bluuebunny/crossref_metadata_2025_split huggingface dataset:
Management of medical confidentiality in English professional football clubs: some ethical problems and issues
Authors: Waddington I , Roderick M 
Published: July 2002

Objective: To examine the ways in which confidential matters are dealt with in the context of the relationship between the club doctor (or physiotherapist) and the player as patient in English professional football clubs.Methods: Semistructured tape recorded interviews with 12 club doctors, 10 club physiotherapists, and 27 current and former players. A questionnaire was also sent to 90 club doctors; 58 were returned.Results: There is among club doctors and physiotherapists no commonly held code of ethics governing how much and what kind of information about players may properly be passed on to managers; associated with this, there is considerable variation from one club to another in terms of the amount and kind of information passed on to managers. In some clubs, medical staff attempt to operate more or less on the basis of the rules governing confidentiality that apply in general practice, but in other clubs, medical staff are more ready to pass on personal information about players. In some situations, this raises serious ethical questions.Conclusions: Guidelines dealing with confidentiality in practitioner-patient relationships in medical practice have long been available and have recently been restated, specifically in relation to the practice of sports medicine, by the British Olympic Association, the British Medical Association, and the Football Association. This is a welcome first step. However, if the guidelines are to have an impact on practice, detailed consideration needs to be given to ensuring their effective implementation; if this is to be achieved, consideration also needs to be given to identifying those aspects of the culture and organisation of professional football clubs that may hinder the full and effective implementation of those guidelines.
Genetics services in a social, ethical and policy context: a collaboration between consumers and providers: Table 1
Authors: Wertz Dorothy C , Gregg Robin 
Published: July 2002

We report a unique, collaborative effort by users and providers of genetic services to arrive at outlines for optimal ethics and clinical practice. Using focus groups of consumers (users) and providers (held separately), a provider-consumer project team developed 1) a consumer wish list, 2) an experientially based ethical overview of situations arising in practice, and 3) detailed suggestions for consumer-provider interactions in clinical settings. Consumers were primarily interested in accurate information, respect for persons, a smoothly functioning team, with the consumer as an equal member of the team, family integrity, and providers who knew the limits of their knowledge and were willing to refer. “Non-directive” counselling and privacy were not major issues in consumer focus groups; some thought providers should openly state their own opinions. Providers had a rather different list of priorities.Books and papers on clinical ethics usually originate from bioethicists and physicians. This pilot project is unique in including consumers and providers equally.
How to select publications on occupational health: the usefulness of Medline and the impact factor
Authors: Gehanno J F , Thirion B 
Published: July 2002

OBJECTIVESPublications in the field of occupational health appear in various journals, including those of other medical specialties. This complicates the follow up of literature for specialists in this field. On the basis of Medline and the impact factor, this diversity was assessed, and a cost effective method for selecting the most pertinent journals in the practice of occupational health was proposed.METHODSA Medline search identified all the articles published in 1998 with occupational diseases or occupational exposures as the main topic. These articles were classified based on the journals in which they appeared. The journals were then compared according to their subject area, the number of articles that were published in the fields studied, and their impact factor.RESULTSThe search retrieved 2247 articles, published in 577 different journals in 1998. Each journal published between one and 105 articles during this period (mean 3.89). However, only 1.4% of the journals accounted for more than 25% of the total articles published. More than half of the articles were published in journals dealing with general practice or medical specialties other than occupational health. Only 66% of retrieved journals had an impact factor, and more than 80% of the articles were published in journals with an impact factor <2.CONCLUSIONSimply following up occupational health journals is not sufficient to meet the requirements of the occupational health professional. Moreover, the use of the impact factor cannot be considered as a reliable research tool to assess follow up. Two lists of eight and 38 journals were thus set up. They permit a literature coverage of 27% and 52% respectively in the specific fields studied, and this seems to be the optimal compromise between time and literature covered. Lastly, practical procedures are suggested to follow up literature and obtain abstracts from selected journals on the internet.
Incidence of cancer among commercial airline pilots
Authors: Rafnsson Vilhjálmur , Hrafnkelsson Jón , Tulinius Hrafn 
Published: July 2002

