bluuebunny/crossref_metadata_2025_split huggingface dataset:
Relations between Desire for Early Death, Depressive Symptoms and Antidepressant Prescribing in Terminally Ill Patients with Cancer
Authors: Tiernan E , Casey P , O'Boyle C , Birkbeck G , Mangan M , O'Siorain L , Kearney M 
Published: November 2017

Some patients with advanced cancer express the wish for an early death. This may be associated with depression. We examined the relations between depressive symptoms and desire for early death (natural or by euthanasia or physician-assisted suicide) in 142 terminally ill patients with cancer being cared for by a specialist palliative care team. They completed the Hospital Anxiety and Depression Scale questionnaire and answered four supplementary questions on desire for early death. Only 2 patients expressed a strong wish for death by some form of suicide or euthanasia. 120 denied that they ever wished for early release. The desire for early death correlated with depression scores. Depressive symptoms were common in the whole group but few were on antidepressant therapy. Better recognition and treatment of depression might improve the lives of people with terminal illness and so lessen desire for early death, whether natural or by suicide.
Relations between Offending, Injury and Illness
Authors: Shepherd Jonathan , Farrington David , Potts John 
Published: November 2017

The objectives of this study were to determine relations between offending and health, and how illness and injury relate to concurrent offending—whether offending predicts health or vice versa, and whether relations persist after adjustment for childhood predictors of offending. Data collected in the Cambridge Study in Delinquent Development were analysed. This is a prospective longitudinal survey of 411 South London males first recruited at age 8. Information about injuries and illnesses between ages 16 and 18 was set against information on offending and other types of antisocial behaviour. Males who were injured (especially in assaults) tended to be convicted, to be violent, to have unskilled manual jobs and to be generally antisocial. Respiratory tract illnesses were negatively related to convictions and antisocial behaviour in general. Drug users were significantly likely to be ill. Adult convictions were predicted by childhood troublesome behaviour, daring/hyperactivity, low IQ/attainment, a convicted parent, family disruption/poor supervision and poverty. Assault injuries and respiratory tract illnesses did not predict adult convictions independently of these childhood factors. It was concluded that injury is one symptom of an antisocial personality that arises in childhood and persists into adulthood. Therefore, measures that lead to a reduction in offending should also lead to a reduction in concurrent injuries. Negative relations between a range of antisocial behaviours and respiratory tract illness deserve further study.
In-Training Assessment for Specialist Registrars: Views of Trainees and Trainers in the Mersey Deanery
Authors: Bache John , Brown Jeremy , Graham David 
Published: November 2017

Annual review of specialist registrars and production of a record of in-training assessment (RITA) is a mandatory component of training that has attracted criticism. Mersey Deanery has established a system of review that includes wider evaluation of the trainee's needs and of training requirements. We conducted a survey to ascertain whether this broadened review process was thought beneficial. In one year 1093 questionnaires were distributed to trainees and trainers. 605 (81%) of 744 trainees and 309 (89%) of 349 trainers responded. At least 89% of both groups said that the procedure had been effective in reviewing the previous year and the most recent post and in identifying training requirements. More than 90% rated the overall process positively. Trainees particularly appreciated the advice on future training, on careers and on research. This form of review is expensive in consultant time but was valued by both trainees and trainers.
How Objective are Systematic Reviews? Differences between Reviews on Complementary Medicine
Authors: Linde Klaus , Willich Stefan N 
Published: November 2017

