bluuebunny/crossref_metadata_2025_split huggingface dataset:
Trends in Invasive Cervical Cancer Incidence in East Anglia from 1971 to 1993
Authors: Gibson Lorna , Spiegelhalter David J , Camilleri-Ferrante Corinne , Day Nicholas E 
Published: January 2017

Objective— To study the trends in the incidence of invasive cervical cancer in East Anglia. Design— Statistical analysis of age specific incidence rate for the period 1971–93 using East Anglian Cancer Registry data. Subjects— All cases of invasive cervical cancer registered with the East Anglian Cancer registry, diagnosed in the period 1971–93. Main outcome measures— Changing incidence of cervical cancer. Results— For the 20 years 1971–90, trends varied widely by district and by age group, with little discernible overall effect of the increasing screening activity. Since 1990, rates have fallen sharply in the age groups targeted for screening, with a reduction of 34% (95% confidence interval 26% to 42%) from that expected based on 1971–90 trends. This fall was preceded by a rapid rise in the national uptake of screening. A shift to more favourable stage at diagnosis has also occurred. Conclusion— Changes in the organisation and management of the national screening programme introduced in 1988 and 1989 seem to have led to substantial improvements in effectiveness.
“If You Want to Get Somewhere Else, You Must Run at Least Twice as Fast as That!”: The Roots of the East Asian Crisis
Authors: Kaplinsky Raphael 
Published: January 2017

The primary hypothesis in this paper is that most East Asian economies have been following growth trajectories which involve ever-intensifying competition in external product markets. The financial crisis of 1997–98, whilst clearly having roots in the operations of both global and national financial systems, is in large part a reflection of these long-run growth trajectories. This is because the concentration by these economies in commodity-sectors with low barriers to entry has resulted in macro-economic policies which depend for their success on depreciations in real exchange rates. The crisis in 1997–98 reflects a return to these growth-paths after the divergent appreciation of real exchange rates in the early 1990s. Not all Asian economies have followed this path, with Japan, Singapore, Taiwan and perhaps Korea being the exceptions. The analysis is pursued through the calculation of long-run terms of trade and real exchange rates, and through a case-study of the Korean electronics sector.
The challenge of ongoing education in multidisciplinary mental health services
Authors: Fielding John , Walterfang Mark , Dakis Jenepher 
Published: January 2017

Objective: To highlight the issues pertaining to ongoing professional education in multidisciplinary mental health services, and provide a framework in which this can occur. Conclusions: Ongoing education in multidisciplinary mental health services is a worthwhile objective. Clinician diversity, effective staff engagement and costs need to be taken into account when considering the variety of achievable ways a service can facilitate ongoing education for clinical staff.
Consultation-liaison psychiatry hits a midlife crisis
Authors: Macleod Sandy 
Published: January 2017

Objective: To illustrate the crisis affecting consultation-liaison psychiatry and its practitioners. Conclusions: There are several options that may be taken, or have already been taken, to secure a future for this psychiatric subspecialty. The need is apparent, and clinicians are willing, but funders are reluctant. The College's response has been critically important, but psychiatrists also need to develop new work skills and innovative job descriptions to ensure the continuation and future development of psychiatric services to general hospital patients.
Early Psychosis intervention by a community mental health team
Authors: Rowston William 
Published: January 2017

Objective: To describe some of the practical considerations and dilemmas that were faced in setting up an Early Psychosis program in the Noarlunga region of Adelaide, South Australia. Conclusions: The clients had high rates of illicit drug use and forensic problems and experienced rates of rehospitalisation of around 60% over the first two years after registration. It was noteworthy that 19% of admissions occurred within three months of registration. The therapeutic relationship between staff and clients with early psychosis was complex, and the ambivalence noted by clients in satisfying dependence/independence needs in the therapeutic relationship appeared to reflect the influences of illness and life stage development. Collaborative relationships with clients were supported by steps such as feedback from clients, leading to simplification of the content of the psychoeducation program, reduction in written information, and co-facilitation of the group by a client who had undergone a psychotic episode. A change in the venue to a local youth group was well received by clients. However, at other times, clients appeared to seek more direction from staff and possess more basic care needs, particularly when seriously ill. Maslow's ‘Hierarchy of Needs’ offered a useful framework for conceptualising many of these issues. A local community network of agencies was formed, allowing clients to address self-identified needs.
Attitudes of psychiatric inpatients to medical student interviews
Authors: Tunde-Ayinmode Mosunmola , Rajagopalan Mani , Little John 
Published: January 2017