OBJECTIVESTo describe the cancer pattern in a cohort of commercial pilots by follow up through the Icelandic Cancer Registry.METHODSThis is a retrospective cohort study of 458 pilots with emphasis on subcohort working for an airline operating on international routes. A computerised file of the cohort was record linked to the Cancer Registry by making use of personal identification numbers. Expected numbers of cancer cases were calculated on the basis of number of person-years and incidences of cancer at specific sites for men provided by the Cancer Registry. Numbers of separate analyses were made according to different exposure variables.RESULTSThe standardised incidence ratio (SIR) for all cancers was 0.97 (95% confidence interval (95% CI) 0.62 to 1.46) in the total cohort and 1.16 (95% CI 0.70 to 1.81) among those operating on international routes. The SIR for malignant melanoma of the skin was 10.20, 95% CI 3.29 to 23.81 in the total cohort and 15.63, 95% CI 5.04 to 36.46 in the restricted cohort. Analyses according to number of block-hours and radiation dose showed that malignant melanomas were found in the subgroups with highest exposure estimates, the SIRs were 13.04 and 28.57 respectively. The SIR was 25.00 for malignant melanoma among those who had been flying over five time zones.CONCLUSIONSThe study shows a high occurrence of malignant melanoma among pilots. It is open to discussion what role exposure of cosmic radiation, numbers of block-hours flown, or lifestyle factors—such as possible excessive sunbathing—play in the aetiology of cancer among pilots. This calls for further and more powerful studies. The excess of malignant melanoma among those flying over five time zones suggests that the importance of disturbance of the circadian rhythm should be taken into consideration in future studies.
A new cause of 'non-responsiveness' in coeliac disease?
Authors: Jennings J S R , Wyatt J I , Howdle P D 
Published: July 2002

Abstract
A 42 year old man presented with gluten-responsive coeliac disease and secondary pancreatic insufficiency. Subsequently his symptoms relapsed and repeat small intestinal biopsy showed villous atrophy and infiltration by leukaemic cells, despite continuation of a gluten-free diet. Serious causes of relapse and non-responsiveness in coeliac disease include enteropathy-associated T-cell lymphoma, ulcerative jejunitis and an end-stage hypoplastic mucosa. This is the first report of non-responsiveness due to infiltration by leukaemia.
Staphylococcus lugdunensisendocarditis
Authors: Farrag N , Lee P , Gunney R , Viagappan G M 
Published: July 2002

Abstract
A case of Staphylococcus lugdunensisendocarditis is presented with low back pain suggesting a secondary bone focus of infection. An umbilical skin lesion may have been an additional embolic phenomenon. The case highlights the aggressive nature of S lugdenensis endocarditis compared with other coagulase negative staphylococci and its association with native heart valves. In addition the importance of full identification of coagulase negative staphylococci isolated from patient samples in a case of suspected S lugdenensis infection is emphasised. Antibiotic treatment may be insufficient alone in the treatment of S lugdenensis endocarditis and early recourse to surgical intervention and valve replacement should therefore be considered.
Familiar drugs may prevent cancer
Authors: Sharma R A , Gescher A J , O'Byrne K J , Steward W P 
Published: July 2002

Abstract
Despite positive results in large scale chemoprevention trials, many physicians are unaware of the potential cancer preventive properties of drugs in common usage. The antioestrogen tamoxifen and the selective cyclo-oxygenase-2 inhibitor celecoxib have been licensed in the USA for the chemoprevention of breast and colorectal cancers respectively in selected high risk individuals. Similarly, folate and retinol have been shown to decrease the incidence of colorectal cancer and squamous cell carcinoma of the skin respectively in large scale intervention trials. Other retinoids have proved efficacious in the tertiary chemoprevention of cancers of the breast and head/neck. Epidemiological evidence also exists in favour of aspirin, non-steroidal anti-inflammatory drugs, and angiotensin converting enzyme inhibitors preventing certain cancers. Phytochemicals may represent less toxic alternatives to these agents. Although some of these drugs are available without prescription and most are not yet licensed for use in cancer chemoprevention, physicians and students of medicine should be aware of this accumulating evidence base. Practitioners should be amenable to patient referral to discuss complex issues such as risk estimation or potential benefit from intervention.
A new variant of Carney's triad: phaeochromocytoma and chondrosarcoma
Authors: Wahid S T , Jones R , Chawla S L , Connolly V M , Kelly W F , Bilous R W 
Published: July 2002

