bluuebunny/crossref_metadata_2025_split huggingface dataset:
Alterations in cortical and extrastriatal subcortical dopamine function in schizophrenia: systematic review and meta-analysis of imaging studies
Authors: Kambeitz Joseph , Abi-Dargham Anissa , Kapur Shitij , Howes Oliver D. 
Published: June 2014

BackgroundThe hypothesis that cortical dopaminergic alterations underlie aspects of schizophrenia has been highly influential.AimsTo bring together and evaluate the imaging evidence for dopaminergic alterations in cortical and other extrastriatal regions in schizophrenia.MethodElectronic databases were searched for in vivo molecular studies of extrastriatal dopaminergic function in schizophrenia. Twenty-three studies (278 patients and 265 controls) were identified. Clinicodemographic and imaging variables were extracted and effect sizes determined for the dopaminergic measures. There were sufficient data to permit meta-analyses for the temporal cortex, thalamus and substantia nigra but not for other regions.ResultsThe meta-analysis of dopamine D2/D3 receptor availability found summary effect sizes of d =–0.32 (95% CI −0.68 to 0.03) for the thalamus, d =–0.23 (95% CI −0.54 to 0.07) for the temporal cortex and d = 0.04 (95% CI −0.92 to 0.99) for the substantia nigra. Confidence intervals were wide and all included no difference between groups. Evidence for other measures/regions is limited because of the small number of studies and in some instances inconsistent findings, although significant differences were reported for D2/D3 receptors in the cingulate and uncus, for D1 receptors in the prefrontal cortex and for dopamine transporter availability in the thalamus.ConclusionsThere is a relative paucity of direct evidence for cortical dopaminergic alterations in schizophrenia, and findings are inconclusive. This is surprising given the wide influence of the hypothesis. Large, well-controlled studies in drug-naive patients are warranted to definitively test this hypothesis.
Manual-assisted cognitive therapy for self-harm in personality disorder and substance misuse: a feasibility trial
Authors: Davidson Kate M. , Brown Tom M. , James Vairi , Kirk Jamie , Richardson Julie 
Published: June 2014

Aims and methodTo assess the feasibility of conducting a larger, definitive randomised controlled trial of manual-assisted cognitive therapy (MACT), a brief focused therapy to address self-harm and promote engagement in services. We established recruitment, randomisation and assessment of outcome within a sample of these complex patients admitted to a general hospital following self-harm. We assessed symptoms of depressed mood, anxiety and suicidality at baseline and at 3 months' follow-up.ResultsTwenty patients were randomised to the trial following an index episode of self-harm, and those allocated to MACT demonstrated improvement in anxiety, depression and suicidal ideation.Clinical implicationsIt is feasible to recruit a sample of these complex patients to a randomised controlled trial of MACT following an index episode of self-harm. There is preliminary support that MACT could be an acceptable and effective intervention in patients with personality disorder and substance misuse.
Standardised patients with intellectual disabilities in training tomorrow's doctors
Authors: Thomas Bini , Courtenay Ken , Hassiotis Angela , Strydom Andre , Rantell Khadija 
Published: June 2014

Aims and methodTo develop a programme to help undergraduate medical students and postgraduate trainees to improve their skills in communicating with people with intellectual disabilities through teaching sessions that had input from simulated patients with intellectual disabilities. We conducted four sessions of training for 47 undergraduate 4th-year medical students. The training involved a multiprofessional taught session followed by a clinical scenario role-play with simulated patients who were people with intellectual disabilities. The training was assessed by completing the healthcare provider questionnaire before and after the training.ResultsThere were improvements in the students' perceived skill, comfort and the type of clinical approach across all three scenarios.Clinical implicationsBy involving people with intellectual disabilities in training medical students there has been a significant improvement in students' communication skills in areas of perceived skills, comfort and type of clinical approach which will raise the quality of care provided by them in the future.
Undertaking clinical audit, with reference to a Prescribing Observatory for Mental Health audit of lithium monitoring
Authors: Paton Carol , Barnes Thomas R. E. 
Published: June 2014