Objective: The aim was to assess the attitudes of psychiatric inpatients to medical student interviews. Method: Psychiatric inpatients' experiences of being interviewed by fourth and fifth year medical students were ascertained through the use of a semi-structured questionnaire. Results: The majority of patients reported a positive interaction with medical students. Conclusion: Psychiatric inpatient involvement in medical student teaching was favourably received by patients in a rural area mental health service setting.
Cecal Vitamin Bezoar Formation Inducing Abdominal Discomfort
Authors: Hunt-Fugate Ann K. , Schmidt Harry J. 
Published: January 2017

OBJECTIVE: To document a case of cecal lecithin-vitamin B12 bezoar formation inducing abdominal discomfort. DESIGN: Case study. SETTING: 500-bed, community teaching hospital PATIENT: 81-year-old man with a history of multiple abdominal surgeries who presented with a chief complaint of abdominal pain. Flat plate X-ray of the abdomen revealed multiple capsule-shaped objects lodged in the cecum. INTERVENTIONS: Catharsis with bisacodyl, magnesium citrate, NaCl 0.9%; dissolution with heated, dilute barium administered rectally in conjunction with external manipulation; laparotomy. MAIN OUTCOME MEASURES: None planned; dissolution or transit of bezoar through gastrointestinal tract desired outcome. RESULTS/DISCUSSION: Classification of bezoars and treatment discussed in relation to this case report. CONCLUSIONS: Medicinal agents have been implicated in bezoar formation. Treatment options have included: cathartics, heated solvent enemas, and external manipulation and surgery.
Itraconazole in Antifungal Therapy
Authors: Cleary John D. , Taylor Jerry W. , Chapman Stanley W. 
Published: January 2017

OBJECTIVE: This overview compares and contrasts the pharmacotherapy of itraconazole with that of other antifungal agents. DATA SOURCES: Primary literature on itraconazole was identified through a medical literature search from 1976 through 1991. This search included journal articles, abstracts, conference proceedings, and reports of animal and human research published in the English language. STUDY SELECTION: All primary literature was reviewed regardless of the study design or outcome. Literature evaluations of efficacy were ranked using a literature rating scale (Dalen JE, Hirsh J. Arch Intern Med 1986;146:462–72), which was slightly modified to include case reports and observations. DATA EXTRACTION: All data were collected and represented with a primary focus on itraconazole's mechanism of action, pharmacokinetics, clinical efficacy in systemic mycotic infections, drug interactions, and adverse reactions. All articles were referenced in the final data presentation unless grouped data had been accurately reviewed and published. DATA SYNTHESIS: Despite the paucity of controlled comparative trials with itraconazole in patients with deep mycoses, results on efficacy are encouraging. It is still unclear what role itraconazole will have in the prophylaxis of fungal infections in immunocompromised hosts. The favorable pharmacokinetic profile permits once- or twice-daily administration and itraconazole appears to be safe and well tolerated. CONCLUSIONS: Itraconazole should prove to be a useful replacement for ketoconazole on hospital formularies. This recommendation is based on itraconazole's greater apparent safety and efficacy. Reevaluation of this agent will be necessary upon the release of newer imidazoles and triazoles.
Impact of Triplicate Prescription Program on Psychotropic Prescribing Patterns in Long-Term Care Facilities
Authors: Hartzema Abraham G. , Porta Miquel S. , Tilson Hugh H. , Zullich Sergio G. , Grasela Thaddeus H. , Fiedler-Kelly Jill B. , Gengo Francis M. 
Published: January 2017