Systematic reviews are considered the most reliable tool to summarize existing evidence. To determine whether reviews that address the same questions can produce different answers we examined systematic reviews of herbal medicine, homeopathy, and acupuncture taken from a previously established database. Information on literature searching, inclusion criteria, selection process, quality assessment, data extraction, methods to summarize primary studies, number of included studies, results and conclusions was compared qualitatively. Seventeen topics (eight on acupuncture, six on herbal medicines, three on homeopathy) had been addressed by 2–5 systematic reviews each. The number of primary studies in the reviews varied greatly within most topics. The most obvious reason for discrepancies between the samples was different inclusion criteria (in thirteen topics). Methods of literature searching may have contributed with some topics but the equivalence of the searches was difficult to assess. Differences were frequently observed in other methodological aspects, in results and in conclusions. This analysis shows that, at least in the three areas examined, systematic reviews often differ considerably. Readers should be aware that apparently minor decisions in the review process can have major impact.
Diagnosis of Perforated Enterocystoplasty
Authors: Fontaine Eric , Leaver Rachel , Woodhouse Christopher R J 
Published: November 2017

In the operation of enterocystoplasty, now widely practised, segments of bowel are used to augment or replace the urinary bladder. An occasional complication is perforation, and this may present in non-specialist settings. We investigated the management of spontaneous perforations among 264 patients with enterocystoplasty followed by one surgeon for 2-18 years. Patients’ charts were examined for data on presentation, diagnosis and treatment. 10 patients had thirteen perforations; data were available for nine perforations in 9 patients. Mean time from enterocystoplasty to perforation was 45 months. Presentation was shoulder pain in 1 and abdominal pain (with or without fever) in 8. Perforation was diagnosed without delay in 3, but the initial diagnosis was urinary tract infection in 4 and small-bowel obstruction in 2. Ultrasound was the most useful investigation being diagnostic in 6 of 7 cases; contrast cystography showed a leak in only 2 of the 6 patients in whom it was performed. Treatment was successful in 8 cases (surgery 6; percutaneous drainage 2); 1 patient, who remained undiagnosed, was treated medically and died. Patients with enterocystoplasty need to be educated about this potentially lethal complication, so that they can alert non-specialist clinicians to what may have happened. In any patient with enterocystoplasty who reports abdominal pain or shoulder pain, perforation has to be ruled out.
How will the Two-Weeks-Wait Rule Affect Delays in Management of Urological Cancers?
Authors: Subramonian K R , Puranik S , Mufti G R 
Published: November 2017

The UK National Health Service has now specified a maximum interval of two weeks between general practitioner (GP) referral and specialist assessment for patients with suspected cancer. We examined progress through the cancer pathway in 160 patients with potentially curable cancers of the prostate, bladder, kidney and testis before implementation of this rule. Median intervals with interquartile ranges were quantified from the first GP consultation to hospital referral, then to the first hospital consultation, confirmation of diagnosis and definitive surgery. 34% of patients were seen at the hospital within two weeks of referral. The overall median interval from GP consultation to radical surgery was 137 days, the longest being for prostate cancer (median 244). For prostate, bladder and renal cancers the principal element of delay was from the time of diagnosis to surgery (76, 73 and 26 days respectively). These results indicate that, under the two-weeks-wait rule, 2 out of every 3 patients achieve earlier initial assessment. However, the overall delay will not be substantially reduced without concomitant increases in diagnostic facilities, theatre time and human resources.
Relation between Severe Illness and Non-Completion of Quality-of-Life Questionnaires by Patients with Rectal Cancer
Authors: Kopp Ina , Lorenz Wilfried , Rothmund Matthias , Koller Michael 
Published: November 2017