SummaryAudit is an important tool for quality improvement. The collection of data on clinical performance against evidence-based and clinically relevant standards, which are considered by clinicians to be realistic in routine practice, can usefully prompt reflective practice and the implementation of change. Evidence of participation in clinical audit is required to achieve intended learning outcomes for trainees in psychiatry and revalidation for those who are members of the Royal College of Psychiatrists. This article addresses some of the practical steps involved in conducting an audit project, and, to illustrate key points, draws on lessons learnt from a national, audit-based, quality improvement programme of lithium prescribing and monitoring conducted through the Prescribing Observatory for Mental Health.
Prescribing for personality disorder: qualitative study of interviews with general and forensic consultant psychiatrists
Authors: Martean Lawrence , Evans Chris 
Published: June 2014

Aims and methodTo explore experiences of psychiatrists considering medication for patients with personality disorder by analysis of transcribed, semi-structured interviews with consultants.ResultsThemes show important relational processes in which not prescribing is expected to be experienced as uncaring rejection, and psychiatrists felt helpless and inadequate as doctors when unable to relieve symptoms by prescribing. Discontinuity in doctor–patient relationships compounds these problems.Clinical implicationsProblems arise from: (a) the psychopathology creating powerful relational effects in consultation; (b) the lack of effective treatments, both actual and secondary to under-resourcing and neglect of non-pharmaceutical interventions; and (c) the professionally constructed role of psychiatrists prioritising healing and cure through provision of technological interventions for specific diagnoses. There is a need for more treatments and services for patients with personality disorder; more support and training for psychiatrists in the relational complexities of prescribing; and a rethink of the trend for psychiatrists to be seen primarily as prescribers.
Russian Far East Regions’ Economic Development Stability
Authors: Басовский  , Basovskiy Leonid , Басовская  , Basovskaya Elena 
Published: June 2014

A technique of regions’ economic development stability assessment has been
stated. The technique is based on diagnosing of economic growth stability loss
by an assessment of economic growth rate dispersion. The economic growth
instability risk is estimated by an indicator reflecting a relative variation of
economic growth rates. Regions of Far East Federal District: Republic of Sakha
(Yakutia), Kamchatka Krai, Primorsky Krai, Khabarovsk Krai, Amur Region,
Magadan Region, Jewish Autonomous Region, Chukotka Autonomous District,
Sakhalin Region have been investigated. Statistical data during 2000–2011 have
been used. It has been established that regions significantly differ ones from
others on the periods of sustainable and unstable development and economic
growth instability degree. It has been revealed that economy of most regions of
the Far East Federal District develops unstably. An exception is Primorsky Krai
which develops more stably.
Economic development instability indicators significantly influence on a level of
investments into region economy. On a sample of regions the economic
development instability explains not less than 30% reduction of investment
level, that allows consider economic development instability impact on
investment climate in the region as significant.
The value of preceptorship for newly qualified midwives
Authors: Feltham Christina 
Published: June 2014

The aim of the study was to examine the views and learning needs of student midwives at the point of registration in order to inform the development of a new preceptorship programme for newly qualified midwives using a qualitative phenomenological approach. Ten third year student midwives enrolled on an undergraduate BSc Midwifery programme were included in the study. Questionnaires and a focus group session were employed to collect data. Eight students returned the questionnaire and nine attended the focus group. Data were thematically analysed using an inductive approach. The results suggest that preceptorship is highly valued by the students questioned and a period of preceptorship in a maternity unit they are familiar with was highlighted as being important in building confidence. It was also suggested that preceptorship programmes should focus on clinical skills enhancement, ward management and socialisation into the workplace.
Factors influencing post-stroke rehabilitation participation after discharge from hospital
Authors: Koh Wei Ling E , Barr Christopher J , George Stacey 
Published: June 2014