OBJECTIVE: To assess the impact of the effect of the New York state triplicate prescription program on psychotropic prescribing patterns in selected long-term care facilities over a one-year period. DESIGN: Retrospective study for changes in psychotropic drug use patterns before and after implementation of the triplicate prescription program. SETTING: Eight private and two public long-term care facilities in the western New York area. PATIENTS: All residents in the long-term care facilities with complete medical records for a one-year period were reviewed. OUTCOME MEASUREMENTS: Charts were reviewed for changes in psychotropic drug patterns and incidence in adverse events such as falls, hip fractures, hospital admission, signs or symptoms of benzodiazepine (BZD) withdrawal syndrome, or behavioral outburst. MAIN RESULTS: BZD use declined precipitously from 25 percent of psychotropic drug orders to 10 percent six months after implementation of the program. The decline in BZD use was accompanied by an increase in the number of orders for alternative psychotropic agents. Although 22 percent of the patients previously receiving BZDs were discontinued from these drugs, more than half of these patients were switched to alternative therapy, including tricyclic antidepressants and antipsychotic drugs. The majority of patients who discontinued BZDs did so without tapering of the dosage; however, few experienced minor withdrawal symptoms and no patient experienced seizures or required hospitalization following discontinuation. The risk of falls, hospital admission for any reason, or combined events was not significantly altered despite a reduction in BZD use. There was a trend, however, for a reduction in falls after implementation of the program. CONCLUSIONS: This study documents that psychotropic drug prescribing patterns were significantly affected by the triplicate prescription program. BZD use declined; however, use of alternative psychotropic drugs increased. Despite changes in psychotropic prescribing patterns, we found no significant risk of adverse events. Further study to evaluate the long-term effect of alternative psychotropic drugs is necessary.
Mathematical Examination of Dual Individualization Principles (III): Development of a Scoring System for Pneumonia Staging and Quantitation of Response to Antibiotics: Results in Cefmenoxime-Treated Patients
Authors: Luzier Aileen , Goss Thomas F. , Cumbo Thomas J. , Schentag Jerome J. 
Published: January 2017

OBJECTIVE: In order to quantitatively express the important, time-related aspects of response to antimicrobial therapy in patients with pneumonia, we required validated measures of the time course of events during the infection. To quantitate the changes in clinical status in relation to changes in cultures, we developed a scoring system to be used for patient assessment during therapy. DESIGN: Retrospective data collection, prospective analysis of factors. SETTING: Intensive care unit, Millard Fillmore Hospital. PATIENTS: Twenty-eight patients with nosocomial pneumonia. MAIN OUTCOME MEASURES: Clinical parameters were assessed daily for the duration of antimicrobial therapy. Using linear regression, the rate of clinical change in each patient treated was quantified. Eradication of the pathogen was determined by serial cultures of the infection site. RESULTS: Seventeen of the patients demonstrated eradication of the organism, and 11 demonstrated persistence of the pathogen (7 were considered colonization). The system described the patients at baseline in that the mean baseline scores were similar in both groups of patients (p=0.79). Patients in whom the pathogen was eradicated showed a rate of clinical improvement significantly different from those who had persistence of the organism (p=0.04). In patients demonstrating eradication, the time to eradication inversely correlated with the rate of clinical improvement (p<0.05). Of the ten parameters descriptive of the disease, those most sensitive to change after eradication of bacteria were body temperature, bacterial Gram stain, white blood cell Gram stain, and volume of sputum. CONCLUSIONS: In this set of pneumonia patients, the scoring system effectively quantified both baseline and time-related changes in clinical status. The system distinguished between the clinical course of the patient with organism eradication versus organism persistence. A shorter time to eradication was associated with a better clinical response. Prospective study of the system will determine its sensitivity.
Possible Severe Thrombocytopenia Associated with a Single Dose of Plicamycin
Authors: Yamreudeewong Weeranuj , Henann Neil E. , Fazio Anthony , Rangaraj Uma 
Published: January 2017

