bluuebunny/crossref_metadata_2025_split huggingface dataset:
Adverse effects of spinal manipulation
Authors: Barrett Ailsa J , Breen Alan C 
Published: July 2017

Summary Guidelines on acute back pain recommend spinal manipulation, but some commentators express concern that the adverse effects are under-reported. Eleven chiropractors distributed questionnaires to 108 consecutive new patients aged >18 years, enquiring about adverse effects one hour, one day and two days after spinal manipulation. The forms were to be completed anonymously. 80 questionnaires (74%) were returned, 68 suitable for analysis. 28 patients reported adverse effects at one hour after treatment, the most common of which were extra pain (14) and radiating pain (9). 8 had reactions beginning the morning after. No serious adverse effects were reported. The adverse reactions, recorded in 53% of respondents, are those to be expected from a treatment that entails initial discomfort. They need to be set against the long-term benefits of spinal manipulation.
Expedition Health and Safety: A Risk Assessment
Authors: Anderson Sarah R , Johnson Chris J H 
Published: July 2017

Little has been published on the risks of participating in an expedition. A questionnaire survey was conducted to quantify those risks and to determine how expedition organizers plan for medical mishaps. 246 expeditions, taking 2381 participants to more than one hundred countries, were studied retrospectively. 65 expeditions (26%) reported no medical incidents; the remaining 181 reported 835 in 130 000 man-days (6.4 per 1000 man-days). 59% of the medical incidents seen on expeditions were preventable, one-third of these being due to gastrointestinal upsets. 78% of medical incidents were classified as minor and only 5% (40) as serious. There was no excess of serious incidents in any particular organizational group or environment. The findings of this survey suggest that the health risks of participating in a well-planned expedition are similar to those encountered during normal active life.
General Practitioners’ Attitudes to Sexual Activity in Under-Sixteens
Authors: Garside R , Ayres R , Owen M R , Pearson V H , Roizen J 
Published: July 2017

In the UK, under-sixteen-year-olds with some exceptions can be provided with contraceptive care even if unwilling to inform their parents. Nonetheless, many teenagers express doubts about confidentiality in these circumstances, as well as fear of being judged. The attitudes of general practitioners in North and East Devon towards the Gillick ruling regarding the treatment of under sixteens for sexual health matters were assessed. They were asked to indicate their level of agreement or disagreement with a series of statements. 235 (73%) responded, and only 15 (6.5%) rejected the notion that the same duty of confidentiality applies to under-sixteens as to older patients. 76% did, however, prefer parents to know they had been consulted about contraception. Only 7 GPs believed that provision of contraception encourages under-age sex. Despite GPs’ general acknowledgment of the importance of confidentiality in relation to sexual activity, teenagers may well be discouraged from seeking advice if they expect strong pressure to tell their parents.
Expectations and quality of life of cancer patients undergoing radiotherapy
Authors: Koller Michael , Lorenz Wilfried , Wagner Katja , Keil Astrid , Trott Diana , Engenhart-Cabillic Rita , Nies Christoph 
Published: July 2017

Summary Expectations, real or false, affect the way patients respond to their illnesses. We assessed therapy-related expectations in relation to global quality of life in 55 cancer patients before and after radiotherapy. Factor analysis indicated that therapy-related expectations come into three broad categories—pain/emotional control, healing and tumour/symptom control. 35 patients expected ‘healing’ even though curative treatment was intended in only 19 and all patients had been fully informed. The expectation of healing was associated with high quality of life, and the same was true of perception of healing after radiotherapy. In the group as a whole, quality of life was little altered by radiotherapy, but it became substantially worse in those patients who had expected healing but perceived that this had failed, even though physician-assessed Karnofsky status did not change. These findings indicate that the expectation of healing, in cancer patients, is a component of a good global quality of life, whereas more limited expectations (pain control, tumour control) relate to lower quality of life. Patients’ expectations deserve further study as a novel approach to improving care.
Neurological complications of cervical spine manipulation
Authors: Stevinson Clare , Honan Will , Cooke Brian , Ernst Edzard 
Published: July 2017

