bluuebunny/crossref_metadata_2025_split huggingface dataset:
Training of Village Health Workers in Tanzania; a Comparison of Two Approaches
Authors: Mayombana C , Jenkins J , de Savigny D , Tayari S , Lubomba G , Burnier E , Tanner M 
Published: January 2017

The paper compares the costs of training for two groups of Village Health Workers (VHWs) Tanzania, where the policy of developing a system based on Primary Health Care principles will require the training of more than 16 000 VHWs during the next decade. In the Kilombero District, one group of VHWs was trained according to the guidelines of the National Programme of the Ministry of Health, and another group followed the training programme of the Kilombero Project, based on the Swiss Tropical Institute Field Laboratory. The training scheme of the Kilombero project cost almost 80070 less for one VHW, largely because it depended on on-the-spot training by local staff. The results of a first investigation of the efficacy of the training were encouraging; a longterm evaluation is in progress. The curricula for the two programmes also differed; the Kilombero programme had shorter blocks of theory, interspersed with supervised practical work, and introduced curative medicine earlier in the course. The advantages and disadvantages of the two programmes are discussed, not only in terms of cost but also in terms of their efficacy in training VHWs who will be motivated, efficient and accepted by the community.
Introduction of a Simplified round Partogram in Rural Maternity Units: Seno Province, Burkina Faso, West-Africa
Authors: Wacker J , Utz B , Kyelem D , Lankoande J , Bastert G 
Published: January 2017

After a 3-day seminar on the utilization of a rectangular World Health Organization (WHO) version of the partogram and the round partogram, both versions were used under supervision in the maternity rooms of the Seno province, Burkina Faso, West-Africa, for 3 months. After this period a semi-standardized questionnaire was distributed among the partogram users. Using the round partogram with a plastic dial (dilatation indicator for the assessment of labour — DIAL), the two most common errors in the utilization of the rectangular partogram, incorrect recording at the initial examination and at the transition from latent to active phase, were largely avoided. Although the partogram was used in only 46.6% of all deliveries at the health unit level, 86% of the maternity staff using the partograms preferred the round partogram because of its time-saving and user-friendly qualities. Eighty-six per cent of its users felt that by starting the alert- and action-lines at a point later than that in the WHO partogram they would be able to avoid transferring patients unnecessarily. The wide acceptance of the simplified round partogram among the peripheral health units surveyed shows that the partogram would be an attractive tool for its users when it is made easy to use and a useful indicator for determining whether a patient transfer is necessary.
Dietary Supplement Labeling: Cognitive Biases, Market Manipulation & Consumer Choice
Authors: McCann Michael A. 
Published: January 2017

There exists increasing concern that the Dietary Supplements Health and Education Act (“DSHEA”) has proven ineffective and perhaps counterproductive. Most illustratively, consider a recent and remarkably candid remark from Tommy Thompson, then Secretary of Health and Human Services: “I really think Congress should take a look at the food supplement law again.It doesn't make any sense to me.”A health law that makes no sense to the Secretary of Health of Health and Human Services should certainly draw the attention of academics and policy-makers alike. Much of the debate concerning DSHEA regards the disparity in legislative treatment between dietary supplements, foods, and pharmaceutical drugs. Specifically, while pharmaceutical drugs must undergo years of costly pre-market testing, most dietary supplements—like most foods—can immediately enter the market, and only after repeated instances of adverse reactions can the Food and Drug Administration (“FDA”) remove them.
Towards a New Moral Paradigm in Health Care Delivery: Accounting for Individuals
Authors: Katz Meir 
Published: January 2017