Abstract
A 61 year old hypertensive woman presented in 1986 with a right scapular chondrosarcoma. She developed type 1 diabetes mellitus in 1991 and suffered a stroke in 1991. Chest radiography showed pulmonary metastases in 1997. Further radiological staging detected a right sided phaeochromocytoma, which was subsequently removed in 1998. Before this, repeated urine estimations of vanillylmandelic acid had been normal. Her diabetes was cured by adrenalectomy. It is believed that the combination of phaeochromocytoma and extrapulmonary chondrosarcoma represents a new variant of Carney's triad.
Adrenal mass in a diabetic with hypergastrinaemia
Authors: Elasha H M S , Devendra D , Travis S , Wilkins D , Newman P , Wilkin T J 
Published: July 2002

Abstract
A 50 year old man originally presented in 1980 at the age of 31 with diarrhoea, weight loss, and abdominal pain. He was initially treated with steroids for presumed inflammatory bowel disease. About a month later he presented with severe abdominal pain, and a laparotomy revealed multiple jejunal perforations and a possible mass in the head of the pancreas. He made a good recovery during which time a nasogastric tube was in place for two weeks. A markedly raised serum gastrin level confirmed the diagnosis of Zohlinger-Ellison syndrome. Other gut hormone levels were normal. A parathyroid adenoma was suspected on account of raised calcium and parathyroid hormone levels.
Adult intussusception—an elusive diagnosis
Authors: Sotheran W J , Wise M H 
Published: July 2002

Abstract
An 81 year old woman presented, as an emergency, with a two day history of abdominal pain. The pain was intermittent and confined to the right upper quadrant. She had no other symptoms and normally enjoyed good health. Examination revealed tenderness in the right hypochondrium. Investigations revealed a mildly raised serum alkaline phosphatase. All other haematological and biochemical parameters were within normal limits. A provisional diagnosis of biliary colic was made.
A state of confusion
Authors: Sofat N , Higgens C S 
Published: July 2002

Abstract
A 66 year old right handed man was admitted via the accident and emergency department with confusion and weakness. His wife gave most of the history, saying he had not been able to express himself clearly for the last day and looked weak. He had no history of ischaemic heart disease, hypertension, hypercholesterolaemia, diabetes mellitus, or previous strokes. He smoked 10 cigarettes a day and drank alcohol only socially. He had been diagnosed with rheumatoid arthritis 20 years before. His drug history included diclofenac. On examination, the admitting doctor found that he had an expressive dysphasia and a right hemiparesis. He had a blood pressure of 140/70 mm Hg, pulse 80 beats/min and regular, both first and second heart sounds present with no added sounds and his chest was clear. His abdomen was soft and non-tender with no organomegaly. He had bilateral metacarpophalangeal joint swelling in his hands with ulnar deviation. On further neurological assessment he had an upper motor neurone right facial nerve palsy and the rest of his cranial nerves were normal. In his limbs, in addition to the right hemiparesis, he also had an ulnar nerve palsy in his left hand.
Fever with pain in bilateral shoulder joints
Authors: Kapoor S , Mehtani A , Batra S 
Published: July 2002

Abstract
A 15 year old male presented with a history of moderate fever with pain and limitation of movement of both shoulder joints for three weeks. On clinical examination the patient was febrile (100°F) and there was tenderness around the shoulder and proximal half of his upper arm on both sides. There was periarticular muscle spasm but no signs of any collection. There was restriction of both active and passive movements. There were no other significant findings.
Education and training in internal medicine in Europe
Authors: Hillen H F P 
Published: July 2002

