets
Authors: Loucas Spiro P. , Maager Paul , Mehl Bernard 
Published: January 2017

OBJECTIVE: A significant practical problem in the standardization of dissolution testing is addressed. In vitro releasing characteristics of hydroxyzine hydrochloride tablets are presented to further the documentation of bioequivalency criteria. DESIGN: The assessment model compares the official United States Pharmacopeia disintegration approach for dissolution analysis with that of the Food and Drug Administration's recommended rotating paddle technique for inducing aqueous disruption of the solid oral dosage form. RESULTS: The rationale and significance of the study focuses attention on the variation in release of the active ingredient observed relative to the four formulation strengths. With differences in the extent of dissolution noted and official standards in mind, emphasis is placed on the development of an alternate test protocol. CONCLUSIONS: Dissolution data derived via ultraviolet spectrophotometry revealed statistically significant differences in the amount of hydroxyzine hydrochloride being released from its coated structure, the extent of which was found to be dependent on the acid nature of the simulated gastric dissolution medium used and intensity of mixing action employed.
Meperidine-Related Seizures Associated with Patient-Controlled Analgesia Pumps
Authors: Hagmeyer Kathleen O. , Mauro Laurie S. , Mauro Vincent F. 
Published: January 2017

OBJECTIVE: To report three cases of meperidine-related seizures when meperidine was administered via patient-controlled analgesia pump (PCAP) and to review literature related to meperidine-associated seizures. DATA SOURCES: Case reports and review articles identified by a computerized search (MEDLINE) and manual search ( Index Medicus). DATA SYNTHESIS: PCAPs are being used frequently to relieve the pain of sickle cell crisis as well as pain from many other etiologies. We report three cases of meperidine-related seizures associated with its administration via PCAP. Each of the patients received either relatively high doses, long-term therapy, or both. Meperidine has been associated with seizure activity when administered via traditional routes. Previously identified risk factors for the development of meperidine-related seizures include renal failure, high meperidine dosages, and coadministration of hepatic enzyme-inducing medications or phenothiazines. CONCLUSIONS: Meperidine administered via PCAP may be associated with seizures. Optimally, an alternative analgesic should be administered when this route is used.
Ceftriaxone-Induced Acute Pancreatitis
Authors: Zimmermann Anthony E. , Katona Brian G. , Jodhka Joginder S. , Williams Richard B. 
Published: January 2017

OBJECTIVE: To report a case of probable ceftriaxone-induced acute pancreatitis. CASE SUMMARY: A patient with a history of short-bowel syndrome on home total parenteral nutrition developed fever, chills, and right flank pain. She was diagnosed with gram-negative catheter sepsis and prescribed antibiotic therapy to be administered for four weeks. After completion of the first week of therapy, the antibiotic regimen was changed to intravenous injections of ceftriaxone to be given daily at home. Prior to discharge the patient developed acute abdominal pain, leukocytosis, jaundice, and markedly elevated lipase and amylase concentrations consistent with acute pancreatitis. The patient's condition improved upon discontinuation of the ceftriaxone and the remainder of her stay was uneventful. DISCUSSION: There is only one other case report in the literature of probable ceftriaxone-induced pancreatitis. Multiple other medications have been implicated in causing acute pancreatitis. The exact mechanism of this uncommon adverse effect of ceftriaxone is unknown. CONCLUSIONS: There was a temporal relationship between the development of this patient's signs and symptoms and the administration of ceftriaxone. We could not identify any other factors that may have been responsible for the development of her acute pancreatitis. Ceftriaxone should be considered as a possible etiologic agent in patients who present with acute abdominal pain and elevated lipase and amylase concentrations.
High-Dose Ciprofloxacin in the Treatment of a Renal Cyst Infection
Authors: Rossi Stephen J. , Healy Daniel P. , Savani Dora V. , Deepe George 
Published: January 2017

OBJECTIVE: To report a case of renal cyst infection successfully treated with ciprofloxacin. CASE SUMMARY: The clinical course of a 33-year-old woman with radiologic and symptomatic evidence of a renal cyst infection continued to worsen after 7 days of apparently adequate antibiotic therapy for Escherichia coli isolated from her urine. Antibiotic therapy with intravenous ciprofloxacin 600 mg every 12 hours was administered for 7 days and then given as oral therapy (750 mg q12h) for another 14 days. The patient's clinical condition rapidly improved on ciprofloxacin and follow-up 28 days later showed no evidence of infection. DISCUSSION: Renal cyst infections are a serious complication of polycystic kidney disease and are often refractory to standard antimicrobial therapy. Ciprofloxacin has the chemical properties and antimicrobial activity needed to treat these infections. Previously reported concentrations of ciprofloxacin in renal cyst fluid are therapeutic for the common pathogens associated with renal cyst infections. CONCLUSIONS: Ciprofloxacin appears to be a safe and effective option for treating renal cyst infections. Further controlled studies evaluating its clinical efficacy are warranted.
Fatal Seizures after Flumazenil Administration in a Patient with Mixed Overdose
Authors: Haverkos Gregory P. , DiSalvo Raymond P. , Imhoff Thomas E. 
Published: January 2017