For years, commentators have debated how to most appropriately allocate scarce medical resources over large populations. In this paper, I abstract the major rationing schema into three general approaches: rationing by price, quantity, and prioritization. Each has both normative appeal and considerable weakness. After exploring them, I present what some commentators have termed the “moral paradigm” as an alternative to broader philosophies designed to encapsulate the universe of options available to allocators (often termed the market, professional, and political paradigms). While not itself an abstraction of any specific viable rationing scheme, it provides a strong basis for the development of a new scheme that offers considerable moral and political appeal often absent from traditionally employed rationing schema.As I explain, the moral paradigm, in its strong, absolute, and uncompromising version, is economically untenable. This paper articulates a modified version of the moral paradigm that is pluralist in nature rather than absolute. It appeals to the moral, emotional, and irrational sensibilities of each individual person. The moral paradigm, so articulated, can complement any health care delivery system that policy-makers adopt. It functions by granting individuals the ability to appeal to an administrative adjudicatory board designated for this purpose. The adjudicatory board would have the expertise and power to act in response to the complaints of individual aggrieved patients, including those complaints that stem from the moral, religious, ethical, emotional, irrational, or other subjective positions of the patient, and would have plenary power to affirm the denial of access to medical care or to mandate the provision of such care. The board must be designed to facilitate its intended function while creating structural limitations on abuse of power and other excess. I make some specific suggestions on matters of structure and function in the hope of demonstrating both that this adjudicatory model can function and that it can do so immediately, regardless of the underlying health care delivery system or its theoretical underpinnings.
Cryosurgery for the Urethral Syndrome
Authors: Boreham Peter 
Published: January 2017

A technique is described for treating the urethral syndrome in ambulant women by cryosurgery under local anaesthesia using a specially devised guard or applicator. This follows a trial study (Parkes & Boreham 1980) in which a modified guard was used. Experience with over 350 cases and detailed follow up of 111 of them has confirmed improvement in 95% (93 of 111). No patient was made worse, only 10 required second treatments and the majority, when asked, said they thought the treatment was of value and that they would be prepared to have the same treatment again if necessary. This is a simple, safe and harmless technique for the treatment of the female urethral syndrome. It can be carried out under local anaesthesia as an outpatient or under general anaesthesia following cystoscopy. It causes few complications and relieves the symptoms in the majority of such patients.
Aneurysms of the Abdominal Aorta: A 20-Year Study
Authors: Bowers Dorrance , Cave William S 
Published: January 2017

One hundred and eighty-eight patients in whom the diagnosis of aneurysm of the abdominal aorta (AAA) was established after 1 January 1960 were followed until their deaths or to 31 December 1979. By the actuarial method, the cumulative 5-year risk of an intact aneurysm progressing to rupture was 35%; the observed 5-year survival rate for patients who had medical management for intact AAA was 33%, for patients who had elective surgery for AAA 74%, for patients who had emergency surgery for ruptured AAA 35%, and for those who did not have surgery for ruptured AAA 0%. Comparison of the non-operated and electively-operated groups of patients showed that the former was disproportionately weighted with older higher-risk patients, suggesting that the difference in survival rates for the two groups might be a reflection of patient selection rather than of surgical intervention. Comparison of the cumulative 5-year risk of rupture of an intact AAA with the cumulative 5-year mortality rate associated with elective surgery for intact AAA showed that elective surgery for intact AAA might be expected to result in a reduction in the cumulative 5-year mortality rates of patients with intact AAA.
Achalasia following Gastro-Oesophageal Reflux
Authors: Smart H L , Mayberry J F , Atkinson M 
Published: January 2017

Five patients initially presenting with symptomatic gastro-oesophageal reflux, proven by radiology or pH monitoring, subsequently developed achalasia, confirmed by radiology and manometry, after an interval of 2–10 years. During this period dysphagia, present as a mild and intermittent symptom accompanying the initial reflux in 3 of the 5, became severe and resulted in oesophageal stasis of food in all. Three of the 5 had a demonstrable hiatal hernia. In none was reflux a troublesome symptom after Rider-Moeller dilatation or cardiomyotomy undertaken for the achalasia. Gastro-oesophageal reflux does not protect against the subsequent development of achalasia. It is suggested that the autonomic damage eventually leading to achalasia may in its initial phases cause gastro-oesophageal reflux.
Pericardial Effusion Complicating Breast Cancer
Authors: Woll Penella J , Knight R K , Rubens R D 
Published: January 2017