Quality of life (QoL) is an important outcome measure in clinical studies, but interpretation is hindered by incompleteness of data. We addressed this issue in a population-based cohort study of 146 patients with newly diagnosed rectal cancer. QoL was assessed by means of European Organization for the Research and Treatment of Cancer questionnaires at discharge from hospital after primary treatment and then every 3 months for 2 years. In parallel, objective clinical data were documented. Analyses were conducted in three steps: participants versus non-participants with QoL-assessment; poor compliers who filled in only one or two questionnaires ( n=20) versus good compliers who filled in all or nearly all questionnaires ( n=18); and the proportion of missing forms and critical (very poor) QoL scores in risk patients versus non-risk patients over the course of 2 years. Non-participants and poor compliers were older, were more likely to receive palliative (rather than curative) treatment, and had worse scores for physical status. Tumour progression and therapeutic interventions were more frequent in poor compliers than in good-compliers. Patients with risk factors (age <75 years, poor physical status, palliative treatment) were more likely to have missing questionnaires and critical QoL scores in respect of physical functioning and global quality of life over the course of 2 years. Missing values for QoL have clinical as well as methodological implications, because QoL scores can enhance a clinician's insight. Unwillingness to fill in a questionnaire is an indicator of serious illness. Studies that report sample statistics without specifying compliance rates and the characteristics of non-compliers will give a misleadingly positive picture.
Telephone Reminders to Reduce Non-Attendance Rate for Endoscopy
Authors: Lee C S , McCormick P A 
Published: November 2017

Non-attendance at clinics and endoscopy units wastes resources and lengthens waiting lists. In a previous study elsewhere, a substantial proportion of patients claimed to have forgotten their appointment. We therefore assessed the value of telephoning patients a week before their booked day-case endoscopy. An observation period of two months was followed by an intervention period of two months in which patients were contacted by phone and asked if they wished to come for their investigation. A maximum of three separate attempts were made to contact each patient. Patients cancelling the appointment were replaced by others on the reserve list. The non-attendance rate was expressed as the percentage of unused beds. During the observation period 56 patients were admitted and 18 beds were unused. During the intervention period it was possible to contact 73 of 88 patients and 8 of these cancelled. 87 beds were available and 83 patients were admitted. When clerical error, overbooking and failure to replace patients were taken into account, the non-attendance rate declined from 23.3% during the observation period to 5.7% during the intervention period (P≤0.05). The intervention seemed more effective in reducing non-attendance in outpatients referrals (0/48) than in general practitioner referrals (5/40).
Risk Factors in Acquired Faecal Incontinence
Authors: Lunniss Peter J , Gladman Marc A , Hetzer Franc H , Williams Norman S , Scott S Mark 
Published: November 2017

Acquired faecal incontinence arising in the non-elderly population is a common and often devastating condition. We conducted a retrospective cohort analysis in 629 patients (475 female) referred to a tertiary centre, to determine the relative importance of individual risk factors in the development of faecal incontinence, as demonstrated by abnormal results on physiological testing. Potential risk factors were identified in all but 6% of patients (7 female, 32 male). In women, the principal risk factor was childbirth (91%), and in most cases at least one vaginal delivery had met with complications such as perineal injury or the need for forceps delivery. Of the males, half had undergone anal surgery and this was the only identified risk factor in 59%. In many instances, assignment of cause was hampered by a long interval between the supposed precipitating event and the development of symptoms. Abnormalities of anorectal physiology were identified in 76% of males and 96% of females (in whom they were more commonly multiple). These findings add to evidence that occult damage to the continence mechanism, especially through vaginal delivery and anal surgery, can result in subsequent faecal incontinence, sometimes after an interval of many years.
The Two-Week-Wait Cancer Initiative in Urology: Useful Modernization?
Authors: Allen Darrell , Popert Rick , O'Brien Tim 
Published: November 2017

The two-week-wait cancer initiative in the UK was designed to speed referral of patients suspected of having cancer and, by so doing, improve their outcome. We reviewed the case notes of all patients referred under this scheme to a single urology department over twelve months. In the department, nearly one-third of new outpatient appointments came under this scheme. 124 patients were referred and all but 7 were seen within the 14-day deadline. In 62 the reason for referral was haematuria, which was macroscopic in 42. Of those with macroscopic haematuria 6 proved to have cancer, newly diagnosed in 4 (2 bladder, 2 renal); no patient with microscopic haematuria had cancer. Of 35 referred with a raised prostate-specific antigen 11 had prostate cancer, in most cases beyond cure. Cancer was found in 1 of 19 patients referred with a testicular mass. In patients referred under the two-week-wait scheme with macroscopic haematuria, cancer is common. Microscopic haematuria is seldom significant. Carcinoma of the prostate is usually advanced and beyond cure at presentation. Among patients referred with scrotal lumps, cancer of the testis is not common. The scheme as a whole is unlikely to improve cancer outcomes. Patients with macroscopic haematuria might be better served by one-stop clinics. For those with testicular lumps, most of which will be benign, the best answer might be direct general practitioner access to scrotal ultrasonography.
Routine Biochemistry in Suspected Vitamin D Deficiency
Authors: Peacey Steven R 
Published: November 2017