OBJECTIVE: To report a fatal case of refractory status epilepticus precipitated by flumazenil use in a mixed benzodiazepine—tricyclic antidepressant overdose. CASE SUMMARY: A 39-year-old woman was brought to the emergency room (ER) in a stupor from a suspected suicidal overdose of an unknown mixture of drugs. Past medical history included seizures and psychiatric disorders managed with benzodiazepine and tricyclic antidepressants. Initial ER electrocardiogram showed a QRS interval of 136 milliseconds. The patient developed refractory seizures after being given flumazenil. Lorazepam, phenytoin, and phenobarbital were administered; however, seizures persisted for 4 hours, resulting in rhabdomyolysis, acute renal failure, severe brain damage, and death. DISCUSSION: Flumazenil should be used with caution in patients with chronic benzodiazepine use, prior seizure history, or when a mixed overdose is suspected. Flumazenil may unmask tricyclic antidepressant—induced seizures by antagonizing the antiepileptic effect of concomitantly ingested benzodiazepine. In this patient seizures occurred within two minutes of flumazenil administration. As benzodiazepine-induced central nervous system depression is rarely life-threatening, the use of flumazenil must be balanced against potential risk. CONCLUSIONS: Seizure risk factors should be assessed in all patients in whom flumazenil use is considered. If risk factors are present, the benefit of flumazenil use is outweighed by the potential risk. If flumazenil is used, resulting seizures may require larger doses of benzodiazepine.
Selective Serotonin Reuptake Inhibitors: Pharmacologic Profiles and Potential Therapeutic Distinctions
Authors: Finley Patrick R. 
Published: January 2017

OBJECTIVE: To review the respective pharmacologic profiles of the selective serotonin reuptake inhibitors (SSRIs), with particular emphasis placed on clinically relevant distinctions. DATA SOURCES: A MEDLINE search was conducted to identify English language literature published within the last five years on the four SSRIs (fluoxetine, sertraline, paroxetine, fluvoxamine). Previous review articles were scrutinized for additional citations, and manufacturers provided a contemporary bibliography of more recent material. STUDY SELECTION/DATA EXTRACTION: Studies were selected for specific citation on the basis of comparative research merit and the contribution of this original literature to the pharmacologic profile(s) described. DATA SYNTHESIS: All SSRIs appear to be more efficacious than placebo for the acute treatment of major depressive disorder (MDD). Short-term (six-week) efficacy was comparable with that of tricyclic antidepressants for the amelioration of MDD regarded as moderate in severity. Further comparative trials are clearly indicated to demonstrate the therapeutic benefits of SSRIs in specific populations (e.g., geriatric, severely ill) and to demonstrate sustained benefit with long-term prophylaxis. Other potential indications for SSRIs include obsessive-compulsive disorder, panic disorder, bulimia, and chronic pain syndromes. Pharmacokinetic profiles of the four SSRIs reveal similar parametric values, and most quantitative differences are of limited clinical significance. Adverse effects are common but ordinarily mild and transient, primarily restricted to the gastrointestinal tract and central nervous system. Important differences in the prevalence or severity of these adverse effects await the accumulation of further clinical experience and the completion of additional comparative trials. Similarly, the relative propensity of SSRIs to inhibit the metabolism of other medications is currently under investigation. CONCLUSIONS: The four SSRIs studied appear to be more similar than they are different. Slowly, important distinctions are beginning to emerge with regard to adverse effect profiles and potential drug interactions. Given that the costs of these respective medications are comparable, such differences may ultimately serve to establish the preferential selection of individual agents in specific clinical situations.
Effects of Intravenous Famotidine on Gastric Acid Secretion in Patients Undergoing Cardiac Surgery
Authors: Wagner Bertil KJ , Amory David W , Majcher Claudine M , DiFazio Louis T , Scott Gregory E , Spotnitz Alan J 
Published: January 2017

Objective: To determine the effects of cardiopulmonary bypass and famotidine on gastric acid secretion in adults undergoing cardiac surgery. Design: Prospective, randomized, double-blind, placebo-controlled study. Setting: University teaching hospital. Participants: Eighteen patients undergoing elective cardiac surgery with cardiopulmonary bypass. Main Outcome Measures: Famotidine 20 mg or NaCl 0.9% placebo was administered intravenously following induction of anesthesia and placement of a nasogastric pH probe. A second dose was given 12 hours after surgery in the intensive care unit. Gastric pH was measured continuously and gastric volume was measured every 4 hours for up to 24 hours after cardiopulmonary bypass. Results: Following famotidine administration, pH increased by 43% within 45 minutes and remained above 5.5 throughout the study period (p < 0.05 vs placebo and baseline). The gastric pH did not increase, but remained above 4.0 in most patients in the placebo group for up to 12 hours after cardiopulmonary bypass. Gastric volumes were on average 24% lower in the famotidine group (p > 0.05). Conclusions: Gastric acid secretion is decreased during and for 12 hours after cardiopulmonary bypass. Perioperative administration of famotidine suppresses gastric secretion in cardiac surgery patients.