bluuebunny/crossref_metadata_2025_split huggingface dataset:
Hospital Days in Risperidone-Treated Patients
Authors: Dickson Ruth A , Dalby J Thomas , Addington Donald , Williams Richard , McDougall Gerald M 
Published: January 2017

Objective: To compare inpatient hospital days of a group of “real world” schizophrenia-spectrum patients for 3 years prior to and 3 years after risperidone initiation. Method: This is a retrospective cohort study using a mirror-image design of hospital days in 120 patients over a 6-year period. Hospital admission and discharge information was obtained from chart review and database extraction at 3 outpatient treatment sites. The sample comprised all patients attending these clinics who were prescribed risperidone during the first year of the drug's release. Results: Patients separated into 3 treatment groups: those who were prescribed risperidone for 3 uninterrupted years (N = 35), those who interrupted but resumed risperidone use and were prescribed the drug at 3 years (N = 8), and those who discontinued risperidone during the 3-year follow-up period (N = 77). The group continuing risperidone to 3 years demonstrated a significant decrease in hospital days after risperidone treatment, in contrast to the other 2 groups. The reduction in inpatient days for the total sample was not statistically significant. Conclusion: In this outpatient clinic sample, the 29% of patients who continued on risperidone showed a significant reduction in inpatient hospital days, from an average of 17.2 days per year in the 3 years before risperidone treatment to an average of 2.1 days per year for the 3 years of risperidone treatment.
Cognitive Decline, Body Mass Index, and Waist Circumference in Community-Dwelling Elderly Participants
Authors: Rodríguez-Fernández Jorge Mario , Danies Emily , Martínez-Ortega José , Chen William C. 
Published: January 2017

Objective: The aim of this study was to explore the association of body mass index (BMI), waist circumference (WC), and BMI and WC changes over time with cognitive decline in a nationally representative sample. Methods: A total of 5239 participants (≥65 years) were followed for 3 years as part of the National Health and Aging Trends Study. Cox proportional hazard regression was applied to model the risk of cognitive decline. Results: BMI, after adjusting for WC and main confounders, was associated with reduced risk of cognitive decline (hazard ratio [HR] 0.97 for each unit BMI increase, 0.95-0.99). After stratifying by gender and age, this effect remained significant among females and young elders ≤80 years. A BMI decrease and WC increase >10% over the study period were associated with increased risk of cognitive decline (HR 1.98, 1.16-3.38; HR 1.30, 1.04-1.62, respectively). Conclusion: In the elderly individuals, lean mass, as measured by BMI adjusted for WC, was associated with reduced risk of cognitive decline. Loss of lean mass and gain of fat mass, as measured by WC adjusted for BMI, were associated with elevated risk of cognitive decline.
The Use of ‘Expectation Enactment’ as a Conceptual Framework for Assessing Managerial Effectiveness: An NHS Hospital Trust Example
Authors: Willcocks S. 
Published: January 2017

This paper examines managerial effectiveness in the National Health Service, utilizing a conceptual framework devised by Fondas and Stewart (1994) which focuses upon the concept of ‘expectation enactment’. The conceptual framework is applied to a National Health Service trust; more specifically, it is used to examine the managerial effectiveness of clinical managers at this trust. The data for this paper is derived from a larger qualitative study of three NHS case studies. The data was collected from a series of in-depth interviews with clinical managers and general managers. In one of these case studies, part of the analysis was undertaken utilizing concepts put forward by Fondas and Stewart (1994). These will form the basis of this paper.
Heterosexually Acquired Human Immunodeficiency Virus Infection in Women in Copenhagen: Sexual Behaviour and other Risk Factors
Authors: Smith E , Kroon S , Gerstoft J , Kvinesdal B , Mathiesen L R 
Published: January 2017