Thirty-five patients with metastatic breast cancer and pericardial effusions are described. They were treated with specific endocrine or chemotherapy. Twenty-two (63%) had presented in cardiac tamponade and were rapidly relieved by pericardiocentesis. Eighteen (82%) of these required no further local treatment, 2 obtained relief from a second aspiration and 2 needed additional treatment (intrapericardial bleomycin instillation and surgical pleuropericardial window). The median survival was 13.2 months. No patient relapsed again in the pericardium, suggesting that their prognosis was that of the underlying disease. Cardiac tamponade should be considered in any breathless patient with malignancy. In breast cancer, pericardiocentesis is lifesaving and systemic treatment can usefully prolong life.
The Management of Symptoms in Advanced Cancer: Experience in a Hospital-Based Continuing Care Unit
Authors: Hoskin P J , Hanks G W 
Published: January 2017

The treatment received by 158 patients with advanced cancer admitted over one year to the Continuing Care Unit at the Royal Marsden Hospital has been reviewed. The unit is an integral part of the hospital and this is reflected in the fact that 46 patients (29%) received radiotherapy, hormone therapy, chemotherapy or surgery in addition to symptomatic treatment for palliation of troublesome symptoms. One hundred and thirty-one patients received oral morphine in doses ranging from 2.5 mg 4-hourly to 700 mg 4-hourly. Patients with renal or hepatic impairment required lower doses of morphine and there was a highly significant inverse relationship between morphine dose and age. Eighty-five patients (54%) received parenteral diamorphine at some time due to their inability to take oral morphine. One hundred and twenty-three patients (78%) received a co-analgesic drug and anti-emetics were required by 78 patients (49% overall; 56% of those receiving morphine). Transcutaneous electrical nerve stimulation, acupuncture and relaxation were employed in selected patients, and graduated compression sleeves were used to treat lymphoedema. These data highlight the wide range of therapeutic options available to control the symptoms of advanced cancer and also indicate that tumoricidal treatments used in conjunction with symptomatic treatments may have a significant part to play.
Magnetic Resonance Imaging of the Nose and Paranasal Sinuses
Authors: Lloyd G A S 
Published: January 2017

Seventy-five patients with a wide range of sinus disease have been investigated by magnetic resonance (MR): these included congenital conditions, allergic and inflammatory sinus disease, fungus infections, and the necrotizing granulomata. In addition, a variety of benign and malignant tumours have been examined, and in the more recent sinus malignancies the paramagnetic contrast agent, Gadolinium (Gd) DTPA (Schering Health Care) has been used. This experience of magnetic resonance scanning has shown that it is superior to computed tomography in demonstrating the extent of malignant disease in the nose and sinuses; most especially when Gd DTPA is used, reaching an accuracy of over 96% by biopsy correlation. An additional advantage of this technique is the wide coverage of the head and neck for the assessment of malignant disease, provided by direct 3 plane imaging and the multislice facility. The main disadvantage of magnetic resonance of the sinuses is the poor demonstration of calcification and bone. For this reason the MR scans may need to be augmented by high resolution CT performed specifically to show bone detail.
Road Traffic Accidents before and after Seatbelt Legislation-Study in a District General Hospital
Authors: Thomas J 
Published: January 2017

Injuries among samples of car accident cases attending the Accident & Emergency (A & E) department of a District General Hospital (DGH) in the year before and after the introduction of seat belt legislation were classified applying the Abbreviated Injury Scale using information recorded in the patient case notes. Those who died or did not attend an A & E department were not included in the sampling frame. The number of those who escaped injury increased by 40% and those with mild and moderate injuries decreased by 35% after seatbelt legislation. There was a significant reduction in soft tissue injuries to the head. Only whiplash injuries to the neck showed a significant increase.
Day-Case Surgery: A Viable Alternative for Surgical Treatment of Varicose Veins
Authors: Berridge D.C. , Makin G.S. 
Published: January 2017