Aim: To explore what the obstacles are that deter patients from continuing stroke rehabilitation after discharge from hospital in Singapore. Methods: In this qualitative study, individual semi-structured telephone interviews were undertaken and analysed using inductive thematic analysis. Thirty one stroke patients, who had been discharged from the hospital after inpatient rehabilitation (mean age=66.46 years, mean duration post-discharge=95.82 days), were interviewed. Results: Five themes were identified as obstacles to post-discharge stroke rehabilitation including: the means to access rehabilitative services; lapse in discharge coordination; family members’ views and actions; discrepancies in expectation; and the perception that rehabilitation is simple. Participants indicated a need for timely and appropriate information, delivered according to their individualised needs. Conclusion: Study findings revealed that the absence of a smooth transition through the continuum of stroke care and not having a common understanding of rehabilitation accounts for the lack of adherence to therapy recommendations. The results suggest that clinicians need to be more aware of their role in providing well-coordinated information about therapy. The study also highlighted the need to review the goal-setting processes that guide the course of rehabilitation. Goals should be more patient-centred to reduce the discrepancies in expectations of rehabilitation. There needs to be a greater involvement of carers in discharge planning to minimise the dissatisfaction in care arrangements and information delivery.
Rebuilding identity after brain injury: Standard cognitive and music-evoked autobiographical memory training
Authors: Gurr Birgit , Foxhall Mia , Shinoda Jun , Baird Amee 
Published: June 2014

Background:This paper presents a report involving a male patient who had experienced a subarachnoid haemorrhage. He presented with profound anterograde and retrograde amnesia, which caused him to be severely confused about his social contacts and his environment.Aim:To describe the complexity of amnesia and identity loss and examine how the combination of cognitive and music-evoked autobiographical training affected a person with anterograde and retrograde amnesia following subarachnoid haemorrhages (acquired brain injury [ABI]).Method:The 47-year-old male patient, who had worked as a DJ for some parts of his life previously had a good memory of musical events and facts about musical artists. This patient received an applied cognitive training programme (part I), which was based on spaced retrieval and errorless learning methods. The patient also received therapy involving the administration of music-evoked emotional responses (part II). The cognitive training programme consisted of 13 hourly sessions spread over four weeks. The music-based intervention included 5 hourly sessions, which took part place over two weeks.Results:Part I optimised the patient's name recall and local orientation. The resulting recovery of day-to-day memory and the awareness of the dependence on learning strategies led to the patient having a realisation of his severe loss of autobiographical memory. The patient became frustrated, angry and depressed and was at risk of disengaging from most areas of his neuro-rehabilitation programme. Part II enabled the patient to link the music or the artist with autobiographical events and to elicit emotional responses to such events. These were stringed into an autobiographical narrative with the result that the patient gained insight into the person he used to be and connected with past emotional experiences. The regained autobiographical memories were maintained beyond the training context.Conclusion:The patient's mood and motivation to continue his neuro-rehabilitation programme improved. This enabled him to make further progress regarding his functional independence.
Staged bilateral total knee replacement
Authors: Scott C. E. H. , Murray R. C. , MacDonald D. J. , Biant L. C. 
Published: June 2014

We explored the outcome of staged bilateral total knee replacement (TKR) for symmetrical degenerative joint disease and deformity in terms of patient expectations, functional outcome and satisfaction. From 2009 to 2011, 70 consecutive patients (41 female) with a mean age of 71.7 years (43 to 89) underwent 140 staged bilateral TKRs at our institution, with a mean time between operations of 7.8 months (2 to 25). Patients were assessed pre-operatively and at six and 12 months post-operatively using the Short Form-12, Oxford knee score (OKS), expectation questionnaire and satisfaction score. The pre-operative OKS was significantly worse before the first TKR (TKR1), but displayed significantly greater improvement than that observed after the second TKR (TKR2). Expectation level increased from TKR1 to TKR2 in 17% and decreased in 20%. Expectations of pain relief and stair-climbing were less before TKR2; in contrast, expectations of sporting and social activities were greater. Decreased expectations of TKR2 were significantly associated with younger age and high expectations before TKR1. Patient satisfaction was high for both TKR1 (93%) and TKR2 (87%) but did not correlate significantly within individuals. We concluded that satisfaction with one TKR does not necessarily translate to satisfaction following the second. Cite this article: Bone Joint J 2014;96-B:752–8.
A comparative study of the use of bioactive glass S53P4 and antibiotic-loaded calcium-based bone substitutes in the treatment of chronic osteomyelitis
Authors: Romanò C. L. , Logoluso N. , Meani E. , Romanò D. , De Vecchi E. , Vassena C. , Drago L. 
Published: June 2014