In order to describe the risk pattern including sexual behaviour among HIV-infected women in Copenhagen we studied the charts of all women tested seropositive between January 1985 and August 1988 in the three main hospitals handling HIV/AIDS. One hundred and fifteen women were positive for HIV antibodies: 35 (31%) were infected by heterosexual contact and 63 (55%) were intravenous drug users. Among the heterosexually transmitted cases 25 (71%) had intercourse with a man from a high risk group and nine women had intercourse with a known HIV antibody positive man without known risk factors. Use of condoms was claimed by 31% of the heterosexually-transmitted women before the HIV test, and by 74% ( P=0.002) after the test. In 1988 73% of the women tested HIV positive were infected by heterosexual contact, in 1985 only 14%. We conclude that among HIV infected women in Copenhagen heterosexual transmission is a problem. These women seem to change sexual behaviour when informed about HIV positivity.
Single-Dose Therapy of Anogenital and Pharyngeal Gonorrhoea with Ciprofloxacin
Authors: Balachandran T , Roberts A P , Evans B A , Azadian B S 
Published: January 2017

A single dose of ciprofloxacin, 250 mg by mouth, was used in an open study to treat pharyngeal or rectal gonorrhoea or both in 64 patients (32 men and 32 women). The study also included 151 men with urethral gonorrhoea and 53 women with cervical or urethral gonorrhoea. Ciprofloxacin cured 63 (98%) patients with pharyngeal or rectal gonorrhoea (including 5 patients with penicillinase-producing Neisseria gonorrhoeae; PPNG), 147 (97%) men with urethral gonorrhoea (including 8 with PPNG) and 52 (98%) women with cervical or urethral gonorrhoea. All the isolates of N. gonorrhoeae were sensitive to 0.03 mg/l of ciprofloxacin. Five of the 6 patients with treatment failure were subsequently cured by a single oral dose of ciprofloxacin 250 mg. None of the patients reported an adverse reaction. Ciprofloxacin 250 mg as a single oral dose is effective and safe in treating patients with pharyngeal or rectal gonorrhoea, including those with PPNG strains.
Female Sexual Health Problems in a Drug Dependency Unit
Authors: Morrison Clive L , Ruben Susan M , Beeching Nick J 
Published: January 2017

The Government of the United Kingdom has produced a strategic plan called the Health of the Nation aimed at achieving better health in key areas including a reduction in rates of unwanted pregnancies, sexually transmitted diseases and cervical cancer. Conventional health care systems fail some groups with special needs. This cross-sectional interview study was undertaken to determine the level and type of contraceptive use, and the attitudes of female opiate abusers to the use and availability of contraceptives and cytology services. The subjects were 201 opiate-dependent women enrolled in a methadone maintenance programme in a large drug dependency unit: 169 (84.5%) were sexually active and 65 (44.2%) of non-pregnant sexually active women did not use a contraceptive method. Thirty-six (43.9%) of those using a contraceptive were using condoms, with which the majority were dissatisfied. Sixty-one (30.3%) had never had a cervical cytology smear and of those who had, 21.4% reported an abnormal result. The contraceptive practices and uptake of cervical screening services by the women studied are inadequate, reflecting poor use of conventional health care services. In addition to providing information on safer sexual practices, particularly promotion of condom use, we suggest that drug dependency units should expand their role to provide educational and preventative services to include aspects of women's health.
Clinical Parameters Associated with Recalcitrant Oral Candidosis in HIV Infection: A Preliminary Study
Authors: McCreary C , Bergin C , Pilkington R , Kelly G , Mulcahy F 
Published: January 2017

Clinical resistance in oropharyngeal candidosis is an increasingly significant management problem in HIV-seropositive patients. This study was undertaken to identify predisposing risk factors including the isolation of particular species of Candida which may be associated with the development of clinical resistance. The effect of particular antifungal prescribing regimens was also assessed. Data were compiled by chart review of 2 groups, each of 10 HIV-seropositive CDC stage IV patients with recurrent oropharyngeal candidosis. All patients had swabs taken at intervals during treatment and all Candida isolates were species typed. The patients in group 1 exhibited Candida infections which did not respond clinically to standard therapeutic regimens. The second patient group did respond to standard oral antifungal therapies. An association was found between the frequent utilization of azoles, particularly fluconazole and the development of clinically resistant oral candidosis. The number of Candida isolates grown from the initial swab was also significantly related to the development of resistance.
Private Costs Associated with Abdominal Aortic Aneurysm Screening: The Importance of Private Travel and Time Costs
Authors: Bryan Stirling , Buxton Martin , McKenna Mike , Ashton Hilary , Scott Alan 
Published: January 2017