One hundred and forty-eight patients (164 limbs) who had varicose vein surgery by the same consultant surgeon 3–10 years previously were reviewed; 61 patients had surgery as an in-patient and 87 as a day-case. The patients were reviewed to assess the efficacy and acceptability of day-case varicose vein surgery. There were no significant differences between the age and sex ratios of the patients. However, twice as many operations in the in-patient group included stripping of the long saphenous vein above the knee (χ2 = 4.2, P = 0.04). Fifteen in-patients had bilateral vein surgery as opposed to only one day-case patient. Fifteen patients suffered complications most of which were minor and were evenly distributed including wound infections (nine), reactionary haemorrhage/haematoma (four), deep vein thrombosis (one) and pulmonary embolus (one). The convalescent period before returning to work was similar in the two groups (U= 953, P= 0.28). The mean duration of stay for the in-patients was 3.9 ± 2.2 days. There was no significant difference in the period off work (day-case: 3.6 ± 2.0 weeks; in-patient: 4 ± 2.9 weeks), or in the length of follow-up (day-case: 6.01 ± 1.24 years; in-patient: 6.79 ± 1.71 years). In the period before review 11 patients in the in-patient group and 13 patients in the day-case group had further surgery or sclerotherapy for recurrent symptomatic varicose veins. At review five patients in the in-patient group and six patients in the day-case group had recurrent sapheno-femoral incompetence (χ2 = 0.1, P = 0.7). A total of 34 patients in both groups had recurrent varicose veins. Only four (4.6%) of the day-case patients expressed a preference for in-patient treatment if they were to have further surgery and 21 (34%) of the in-patient group would prefer day-case surgery. Day-case varicose vein surgery has not been shown to be inferior in terms of complications or recurrence rate. Patient acceptability is good and it is a viable alternative to in-patient treatment in suitable patients in areas with adequate district nurse facilities.
Acceptability and Safety of Out-Patient Sapheno-Femoral Ligation under Local Anaesthesia. A Report of 100 Consecutive Cases
Authors: Sugrue Michael , Mehigan Denis , Hederman William P. 
Published: January 2017

The results of 100 consecutive Trendelenberg groin ligations performed during an 8-month period on 85 patients were assessed. Surgery was performed on an out-patient basis by one surgeon (M.S.) under local anaesthesia. All patients were recalled for review. Mean follow-up time was 4 months. Operative pain was severe in two patients, moderate in 16, mild in 26 and absent in 56. Postoperative pain was severe in nine patients, moderate in 22, mild in 34 and absent in 55. There was one infection, one haematoma, and one acute haemorrhage needing re-operation. The average number of work days lost was four. There was no evidence of recurrent sapheno-femoral incompetence. Eighty of the 85 patients felt they had obtained a good result from the operation, and only three patients would not have undergone the operation again. We conclude that out-patient sapheno-femoral ligation under local anaesthesia is acceptable to patients and has low morbidity.
Results of Femoro-Femoral Vein Bypass Grafting with Temporary Arteriovenous Fistula for Femoro-Iliac Venous Thrombosis: Differences between Operations in the Acute and Chronic Phases
Authors: Ijima Hiroshi , Hirabayashi Kunihiko , Sakakibara Yuzura , Tsutsui Tatsuo , Mitsui Toshio , Hori Motokazu 
Published: January 2017

Femoro-femoral vein bypass operation using a synthetic vascular graft with simultaneous construction of a temporary arteriovenous fistula (A-V f.) was performed in eight patients with acute femoro-iliac venous thrombosis after successful femoral thrombectomy but unsuccessful iliac thrombectomy; this operation was also performed in one patient with subacute thrombosis of the iliac vein and three patients with femoro-iliac post-phlebitic syndrome. Of the first nine patients who underwent the operation in the acute or subacute phase of the disease, the synthetic vascular grafts remained patent after closure of the A-V f. in six (66.7%), and no recurrence of symptoms was observed in any of the nine, including those in whom the graft was occluded. However, the graft remained patent in only one (33.3%) of the three patients who underwent the operation in the chronic phase and no improvement in symptoms was observed in the patients with occluded grafts. These differences in the results of bypass grafting are considered to be due to differences in the development of pelvic venous collaterals. The indications for this operation should be evaluated after close examination of the state of collateral vasculature.
Association between the Results of Foot Volumetry and Superficial and Deep Venous Incompetence as Demonstrated by Duplex Ultrasonography
Authors: Bradbury A. W. , Stonebridge P. A. , Callam M. J. , Ruckley C. V. , Allan P. L. 
Published: January 2017