OBJECTIVE: To report a case of possible severe thrombocytopenia associated with administration of a single dose of plicamycin. CASE SUMMARY: A 73-year-old man with prostate cancer was admitted to the hospital with hypercalcemia (total serum calcium concentration 4.02 mmol/L) and a low baseline platelet count (152 × 109/L). Because of his symptomatic hypercalcemia, he was treated with NaCl 0.9%, furosemide, oral inorganic phosphate, and a single dose of plicamycin (15 μg/kg). Five days after plicamycin administration his platelet count decreased to 52 × 109/L, and continued to decrease further even after the transfusion of four units of platelets to a nadir of 7 × 109/L (hospital day 20). A second transfusion produced a small increase in his platelet count. The patient's clinical status continued to deteriorate, however, and he subsequently died. DISCUSSION: Plicamycin and other drugs that may induce thrombocytopenia are reviewed. The time course between plicamycin administration and the development of thrombocytopenia in our patient is assessed. Other contributing factors such as a low baseline platelet count and advanced age are also addressed. CONCLUSIONS: It is likely that the severe thrombocytopenia experienced by our patient was caused by a single dose of plicamycin. Adjusting the dosage for a patient's renal function as well as close monitoring of the platelet count are necessary when administering this drug. We report this case to remind clinicians of the potential for the development of severe thrombocytopenia following administration of a single dose of plicamycin.
Toxicity Potential of Oral Lidocaine in a Patient Receiving Mexiletine
Authors: Geraets Douglas R. , Scott Shane D. , Ballew Kenneth A. 
Published: January 2017

OBJECTIVE: To report a case of toxicity from orally administered lidocaine in a patient with cardiomyopathy receiving concurrent mexiletine therapy. DATA SOURCES: Case reports, review articles, and studies identified by search of the MEDLINE database and Current Contents. STUDY SELECTION: All reports of toxicity from orally administered lidocaine were reviewed. DATA SYNTHESIS: Lidocaine, a local anesthetic, is widely used to treat cardiac arrhythmias. Toxicity with the parenteral form occurs frequently. In contrast, there are few reports of toxicity with oral lidocaine, most of them occurring in children receiving large doses relative to body weight. We report a case of intoxication in an adult with severe cardiomyopathy and concurrent mexiletine therapy who received only two doses of oral lidocaine. CONCLUSIONS: Although it is rarely reported in adults, clinicians must be alert to the possibility of toxicity from orally administered lidocaine. This is most likely to occur in patients with conditions known to reduce lidocaine clearance, when higher-than-usual doses are administered, or when concurrent therapy with oral lidocaine analogs may be present.
Adjunctive Medications in Patients Receiving Thrombolytic Therapy: A Multicenter Prospective Assessment
Authors: Gonzalez Edgar R. , Jones Lori A. , Ornato Joseph P. , Bleecker Giselle C. , Strauss Michael J. ,   Virginia Multicenter Thrombolytic Study Group
Published: January 2017

OBJECTIVE: To describe the use of adjunctive therapies in patients with acute myocardial infarction receiving thrombolytic agents. DESIGN: Data were collected prospectively by the study-site investigator or the emergency department physician caring for the patient. Study participation did not influence thrombolytic regimen selection or the adjunctive therapies ordered. SETTING: Thirteen Virginia hospitals representing a cross-section of hospitals in the state. Eleven are urban medical centers; four have graduate medical education programs. PARTICIPANTS: Patients were included in the study if the decision to administer thrombolytic therapy was made in the emergency department. MAIN OUTCOME MEASURES: Concomitant medications administered during the first six hours after initiation of thrombolytic therapy. RESULTS: Two hundred ten patients (aged 57 ± 14.1 y) were evaluated. Ninety-five percent of these patients were treated with tissue plasminogen activator, 3 percent received anisoylated plasminogen streptokinase activator complex, and 2 percent received streptokinase. Ninety-one percent of the patients also received heparin, the most commonly used adjunctive medication; 77 percent concomitantly received lidocaine; 62 percent received aspirin; and only 19 percent received a beta-blocker. CONCLUSIONS: Our data provide a reference point for future studies to determine factors that influence the selection of adjunctive agents for treating patients with acute myocardial infarction receiving thrombolytics.
Assessment of the Drug Interaction between Intravenous Nitroglycerin and Heparin
Authors: Gonzalez Edgar R. , Jones Holly D. , Graham Susan , Elswick R.K. 
Published: January 2017