Objectives — To assess the importance of the private costs incurred by patients when making a judgment on the economics of screening for abdominal aortic aneurysm (AAA), and to explore the variation in such costs depending on screening location. Setting — A district general hospital and general practitioner surgeries. Methods — Four hundred and ninety nine consecutive subjects attending for AAA screening completed a questionnaire asking about travel arrangements for the journey to and from the clinic, the distance travelled, the time taken, the mode of transport, and any out-of-pocket expenses incurred. In addition, at the clinic each subject was asked what activities they had forgone in attending the clinic. Time was valued differently depending on whether work or leisure activities were forgone. The total private cost for each attender was calculated and comparison was made between attenders at hospital and at general practice. Results — A significantly greater proportion of subjects were accompanied when attending hospital than when attending general practitioner (GP) surgeries. Most attenders travelled by car, but the journey time was significantly longer for those visiting hospital. The expected total private cost associated with attendance for AAA screening was £5.47. Attendance at GP surgeries had a lower private cost (£4.21) than attendance at hospital (£6.87). Only 7·3% of all men surveyed, and 6·5% of all companions, would have been taking part in some form of paid occupation if they had not attended for screening. Conclusion — Despite the fact that most attenders for AAA screening will be retired, the associated private costs are appreciable and should be considered in assessing the economics of such screening programmes. The level of private costs varied depending on the location of screening: clinics held at GP practices had lower private costs than those held at hospital.
Acceptance of Screening for Colorectal Cancer by Flexible Sigmoidoscopy
Authors: Cockburn J , Thomas R J S , McLaughlin S J , Reading D 
Published: January 2017

Objective — To determine the acceptance rate of screening by flexible sigmoidoscopy in a sample of general practice patients aged 50 to 60, and the acceptability of the procedure among those undergoing the test. Setting — Recruitment took place in selected general practices in Melbourne, Australia. Flexible sigmoidoscopies were performed at the local public hospital. Patients and methods — 187 patients aged between SO and 60, and without bowel symptoms, were seen by one of 12 non-randomly selected general practitioners during the study period. At the conclusion of routine consultation general practitioners discussed colorectal screening with eligible patients and recommended that they attend a free screening clinic at the local hospital. The patients who attended the clinic underwent flexible sigmoidoscopy performed by experienced endoscopists. Clinic attenders completed a questionnaire which measured perceptions of the screening visit. Results — The attendance rate was 49%. All clinic attenders were satisfied with the care received at clinic. Sixty five per cent of people experienced either no discomfort or mild discomfort, while 15% of people experienced moderate or severe pain. A bloated feeling was common (80%), with around 36% of people experiencing moderate or extreme bloating. Most people said that they were not at all embarrassed (64%), though 9% reported moderate or extreme embarrassment. Seventeen people (19%) were found to have polyps. Conclusions — Although the procedure was acceptable to those who underwent the screening test, further research on effective recruitment strategies is required if a full scale flexible sigmoidoscopy screening programme is to be considered feasible.
What are Women Told about Pap Smears That Lack Endocervical Cells?
Authors: Schofield Margot J , Byles Julie E , Sanson-Fisher Rob 
Published: January 2017