Abstract
Sir William Osler was the Regius Professor of Medicine in Oxford at the end of World War I. In those days there was a great demand for postgraduate medical education. This was the motive for the foundation of the Fellowship of Postgraduate Medicine, under the presidency of William Osler. Osler himself had received his postgraduate education in Europe, from 1872 to 1874, during a two year sabbatical leave in teaching clinics in Germany. It was during this period that internal medicine was introduced as a specialty in the schools of medicine in Berlin, Göttingen, and Vienna.1 Postgraduate education in these clinics was directed at the practice of clinical medicine and was based on the latest advances in physiology, bacteriology, and pathology. The switch from mere observation to understanding had been made.
Visual disturbances and weight gain
Authors: Sharma S , Granot R , Thomas N , Wilcsek G A , White C , Fitzsimons R , Tidmarsh J , Tuch B E 
Published: July 2002

Abstract
A 51 year old man presented with a two year history of gradually deteriorating vision in his left eye, accompanied by 34 kg weight gain, easy bruising, and hypertension which was relatively resistant to conventional treatment. The patient denied any history of headaches. On examination, his general appearance was as shown (fig 1). On ocular examination his visual acuity was 6/6 in the right and 6/12 in the left eye. A left relative afferent pupillary defect was present and fundoscopically there was left optic nerve atrophy. Numerous investigations were performed, including Humphrey's field analysis (fig 2), and a cerebral magnetic resonance imaging (MRI) scan (fig 3). Eye positions on left lateral gaze were as shown (fig 4).
Diabetes and rapidly advancing pneumonia
Authors: Bhansali A , Suresh V , Chaudhry D , Vaiphei K , Dash R J , Kotwal N 
Published: July 2002

Abstract
A 20 year man, who was known to have had type 1 diabetes for the past one year, had high grade fever with chills and rigors, and cough with expectoration for 15 days. He was admitted with epigastric pain, vomiting, and tachypnoea after not taking insulin for four days before admission.
Autoamputation of the tongue
Authors: Pantanowitz L 
Published: July 2002

Abstract
Editor,—The case published by Patel et al recently of autoamputation of the tongue is an unusual life threatening incident worthy of reporting.1 However, the authors' statement that such an occurrence has never before been reported is inaccurate. At least five cases of autoamputation of the tongue have been reported in the English literature.2, 3, 4, 5, 6 I had previously been involved in reporting a case of tongue autoamputation in a mentally retarded patient after a flupenthixol injection.2 Self mutilation in this case was secondary to neuroleptic induced acute atypical orolingual dyskinesia. Bizarre and sporadic oral self injurious acts resulting in traumatic glossectomy have been known to occur among psychotic patients.3 Amputation of the tongue has also been documented after a motor vehicle accident, in which the unrestrained passenger was forced to bite down on his tongue with enough force to amputate a segment.4 Furthermore, self inflicted amputation of the tongue has been noted by other authors to cause macroglossia that compromised the upper airway, as well as result in life threatening secondary infections.5 6 Finally, serious oral self mutilation may be a rare pathological behavioural pattern that is observed in various neurological conditions such as encephalitis, coma, cerebral palsy, autism, mental retardation, seizures, as well as familial dysautonomia, Lesch-Nyhan syndrome, Tourette's syndrome, and the Cornelia de Lange syndrome.2 Clinicians should be aware of these possible underlying conditions when they are confronted with a patient presenting with such unusual self inflicted oral injuries.
Sleep deprivation and junior doctors’ performance and confidence
Authors: Lewis K E , Blagrove M , Ebden P 
Published: July 2002

Abstract

Purpose of study
To determine whether sleep deprivation affects not only junior doctors’ performance in answering medical questions but whether their ability to judge their own performance is also affected by lack of sleep.

Methods
A questionnaire based follow up study in two district general hospitals of the Carmarthenshire NHS Trust. Eleven house officers and 15 senior house officers (SHOs) within the medical directorate participating in the on-call rota were recruited between July 1999 and May 2000.

Results
SHOs answered significantly more questions correctly (p=0.04) and were more confident than house officers when they were either correct or incorrect (p&lt;0.001). Length of unbroken or continuous sleep is associated with more correct answers (p=0.03) and higher energy (p=0.09) and confidence (p=0.07) scores self rated by the profile of mood states. Length of continuous sleep was not related to the appropriateness of confidence, as measured by the “within-subject confidence-accuracy correlation” (p=0.919).