To obtain preliminary data on neurological complications of spinal manipulation in the UK all members of the Association of British Neurologists were asked to report cases referred to them of neurological complications occurring within 24 hours of cervical spine manipulation over a 12-month period. The response rate was 74%. 24 respondents reported at least one case each, contributing to a total of about 35 cases. These included 7 cases of stroke in brainstem territory (4 with confirmation of vertebral artery dissection), 2 cases of stroke in carotid territory and 1 case of acute subdural haematoma. There were 3 cases of myelopathy and 3 of cervical radiculopathy. Concern about neurological complications following cervical spine manipulation appears to be justified. A large long-term prospective study is required to determine the scale of the hazard.
Life and times of the impact factor: retrospective analysis of trends for seven medical journals (1994-2005) and their Editors’ views
Authors: Chew Mabel , Villanueva Elmer V , Van Der Weyden Martin B 
Published: July 2017

Summary Objective (1) To analyse trends in the journal impact factor (IF) of seven general medical journals ( Ann Intern Med, BMJ, CMAJ, JAMA, Lancet, Med J Aust and N Engl J Med) over 12 years; and (2) to ascertain the views of these journals’ past and present Editors on factors that had affected their journals’ IFs during their tenure, including direct editorial policies. Design Retrospective analysis of IF data from ISI Web of Knowledge Journal Citation Reports—Science Edition, 1994 to 2005, and interviews with Editors-in-Chief. Setting Medical journal publishing. Participants Ten Editors-in-Chief of the journals, except Med J Aust, who served between 1999 and 2004. Main outcome measures IFs and component numerator and denominator data for the seven general medical journals (1994 to 2005) were collected. IFs are calculated using the formula: (Citations in year z to articles published in years x and y) / (Number of citable articles published in years x and y), where z is the current year and x and y are the previous two years. Editors’ views on factors that had affected their journals’ IFs were also obtained. Results IFs generally rose over the 12-year period, with the N Engl J Med having the highest IF throughout. However, percentage rises in IF relative to the baseline year of 1994 were greatest for CMAJ (about 500%) and JAMA (260%). Numerators for most journals tended to rise over this period, while denominators tended to be stable or to fall, although not always in a linear fashion. Nine of ten eligible editors were interviewed. Possible reasons given for rises in citation counts included: active recruitment of high-impact articles by courting researchers; offering authors better services; boosting the journal's media profile; more careful article selection; and increases in article citations. Most felt that going online had not affected citations. Most had no deliberate policy to publish fewer articles (lowering the IF denominator), which was sometimes the unintended result of other editorial policies. The two Editors who deliberately published fewer articles did so as they realized IFs were important to authors. Concerns about the accuracy of ISI counting for the IF denominator prompted some to routinely check their IF data with ISI. All Editors had mixed feelings about using IFs to evaluate journals and academics, and mentioned the tension between aiming to improve IFs and ‘keeping their constituents [clinicians] happy.’ Conclusions IFs of the journals studied rose in the 12-year period due to rising numerators and/or falling denominators, to varying extents. Journal Editors perceived that this occurred for various reasons, including deliberate editorial practices. The vulnerability of the IF to editorial manipulation and Editors’ dissatisfaction with it as the sole measure of journal quality lend weight to the need for complementary measures.
Palliative care in chronic obstructive pulmonary disease: a review for clinicians
Authors: Seamark David A , Clare J Seamark , Halpin David M G 
Published: July 2017