Background — Debate exists about the definition of what constitutes an adequate Pap smear and about the recommended rescreening interval for Pap smears lacking an endocervical component. This study aimed at determining whether women are currently informed about the endocervical status of their Pap smears and what rescreening recommendations are made to women whose smears lack endocervical cells. Method — Consecutive Pap smears lacking an endocervical component were identified from pathology records. After obtaining consent from the referring doctor, 165 women were interviewed by telephone. Results — Only 110 (67%) of 165 women received active notification of their Pap test result and only six (4%) were aware that their smear lacked endocervical cells. Thirteen (8%) had been advised to have a repeat smear within three months. Nearly half the women reported that they would like more information about their result. Conclusions — It seems that current Pap smear notification patterns for women in New South Wales could be improved. One third are not actively informed at all about their results, and few are given detailed information about their Pap test results. Methods of enhancing the level of information women are given about their medical and screening tests need to be improved.
Characteristics of Subgroups of Attenders and Non-Attenders in an Organised Screening Programme for Cervical Cancer
Authors: Larsen Lars Peter Skovgaard , Olesen Frede 
Published: January 2017

Objective –Several studies have compared attenders and non-attenders in organised cervical screening programmes but few have analysed subgroups of at-tenders and non-attenders. This study presents social and other characteristics of such subgroups. Setting—Aarhus County, Denmark. Methods –A case-control study in a cohort of 133 500 women, aged 23–60, included in the programme from 1 October 1990 to 1 April 1994. The participation rate was 75%, and those taking part comprised women with opportunistic screening or who had had a smear owing to symptoms in the previous three years (“active” attenders), and women who were invited for screening because they had not been otherwise tested (“passive” attenders). “Passive” (n = 708) and “active” attenders (n = 692) were compared. Women who had never had a smear test (“never” attenders, n = 287) were then compared with “ever” attenders (n = 1215)—that is, women who had not had a smear test during the previous 42 months, but had had at least one previous test. Data were collected by mailed questionnaires. Results –The response rate was 81% and 53% for attenders and non-attenders, respectively. After correction for age, there was no difference between the “active” and “passive” attenders for cancer risk factors (smoking, age of first intercourse, number of sexual partners, and social group), or in the degree of responsibility for close relatives, but “active” attenders seemed to have more frequent contact with their general practitioner. “Never” attenders had less frequent contact with their general practitioner than “ever” attenders. They were more often living alone and nullipara, but had no overrepresentation of cancer risk factors. Conclusions –Increased effect cannot be obtained by focusing on the described groups, but by increasing the participation rate. “Never” attenders do not belong to a special risk group.
Relation between the Incidence of Invasive Cervical Cancer and the Screening Interval: Is a Five Year Interval Too Long?
Authors: Herbert Amanda , Stein K , Bryant T N , Breen Catherine , Old P 
Published: January 2017

Objective –To examine the incidence of invasive cervical cancer per 100 000 women years at risk and relative risk according to screening history among eligible women aged 25–69 in Southampton and South West Hampshire during the three years after completion of the first round of comprehensive screening. Results –There was a significantly higher incidence of invasive cervical cancer in women who had not been screened during the preceding 0.5–5.5 years than in those who had been screened (relative risk (RR) 2.6; 95% confidence interval (CI) 1.6 to 4.3). Among the latter group of women (with interval cancers) there was a significantly higher incidence in those with a long interval of 3.5–5.5 years since their most recent smear than in those with a short interval of 0.5–3.5 years (RR 2.2; 95% CI 1.3 to 3.8). Among women with non-interval cancers, there was a significantly higher incidence among those who had no cytology record than among those who had been screened but were overdue for a smear (RR 3.0; 95% CI 1.2 to 7.3). When screen detected cancers were excluded from the figures the relative risks for all the comparative groups described above were greater, though the 95% confidence limits were wider because the numbers were smaller. The most pronounced difference in incidence was between symptomatic cancers in women with a short screening interval (5.8 per 100 000 women years at risk) and in women with no cytology record (71.3 per 100 000 years at risk). Most cancers were interval cancers (76%) because of the high screening coverage: 89.2% of eligible women aged 25–69 had been screened during the preceding 0.5–5.5 years. The overall incidence per 100 000 women years at risk approached that of interval cancers, and was nearer to that observed in the short than the long interval because 74.7% of women had been screened within 3.5 years. Conclusion –The results confirm the effectiveness of screening but suggest that a five year screening interval may be too long, at least during the early rounds of screening.
A Collaborative Approach to Cervical Cancer Screening
Authors: Brown Wendy J , Byles Julie E 
Published: January 2017