OBJECTIVE: To assess whether a clinically significant interaction occurs between heparin and nitroglycerin (NTG). METHODOLOGY: Activated partial thromboplastin time (APTT) was measured in patients with unstable angina who were stabilized on intravenous NTG and heparin just prior to weaning the NTG infusion, and one and four hours after stopping the NTG. RESULTS: In 22 heparin-treated patients (20 men, 2 women; aged 56.7 ± 10 years; weight 79.5 ± 15 kg), the APTT ratio was inversely related to the dose of NTG (slope = −0.003; p<0.05). However, there were no significant differences between the APTT values measured before and after discontinuation of NTG (p=0.8511). CONCLUSIONS: Our study demonstrates a clinically insignificant interaction between NTG and heparin at NTG doses commonly used in patients.
Seizures Associated with High-Dose Intravenous Morphine Containing Sodium Bisulfite Preservative
Authors: Meisel Steven B. , Welford Paula K. 
Published: January 2017

OBJECTIVE: To report a case of seizures occurring during administration of high-dose intravenous morphine containing sodium bisulfite as a preservative. CASE SUMMARY: A 56-year-old woman hospitalized with multiple myeloma developed myoclonic and tonic-clonic seizures following administration of intravenous morphine with sodium bisulfite preservative at doses exceeding 400 mg/h. These seizures resolved when the morphine was discontinued, anticonvulsants were administered, and the drug therapy was changed to intravenous fentanyl without preservative. DISCUSSION: The factors potentially associated with this adverse reaction are discussed and the literature concerning the adverse central nervous system effects of opiates and sulfites is reviewed. CONCLUSIONS: High doses of intravenous morphine with sulfite preservative may be associated with seizure development. If patients require high doses of intravenous morphine, a preservative-free formulation should be used to avoid possible additive or synergistic toxicities.
Erythromycin Base-Induced Rash and Liver Function Disturbances
Authors: Shirin Haim , Schapiro Jonathan M. , Arber Nadir , Pinkhas Jack , Sidi Yeheskel , Salomon Francis 
Published: January 2017

OBJECTIVE: To report a case of erythromycin base-induced rash and liver function disturbances. CASE SUMMARY: A patient with erythema nodosum and high antistreptolysin-O titers was treated with erythromycin on the assumption that occult streptococcal infection was the cause of the erythema nodosum. Forty-eight hours after the initiation of therapy the patient developed fever, severe generalized rash, pruritus, and cholestatic and hepatocellular liver function disturbances. Extensive evaluation to determine the cause of liver function disturbances was unrevealing. Marked improvement was noticed within days after cessation of erythromycin. DISCUSSION: Case reports in the literature on the adverse effects of erythromycin and its derivatives were reviewed. The possible immunologic mechanism involved is postulated. CONCLUSIONS: Erythromycin base must be added to the list of erythromycin derivatives that can cause rash and liver function disturbances. The concomitant appearance of fever, rash, jaundice, and liver function disturbances raises the possibility of hypersensitivity as the mechanism for the liver disturbances.
Hirudins: Antithrombin Anticoagulants
Authors: Stringer Kathleen A. , Lindenfeld Joann 
Published: January 2017

OBJECTIVE: To review the chemistry, pharmacology, available clinical data, and adverse effects of the hirudin anticoagulants. DATA SOURCES: A MEDLINE search and a review of recent scientific abstracts was conducted to identify pertinent literature. STUDY SELECTION: Focus was placed on studies conducted in humans. Because hirudin is still an investigational agent, however, relevant animal data, particularly pharmacokinetic studies and studies of preclinical efficacy, were also selected. DATA EXTRACTION: Data from both human and animal studies were evaluated; emphasis was placed on human trials. DATA SYNTHESIS: Hirudin has demonstrated potent anticoagulant effects. Although hirudin could have a significant impact on the therapeutic management of patients requiring anticoagulant therapy, only a limited number of human studies have been published to date. Trials comparing hirudin and heparin in specific patient populations are still ongoing. CONCLUSIONS: Although still in clinical trials, hirudin is a unique agent that may represent a breakthrough in anticoagulant therapy. The specific role that this agent will play in the management of patients has yet to be determined.