Conclusions
SHOs performed better than house officers even allowing for sleep loss. Sleep deprivation had adverse effects on mood and performance but junior doctors can still monitor their performance and retain insight into their own ability when sleep deprived.
Integrated care pathways for vascular surgery: an analysis of the first 18 months
Authors: Sweeney A B , Flora H S , Chaloner E J , Buckland J , Morrice C , Barker S G E 
Published: July 2002

Abstract

Objectives
A review of the use of previously described integrated care pathways (ICPs) established for three elective vascular surgical procedures.

Design
A retrospective analysis of information gathered prospectively over an initial 18 month period of use of vascular surgical ICPs.

Subjects
Patients admitted to a single vascular unit for “open” repair of abdominal aortic aneurysm (AAA), carotid endarterectomy, or femoropopliteal bypass grafting.

Methods
An analysis of variance data, length of stay, and costings after the use of ICPs, compared with previous clinical practice.

Results
Variance data were gathered for each of the three procedures. Variances of medication prescribing and delays in discharge were common to all procedures. In particular: (i) gastrointestinal complications were more specific to AAA repair and (ii) wound drains were removed a day later than originally proposed after femoropopliteal bypass. Overall, improved efficiency due to use of ICPs reduced the length of stay for all procedures, which was reflected in a potential cost saving of some 25%.

Conclusion
There are clear benefits to the use of ICPs, resulting in more structured, efficient, and cost effective patient care. Recommended changes to current practice based on variance analysis will require continued audit to sustain this “evidence based” approach.
Comparison of the nicotine content of tobacco used in bidis and conventional cigarettes
Authors: Malson Jennifer L , Sims Kristi , Murty Ram , Pickworth Wallace B 
Published: July 2002

OBJECTIVETo compare the nicotine content of 12 unfiltered brands of bidi cigarettes (hand rolled cigarettes imported from India) with 8 popular brands of filtered and unfiltered US and conventional cigarettes from India.MAIN OUTCOME MEASURESIdentical laboratory procedures were used to determine nicotine content (in duplicate) and physical characteristics.RESULTSThe nicotine concentration in the tobacco of bidi cigarettes (21.2 mg/g) was significantly greater than the tobacco from the commercial filtered (16.3 mg/g) and unfiltered cigarettes (13.5 mg/g).CONCLUSIONSBidi cigarettes contain higher concentrations of nicotine than conventional cigarettes. Therefore, it is logical to presume that bidi smokers are at risk of becoming nicotine dependent. These findings belie a popular belief among US teens that bidis are a safe alternative to commercial cigarettes.
BEYOND STRONG SUBADDITIVITY? IMPROVED BOUNDS ON THE CONTRACTION OF GENERALIZED RELATIVE ENTROPY
Authors: RUSKAI MARY BETH 
Published: July 2002

New bounds are given on the contraction of certain generalized forms of the relative entropy of two positive semi-definite operators under completely positive mappings. In addition, several conjectures are presented, one of which would give a strengthening of strong subadditivity. As an application of these bounds in the classical discrete case, a new proof of 2-point logarithmic Sobolev inequalities is presented in an Appendix.
PWM Flow Rate Control of ER Valve and its Application to ER Actuator Control
Authors: Nakano Masami , Minagawa Shuji , Hagino Katsuya 
Published: July 2002

The PWM (Pulse Width Modulation) control of ER valve consisting of two parallel electrodes has been investigated to continuously control the flow rate of an electrorheological (ER) suspension containing sulfonated polymer particles in silicone oil. PWM wave voltages are applied to the electrodes of the ER valve. It is possible to control continuously the flow rate by changing the duty ratio of the PWM wave from 1 to 0, where the duty ratio of 1 corresponds to the state to stop the flow. A miniature bellows actuator driven by a pair of PWM controlled ER valves has been developed, and the control characteristics of the actuator have been investigated. The duty ratios of both ER valves have been proposed to be changed alternately in proportion to the control voltage V to control the flow rate into and out of the bellows chamber, and also an overlap duty ratio D ov at V=0V has been introduced. The introduction of the overlap duty ratio D ov was found to be very important to smoothly control the actuator and to improve the control performance.