Chronic obstructive pulmonary disease (COPD) is a progressive condition characterized by airflow obstruction which ultimately kills many patients. It is common in both men and women and there is a 24—30% 5-year survival rate in the UK for those with severe disease. The annual death rate in the UK from COPD approaches that from lung cancer. Patients’ symptoms can be improved by drug therapy, but stopping smoking is also an effective way of improving the outcome in patients at all stages of COPD. Predicting prognosis has been difficult in COPD due to the variable illness trajectory. However, assessment of severity of lung function impairment, frequency of exacerbations and requirement for long term oxygen therapy can help identify patients entering the final 12 months of life. Symptom burden and impact on activities of daily living for patients with COPD are comparable with that of cancer patients, and palliative care approaches are equally necessary, yet few publications exist to guide clinicians in this area. An evidence base exists for the management of dyspnoea with oxygen therapy and opioid drugs. There is less evidence for the effective treatment of depression and anxiety, fatigue and pain, and treatment is based on experience and considered best practice. This review discusses the problems that patients experience and offers practical guidance. The management of patients should be shared between primary and secondary care, with multidisciplinary teams being involved at an early stage. Patients and their families require honest and clear communication about the condition and what to expect in the future. The strict application of advance care planning and directives may not be feasible or appropriate, but there is evidence that attitudes towards resuscitation and artificial ventilation can be explored without distress. The requirement by patients and carers for surveillance and timely support is acknowledged, but how to provide such input is as yet unclear, with little evidence to support the widespread implementation of nurse-led management interventions. The hospice movement has become increasingly involved in the management of life-threatening, non-malignant disease and should be involved in the multidisciplinary care of patients dying from COPD.
The Department of Health's research governance framework remains an impediment to multi-centre studies: findings from a national descriptive study
Authors: Kielmann Tara , Tierney Alison , Porteous Rosemary , Huby Guro , Sheikh Aziz , Pinnock Hilary 
Published: July 2017

Objective We describe our experience of using the standard application form, designed to streamline applications for multicentre research, to seek approval from all primary care organizations (PCOs) in England and Wales to undertake a single telephone interview with a health service manager. Design We sent applications ( n=316), by email to each PCO, or consortium of PCOs, attaching a completed standard application form, the 15 required documents, and the approval we had been granted by the lead NHS organization. We maintained detailed records of the responses to our application, subsequent correspondence, additional paperwork requested, and time spent on the approval process. Setting The UK Research Governance Framework, which regulates all research conducted in health and social care settings. Participants All PCOs in England and Wales. Interventions None. Main outcome measures Time taken to obtain approval to undertake a telephone interview with a health service manager. Results We were unable to establish contact with 13 (4%) PCOs. Six months after submitting our application we had received approval from 259/316 (82%) PCOs and were still awaiting a verdict from 41 (13%). The median time to approval was 56 days (IQR 42-72). Overall, an estimated 318 staff-hours were spent completing supplementary forms, providing additional information and chasing up dormant applications. Conclusions Recent initiatives to ‘streamline’ research governance approval have failed to address the problems that face researchers undertaking multi-centre studies. There is an urgent need to develop a simpler process that allows low risk research to take place without threatening staff morale and endangering the quality of the research outputs. In the meantime, we advise researchers to allow far greater time than might reasonably be envisioned to obtain research governance approval.
A matter of faith, not science’: analysis of media coverag of prostate cancer screening in Australian news media 2003-2006
Authors: Mackenzie Ross , Chapman Simon , Holding Simon , McGeechan Kevin 
Published: July 2017

Objective Despite a near universal absence of evidence-based policies supporting population screening for prostate cancer, the prostate-specific antigen (PSA) test is aggressively promoted in the media as a life-saving form of screening. The objective of this study was to examine media coverage of prostate-cancer screening in Australia. Design Frame analysis of all direct or attributed quotes about prostate cancer. Setting Australian capital city newspapers (February 2003-December 2006) and Sydney television news (January 2003-December 2006). Main outcome measures Quotes regarding prostate cancer screening: n=436 in newspapers and television news. Results Seven rhetorical frames were identified. 86% of all quotes framed prostate screening and its outcomes as desirable, associating PSA testing as being consonant with other early-detection cancer-control messages. Adverse surgical sequelae to screening were often minimized, scientific progress highlighted and gender equity appeals appropriated. Those questioning screening were vilified, with epidemiology being framed as an inferior form of knowledge than clinical experience. Conclusions Australian men are exposed to unbalanced and often non-evidence-based appeals to seek PSA testing. There is a disturbing lack of effort to redress this imbalance.
Development of a Guide to Recommended Print Materials for Diabetes Patient Education
Authors: Frey Mary L. , Hiss Roland G. 
Published: July 2017