Objective: To examine the association between superficial and deep vein incompetence demonstrated by duplex ultrasonography and the results of foot volumetry. Design: Duplex ultrasonography was used to detect superficial and deep venous incompetence. Foot volumetry was used to determine expulsion fraction (expelled volume/total foot volume, EF, %) and half-refilling time (HRT, seconds). Setting: Hospital outpatients attending the Royal Infirmary of Edinburgh. Patients: Forty-three patients with venous ulcer disease. Results: EF, obtained with tourniquet occlusion of superficial veins, in patients without deep vein incompetence was not significantly different from EF in patients with either femoral vein incompetence (FVI), popliteal vein incompetence (PVI) or both. HRT in patients without deep vein incompetence was significantly higher than HRT in patients with FVI ( p < 0.02), PVI ( p < 0.01) and both FVI and PVI ( p < 0.03, Wilcoxon signed rank test). EF and HRT values obtained without tourniquet occlusion were unrelated to the presence or absence of deep vein incompetence. There was no relationship between the results of foot volumetry and superficial vein incompetence. Conclusions: The results of foot volumetry are related to deep, but not superficial, venous incompetence as demonstrated by duplex ultrasonography.
Topographical Structural Variations of the Human Long Saphenous Vein and its Age-Related Remodelling as Revealed by Correlated Light and Scanning Electron Microscopy
Authors: Caggiati A. , Macchiarelli G. , Familiari G. 
Published: January 2017

Objective: To study topographical variations of the healthy human long saphenous vein structure and its age-related changes. Methods: One hundred and forty-four specimens taken at different levels from 36 long saphenous veins were studied by correlated light microscopy and scanning electron microscopy. Results: Continuous remodelling occurs in the wall of the long saphenous vein during the progress of life. In young subjects, the intima was narrow, circular muscular cells were present only in the media, and a rich elastic framework was evident in all the three tunicae. A progressive increase in collagen content and longitudinal musculature accompanied by a reduction in elastic tissue was observed in relation to ageing. Furthermore, at all ages, the saphenous vein wall thickened in its caudal portion due to a greater cellular proliferation and deposit of extracellular matrix. Conclusions: The topographical variations in saphenous wall structure as well as its age-related remodelling likely represent the parietal reaction to the physiological hydrostatic load related to the vertical pasture.
Skin Reactions Due to Antiepileptic Drugs: Several Case-Reports with Long-Term Follow-up
Authors: Feliciani C. , Verrotti A. , Coscione G. , Toto P. , Morelli F. , Di Benedetto A. , Salladini C. , Chiarelli F. , Tulli A. 
Published: January 2017

In this study, the clinical findings and management of allergic skin reactions induced by the most used antiepileptic drugs, Lamotrigine (LMT) and Carbamazepine (CBZ), were evaluated. Lamotrigine is an antiepileptic drug recently released in several countries; it is effective for a variety of seizure types in adults and children, both as an add-on agent and in monotherapy, and it is generally well tolerated. Clinical and epidemiologic evidence suggest serious cutaneous reactions to antiepileptic drugs are more likely to occur during the first 8 weeks and they appear to increase when drugs are administered with other anticonvulsants, such as valproate (VPA). We selected 10 patients who presented an idiosyncratic skin rash when treated with carbamazepine (8 patients) and lamotrigine (2 patients) administered as monotherapy, and we followed up on these patients for several years. Seven reactions were mild/severe cutaneous eruptions; one Toxic Epidermal Necrolysis, a case of Stevens-Johnson and a case of Hypersensitivity Syndrome. All severe skin drug reactions were induced by Carbamazepine. In five patients the AEDs were ceased abruptly (sometimes with the administration of a different molecule), tapered in four and continued unchanged in one. We conclude that the discontinuation of the drug with substitution with another is the most effective treatment and that corticosteroids are helpful in mild cutaneous reactions, while in severe skin reactions, such as Toxic Epidermal Necrolysis, corticosteroids are only a complementary therapy since intravenous immunoglobulins are the first choice treatment.