Vitamin D deficiency, which continues to be widespread amongst persons of Asian descent in the UK, is often detected from abnormal results on routine biochemistry. The aim of this study was to assess the frequency of abnormal results from routine baseline tests of serum calcium, phosphate, and alkaline phosphatase in patients who subsequently proved to have vitamin D deficiency and secondary hyperparathyroidism. A retrospective examination was undertaken to assess these baseline indices in a cohort of 84 such patients seen in Bradford—5 male; 80 of Asian descent; median age 46 years (range 16-82); serum 25-hydroxyvitamin D < 10 μg/L; parathyroid hormone >54ng/L. Calcium was normal in 55 patients (66%), phosphate in 68 (81%) and alkaline phosphatase in 24 (29%). In only 5 patients were all three indices outside the normal range. The median parathyroid hormone concentration was significantly greater in patients with abnormal routine biochemistry (145 [range 55-1662] ng/L) than in patients with normal routine biochemistry (88 [59-322] ng/L) but the median 25-hydroxyvitamin D levels did not differ (3.1 [1.3-9.9] and 3.0 [1.5-7.3] μg/L). Routine biochemistry was normal in 20% of cases. If routine biochemistry is relied upon to detect vitamin D deficiency and osteomalacia, a substantial minority of cases will be missed.
Community Hospitals: an Under-Recognized Resource for Palliative Care
Authors: Payne Sheila , Kerr Chris , Hawker Sheila , Seamark David , Davis Carol , Roberts Helen , Jarrett Nicola , Roderick Paul , Smith Helen 
Published: November 2017

In the UK there are concerns that, in certain groups of dying patients such as the old, those with non-cancer diagnoses and those in rural areas, the quality of care is unacceptably variable. There has been no systematic survey of the extent to which community hospitals provide general palliative care for such patients. Therefore, by means of a structured questionnaire we asked senior nurses/managers at all 478 community hospitals in the UK for information on staff expertise, facilities and specialist equipment, liaison arrangements with specialist palliative care providers, priorities, practice and policy in end-of-life care. Of the 346 hospitals (72%) that responded, only 28 were in urban areas. 73% of hospitals employed at least one nurse with additional training in palliative care, 72% had access to 24-hour specialist palliative care advice and 51% had separate overnight accommodation for relatives, but only 22% had designated palliative care beds. Most hospitals did not have written policies or guidelines for patient assessment or symptom control. These findings add to evidence that community hospitals represent an important resource to improve access to palliative care for groups that are currently under-served.
Incidence of Fatigue Symptoms and Diagnoses Presenting in UK Primary Care from 1990 to 2001
Authors: Gallagher Arlene M , Thomas Janice M , Hamilton William T , White Peter D 
Published: November 2017