The treatment of chronic osteomyelitis often includes surgical debridement and filling the resultant void with antibiotic-loaded polymethylmethacrylate cement, bone grafts or bone substitutes. Recently, the use of bioactive glass to treat bone defects in infections has been reported in a limited series of patients. However, no direct comparison between this biomaterial and antibiotic-loaded bone substitute has been performed. In this retrospective study, we compared the safety and efficacy of surgical debridement and local application of the bioactive glass S53P4 in a series of 27 patients affected by chronic osteomyelitis of the long bones (Group A) with two other series, treated respectively with an antibiotic-loaded hydroxyapatite and calcium sulphate compound (Group B; n = 27) or a mixture of tricalcium phosphate and an antibiotic-loaded demineralised bone matrix (Group C; n = 22). Systemic antibiotics were also used in all groups. After comparable periods of follow-up, the control of infection was similar in the three groups. In particular, 25 out of 27 (92.6%) patients of Group A, 24 out of 27 (88.9%) in Group B and 19 out of 22 (86.3%) in Group C showed no infection recurrence at means of 21.8 (12 to 36), 22.1 (12 to 36) and 21.5 (12 to 36) months follow-up, respectively, while Group A showed a reduced wound complication rate. Our results show that patients treated with a bioactive glass without local antibiotics achieved similar eradication of infection and less drainage than those treated with two different antibiotic-loaded calcium-based bone substitutes. Cite this article: Bone Joint J 2014; 96-B:845–50.
Autologous wound drains have no effect on allogeneic blood transfusions in primary total hip and knee replacement
Authors: Thomassen B. J. W. , den Hollander P. H. C. , Kaptijn H. H. , Nelissen R. G. H. H. , Pilot P. 
Published: June 2014

We hypothesised there was no clinical value in using an autologous blood transfusion (ABT) drain in either primary total hip (THR) or total knee replacement (TKR) in terms of limiting allogeneic blood transfusions when a modern restrictive blood management regime was followed. A total of 575 patients (65.2% men), with a mean age of 68.9 years (36 to 94) were randomised in this three-arm study to no drainage (group A), or to wound drainage with an ABT drain for either six hours (group B) or 24 hours (group C). The primary outcome was the number of patients receiving allogeneic blood transfusion. Secondary outcomes were post-operative haemoglobin (Hb) levels, length of hospital stay and adverse events. This study identified only 41 transfused patients, with no significant difference in distribution between the three groups (p = 0.857). The mean pre-operative haemoglobin (Hb) value in the transfused group was 12.8 g/dL (9.8 to 15.5) versus 14.3 g/dL (10.6 to 18.0) in the non-transfused group (p < 0.001, 95% confidence interval: 1.08 to 1.86). Post-operatively, the median of re-transfused shed blood in patients with a THR was 280 mL (Interquartile range (IQR) 150 to 400) and in TKR patients 500 mL (IQR 350 to 650) (p < 0.001). ABT drains had no effect on the proportion of transfused patients in primary THR and TKR. The secondary outcomes were also comparable between groups. Cite this article: Bone Joint J 2014;96-B:765–71.
Graft-bending angle and femoral tunnel length after single-bundle anterior cruciate ligament reconstruction
Authors: Shin Y. S. , Ro K. H. , Jeon J. H. , Lee D. H. 
Published: June 2014