Objectives –The main objective of this project was to evaluate a collaborative nurse and general practitioner approach to improve screening for cervical cancer. Design—Multiple group time series design. Setting –Six postal areas in the Hunter Valley of New South Wales, Australia, chosen as intervention sites because of very low Pap test rates compared with the rest of NSW (fewer than 50% of women screened). Six regions of similar size and with similar baseline screening levels were selected as comparison sites. Subjects—All women selected in the resident postal areas. Interventions –Women's health nurses worked in collaboration with general practitioners within the communities selected from within the Hunter area to prond provide screening for cervical cancer. Main Outcome Measures –Qualitative information on initial expectations and impressions of the collaborative processes were collected at the start of the project period. Process data on client characteristics and Pap test results were obtained from minimum data collections; client satisfaction was assessed from client surveys. Outcome data on the increase in the number of women in each community who were screened for cervical cancer were obtained from Health Insurance Commission claims for screening Pap tests (and from nurses' records where Pap tests were examined under block funding arrangements). Results –This project showed that nurses and general practitioners can collaborate to provide appropriate and highly acceptable cervical cancer screening services for women. Many of the women screened by the nurses were in the high risk age range for cervical cancer (40 years and older) and had only basic education levels, thus representing women who are most likely to have poor screening rates. Further, 33.1% of the women screened had not had a Pap test in the past four years or had never been screened. The number of women having a Pap test during the first six months of the project, compared with the number expected from preintervention patterns, was significantly greater in four intervention areas (P < 0.01). No corresponding increase was seen in comparison areas with similar screening rates at baseline. Conclusions –There is great potential for nurses to work in collaboration with general practitioners to improve the availability and coverage of community cervical cancer screening programmes.
Aerosolized Pentamidine and Pneumocystis Carinii Pneumonia: Patient Compliance and Outcomes
Authors: Bjornson Darrel C. , Oster Charles N. , Cortese Linda M. , Nelson Bruce A. 
Published: January 2017

OBJECTIVE: The study objectives were to compare compliance between every-two-week and every-four-week aerosolized pentamidine regimens, and to determine if patients who were more compliant with the use of aerosolized pentamidine were at decreased risk for developing Pneumocystis carinii pneumonia (PCP). DESIGN: Nonrandomized observational study of patients receiving aerosolized pentamidine for PCP prophylaxis using the hospital pharmacy computer system to document aerosolized pentamidine use and compliance, and the Patient Administration Division's computer to document cases of PCP. SETTING: Tertiary care, US Army medical center. PATIENTS: All patients who were prescribed aerosolized pentamidine (60 mg every two weeks, 300 mg every four weeks, or both) over a 3.5-year period. MAIN OUTCOME MEASURES: Mean percent compliance was determined and compared between every-two-week and every-four-week regimens. The relationship between compliance and cases of PCP was determined using nonparametric statistics. RESULTS: Patients (n=146) who were prescribed aerosolized pentamidine 60 mg every two weeks were more compliant (p=0.006) than those prescribed 300 mg every four weeks. In addition, those patients who initially received the 60-mg regimen and were switched to the 300-mg regimen were more compliant when taking the 60-mg dose (p=0.027). There was no association between compliance with either regimen and cases of PCP. Compliance generally was poor with both regimens. CONCLUSIONS: Patients on every-two-week regimens of aerosolized pentamidine were more compliant than those on every-four-week regimens. However, regardless of compliance, some patients failed aerosolized pentamidine over the 3.5-year period. Other agents that lend themselves to compliance may be more appropriate for PCP prophylaxis than aerosolized pentamidine.