There are hundreds of current booklets, pamphlets, and manuals available for diabetes patient educa tion. Everyone, it seems, is writing them from large pharmaceutical com panies and publishing houses to small rural hospitals. A national review of those materials has led to the development of an an notated resource booklet entitled "Recommended Print Materials for Diabetes Patient Education, 1984. " This article discusses the overall results of the review and the methodology used in its formation.
Small fenestra stapedectomy technique: Reducing risk and improving hearing
Authors: Bailey H. A. Ted , Pappas James J. , Graham Sharon S. 
Published: July 2017

During the past 25 years many variations have emerged in stapedectomy, most of which centered around either a change in the prosthesis itself or in the type of oval window seal. The small fenestra stapedectomy technique (SFT) represents a change in surgical procedure rather than in prosthetic design. This technique offers the opportunity to improve hearing results while reducing risks in stapedectomy surgery. Four areas of significant improvement are seen in patients in whom the SFT was used: (1) improved hearing in the high frequencies of 2000, 4000, and 8000 Hz, (2) improved speech discrimination scores, (3) a significant reduction in the number of reported vestibular complaints, and (4) a reduction in the number of serious postoperative sensorineural hearing losses.
The Pathology of Lupinosis of Sheep
Authors: Gardiner M. R. 
Published: July 2017

The gross- and histo-pathology in relation to the main clinical features of inappetence, loss of body weight and jaundice, of some 500 sheep in various stages of lupinosis is described. The gross changes occurring in the liver, the principal organ affected, of pen trial sheep receiving pure diets of toxic lupins were classified as (a) early, (b) subacute, and (c) chronic. The corresponding histological features were found to be (a) eosinophilic and nuclear degeneration of hepatocytes with or without granular formation in the cytoplasm, (b) accumulation of granular degenerated hepatocytes in centrilobular areas with proximate fibrosis, and (c) portal tract fibrosis, bile duct cell and Kupffer cell proliferations, and cirrhosis. The granular degenerated hepatocytes were found to be composed mainly of lipofuscins and haemosiderin with small admixtures of other cell decomposition products. Their probable derivation is by cellular peroxidation mechanisms under the influence of increased serum and liver iron and copper in association with toxins forming at times on lupin roughage. Haemosiderosis of liver, spleen and kidney was correlated along with nutritional deficits in the pathogenesis of lupinosis.
Pathology of Skull, Radius and Rib in Hypervitaminosis A of Young Calves
Authors: Grey R. M. , Nielsen S. W. , Rousseau J. E. , Calhoun M. C. , Eaton H. D. 
Published: July 2017

In an experiment to produce hypervitaminosis A, twenty-two Holstein calves, 3 months of age and with a plasma vitamin A of 10 μg/100 ml or less, were fed vitamin A levels of 18, 54, 4000, 12,000 or 16,000 μg/lb of body weight per day for a 12-week period, except for the 16,000 μg group which was terminated in 8 weeks. The long bones and skulls were examined by X-rays and histologically. The roentgenologic changes were a slowing of growth and remodeling processes in all calves on the 3 highest levels resulting in diminution of the overall size, thinning of the cortical bone and a marked decrease in the amount of spongious bone. Serial radiographs at weekly intervals of the radii of the calves on the highest level of vitamin A demonstrated changes as early as 2 weeks after administration of the vitamin supplement was begun. The gross pathologic changes correlated well with the radiographic findings, except that failure of the internal bony plates of the frontal sinuses to form was not detected in the radiographs. The lack of bony separation of the brain from the frontal sinuses and the expansion of the cerebrum into these sinuses may explain the decreased cerebrospinal fluid pressure which accompanied the dilated cerebral ventricles. Histologically, the essential change was retarded osteogenesis with poor differentiation of the mesenchymal cells into osteoblasts. As a result, the compacta was thin, osteoporotic and, at the 2 higher levels of vitamin A administration, contained large amounts of fibrous bone. As demonstrated in calves, the effect of excessive vitamin A on bone appears to be retardation of bone growth due to a defect in osteoid production resulting in osteoporosis.
Headache Temporal Patterns: Towards a Chronobiological Model
Authors: Nappi Giuseppe , Micieli Giuseppe , Sandrini Giorgio , Martignoni Emilia , Lottici Patrizia , Bono Giorgio 
Published: July 2017