We used immediate post-operative in vivo three-dimensional computed tomography to compare graft bending angles and femoral tunnel lengths in 155 patients who had undergone single-bundle reconstruction of the anterior cruciate ligament using the transtibial (n = 37), anteromedial portal (n = 72) and outside-in (n = 46) techniques. The bending angles in the sagittal and axial planes were significantly greater but the coronal-bending angle was significantly less in the transtibial group than in the anteromedial portal and outside-in groups (p < 0.001 each). The mean length of the femoral tunnel in all three planes was significantly greater in the transtibial group than the anteromedial portal and outside-in groups (p < 0.001 each), but all mean tunnel lengths in the three groups exceeded 30 mm. The only significant difference was the coronal graft- bending angle in the anteromedial portal and outside-in groups (23.5° vs 29.8°, p = 0.012). Compared with the transtibial technique, the anteromedial portal and outside-in techniques may reduce the graft-bending stress at the opening of the femoral tunnel. Despite the femoral tunnel length being shorter in the anteromedial portal and outside-in techniques than in the transtibial technique, a femoral tunnel length of more than 30 mm in the anteromedial portal and outside-in techniques may be sufficient for the graft to heal. Cite this article: Bone Joint J 2014;96-B:743–51.
The treatment and outcome of peri-prosthetic infection of the ankle
Authors: Kessler B. , Knupp M. , Graber P. , Zwicky L. , Hintermann B. , Zimmerli W. , Sendi P. 
Published: June 2014

The treatment of peri-prosthetic joint infection (PJI) of the ankle is not standardised. It is not clear whether an algorithm developed for hip and knee PJI can be used in the management of PJI of the ankle. We evaluated the outcome, at two or more years post-operatively, in 34 patients with PJI of the ankle, identified from a cohort of 511 patients who had undergone total ankle replacement. Their median age was 62.1 years (53.3 to 68.2), and 20 patients were women. Infection was exogenous in 28 (82.4%) and haematogenous in six (17.6%); 19 (55.9%) were acute infections and 15 (44.1%) chronic. Staphylococci were the cause of 24 infections (70.6%). Surgery with retention of one or both components was undertaken in 21 patients (61.8%), both components were replaced in ten (29.4%), and arthrodesis was undertaken in three (8.8%). An infection-free outcome with satisfactory function of the ankle was obtained in 23 patients (67.6%). The best rate of cure followed the exchange of both components (9/10, 90%). In the 21 patients in whom one or both components were retained, four had a relapse of the same infecting organism and three had an infection with another organism. Hence the rate of cure was 66.7% (14 of 21). In these 21 patients, we compared the treatment given to an algorithm developed for the treatment of PJI of the knee and hip. In 17 (80.9%) patients, treatment was not according to the algorithm. Most (11 of 17) had only one criterion against retention of one or both components. In all, ten of 11 patients with severe soft-tissue compromise as a single criterion had a relapse-free survival. We propose that the treatment concept for PJI of the ankle requires adaptation of the grading of quality of the soft tissues. Cite this article: Bone Joint J 2014;96-B:772–7.
Outpatient Management of Heart Failure in the United States, 2006–2008
Authors: Mosalpuria Kailash , Agarwal Sunil K. , Yaemsiri Sirin , Pierre-Louis Bredy , Saba Samir , Alvarez Rene , Russell Stuart D. 
Published: June 2014

Better outpatient management of heart failure might improve outcomes and reduce the number of rehospitalizations. This study describes recent outpatient heart-failure management in the United States.
We analyzed data from the National Ambulatory Medical Care Survey of 2006–2008, a multistage random sampling of non-Federal physician offices and hospital outpatient departments.
Annually, 1.7% of all outpatient visits were for heart failure (51% females and 77% non-Hispanic whites; mean age, 73 ± 0.5 yr). Typical comorbidities were hypertension (62%), hyperlipidemia (36%), diabetes mellitus (35%), and ischemic heart disease (29%). Body weight and blood pressure were recorded in about 80% of visits, and health education was given in about 40%. The percentage of patients taking β-blockers was 38%; the percentage taking angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (ACEI/ARBs) was 32%. Medication usage did not differ significantly by race or sex. In multivariate-adjusted logistic regression models, a visit to a cardiologist, hypertension, heart failure as a primary reason for the visit, and a visit duration longer than 15 minutes were positively associated with ACEI/ARB use; and a visit to a cardiologist, heart failure as a primary reason for the visit, the presence of ischemic heart disease, and visit duration longer than 15 minutes were positively associated with β-blocker use. Chronic obstructive pulmonary disease was negatively associated with β-blocker use. Approximately 1% of heart-failure visits resulted in hospitalization.
In outpatient heart-failure management, gaps that might warrant attention include suboptimal health education and low usage rates of medications, specifically ACEI/ARBs and β-blockers.