Little is known about whether the incidence of symptoms of fatigue presented in primary care, and the consequent diagnoses made, change over time. The UK General Practice Research Database was used to investigate the annual incidence of both fatigue symptoms and diagnoses recorded in UK primary care from 1990 to 2001. The overall incidence of all fatigue diagnoses decreased from 87 per 100000 patients in 1990 to 49 in 2001, a reduction of 44%, while postviral fatigue syndromes decreased from 81% of all fatigue diagnoses in 1990 to 60% in 2001. Chronic fatigue syndrome (CFS) and myalgic encephalomyelitis (ME) together increased from 9% to 26% of all fatigue diagnoses. The incidence of fibromyalgia increased from less than 1 per 100000 to 35 per 100000. In contrast, there was no consistent change in the incidence of all recorded symptoms of fatigue, with an average of 1503 per 100000, equivalent to 1.5% per year. CFS/ME and fibromyalgia were rarely diagnosed in children and were uncommon in the elderly. All symptoms and diagnoses were more common in females than in males. The overall incidence of fatigue diagnoses in general has fallen, but the incidence rates of the specific diagnoses of CFS/ME and fibromyalgia have risen, against a background of little change in symptom reporting. This is likely to reflect fashions in diagnostic labelling rather than true changes in incidence.
Local Anaesthesia for Venous Cannulation and Arterial Blood Gas Sampling: Are Doctors Using It?
Authors: Sado Daniel M , Deakin Charles D 
Published: November 2017

The pain of venous cannulation and arterial puncture can be greatly lessened by local anaesthesia. We sought information about the use of local anaesthesia for these procedures by doctors working in medicine, surgery and anaesthetics. A questionnaire was hand-delivered to 178 doctors in eight hospitals, all of whom responded. For insertion of large-bore cannulae, local anaesthesia was used by all the anaesthetists but less than half the medical and surgical doctors. For arterial blood sampling it was used by 60% of anaesthetists and 2% of ward doctors. Previous recommendations to use local anaesthesia seem to have been ignored, and in many instances these procedures are more painful than necessary.
Sex and Drugs in Popular Movies: An Analysis of the top 200 Films
Authors: Gunasekera Hasantha , Chapman Simon , Campbell Sharon 
Published: November 2017

We analyse the portrayal of sex and drug use in the most popular movies of the last 20 years using the Internet Movie Database list of the top 200 movies of all time. Films released or set prior to the HIV era (pre 1983), animated, not about humans or G/PG rated, were excluded. Films were reviewed by one of two teams of two observers using a data extraction sheet tested for inter-rater reliability. Sexual activity, sexually transmitted disease (STD) prevention, birth control measures, drug use and any consequences discussed or depicted were recorded. There were 53 sex episodes in 28 (32%) of the 87 movies reviewed. There was only one suggestion of condom use, which was the only reference to any form of birth control. There were no depictions of important consequences of unprotected sex such as unwanted pregnancies, HIV or other STDs. Movies with cannabis (8%) and other non-injected illicit drugs (7%) were less common than those with alcohol intoxication (32%) and tobacco use (68%) but tended to portray their use positively and without negative consequences. There were no episodes of injected drug use. Sex depictions in popular movies of the last two decades lacked safe sex messages. Drug use, though infrequent, tended to be depicted positively. The social norm being presented is concerning given the HIV and illicit drug pandemics.
Adrenomyeloneuropathy in Patients with ‘Addison's Disease’: Genetic Case Analysis
Authors: Mukherjee Sagarika , Newby Elizabeth , Harvey John N 
Published: November 2017

Objective To review the clinical presentations and diagnostic issues in adrenomyeloneuropathy and adrenoleukodystrophy, which are different presentations of the same single gene disorder. Design Observational study. Participants Three generations of an affected kindred. Intervention None. Main outcome measures Neurological features suggestive of adrenoleukodystrophy or adrenomyeloneuropathy. Measurement of very long chain fatty acids. Molecular analysis of the adrenoleukodystrophy gene. Results Three adults presented with adrenomyeloneuropathy and two children with adrenoleukodystrophy. Circulating concentrations of long chain fatty acids were raised consistent with clinical features. A mutation in exon 6 of the adrenoleukodystrophy gene (P543L) was identified. This had not previously been identified but has subsequently been reported by other groups. Conclusions Adrenomyeloneuropathy should be considered in the differential diagnosis in male patients presenting with adrenal failure. Early diagnosis allows genetic counselling in such families and may become more important as treatment strategies evolve.