Rhythmical changes in terrain susceptibility and trigger occurrence can induce periodic temporal patterns in headache patients, with readily foreseeable frequency cycles of attacks. The impaired ability of biological functions to adjust to cyclic environmental changes represents the minus, the handicap, the increased risk of clinical symptomatology (headache); attacks occur when the precarious systems of these patients are forced by cyclical environmental stimuli towards phase shiftings or to cope with new levels of performance. A dyschronic hypothesis of primary headache must be based upon observations demonstrating that along with dysfunctions of the pain control systems there is also a vulnerability of the rhythmic physiological organization of CNS. On sait que les fluctuations de la “susceptibilité du terrain” et la succession rythmique d'évènements trigger différents sont à même de conditionner des profils céphalalgiques périodiques, tout à fait prévisibles dans leur caractère séquentiel. La perte de la capacité des fonctions biologiques de s'adapter aux oscillations ambiantes de nature cyclique représente le “minus”, le “handicap”, le risque accru d'une véritable symptomatologie (céphalée); les crises se manifestent au moment où les stimuli ambients périodiques contraignent les systèmes neuronals précaires de ces patients à un glissement de phase ou à faire face à de nouveaux niveaux critiques d'activité. Une hypothèse dyschronique des céphalées primaires doit se fonder sur des observations démontrant qu'il existe aussi, dans ces patients, à côté du trouble des systèmes préposés au contrôle et à la perception des stimuli nociceptifs, une vulnérabilité de l'organisation physiologique rythmique du SNC. E’ di rilievo comune come fluttuazioni della “suscettibilità di terreno” ed il succedersi ritmico di vari eventi trigger siano in grado di condizionare profili cefalalgici periodici, ampiamente prevedibili nella loro sequenzialità. La perdita della capacità delle funzioni biologiche di adattarsi alle oscillazioni ambientali di natura ciclica costituisce il “minus”, l’ “handicap”, l'aumentato rischio di sintomatologia vera e propria (cefalea); le crisi si manifestano nel momento in cui stimoli ambientali periodici sollecitano i precari sistemi neuronali di questi pazienti a slittare di fase o far fronte a nuovi livelli critici di attività. Un'ipotesi discronica delle cefalee primarie deve fondarsi su osservazioni che dimostrino come in questi pazienti, a lato della disfunzione dei sistemi preposti al controllo ed alla percezione degli stimoli nocicettivi, una vulnerabilità anche esista della fisiologica organizazione ritmica del SNC.
Evaluation of central opioid tonus in menstrual migraine
Authors: Petraglia F. , Martignoni E. , Sola D. , Cicoli C. , Facchinetti F. , Nappi G. , Genazzani A. R. 
Published: July 2017

The aim of this study is to make an evaluation of the activity of endogenous opioid tonus in patients affected by menstrual migraine. We tested the LH response to naloxone injection, an opiate receptor antagonist, in 18 migraineurs in the early and late luteal periods going towards the attacks. The lack of any response in the latter group demonstrates an opioid disregulation in this kind of pathology. Notre but a été l'études des eventuelles variation du systèm opioide chez des patientes souffrantes de maladie migraineuse en phase premenstruelle. On a mesurés la reponse de la LH a la stimulation par le Naloxone, antagoniste des recepteurs aux opiates, chez 18 femmes souffrantes de maladie migraineuse, en phase luteale moyenne et tardive. Pendants les jours immediatements precedents les règles, cette réponse a totalment fallu etant condictionnée positivement par l'augmentation du rapport Progesterone/Estradiole. Ces donnés demontrent l'existence, chez ces patientes, d'une alteration du tonus opioides. Scopo della presente ricerca è la valutazione delle modificazioni del tono oppioide centrale nel corso del ciclo mestruale di pazienti affette da cefalea catameniale. E stata valutata la risposta dei tassi plasmatici di LH alla stimolazione endovenosa con Naloxone, antagonista dei recettori per gli oppioidi, in 18 pazienti nel corso della fase luteale media e tardive del ciclo mestruale. In fase premestruale questa risposta neuroendocrina è totalmente assente e sembra essere modulata dal rapporto Progesteron/Estradiolo, sostenedo l'esistenza di una sregolazione del tono oppioide nelle cefalee catameniali.