bluuebunny/crossref_metadata_2025_split huggingface dataset:
Oxygen therapy in patients with chest pain of acute onset: single centre audit experience
Authors: Lagan Jakub , Garg Pankaj , Tang Joseph MF , Burgess Malcolm 
Published: May 2014

Introduction: Although oxygen therapy has been commonly used in the treatment of acute coronary syndromes, evidence shows that oxygen administration is not always beneficial to patients with acute chest pain and in certain circumstances may, in fact, be harmful. Hence, several national and international organizations have issued guidelines restricting its use to hypoxic patients only. Aim: To audit and change the inappropriate practice of administering oxygen therapy indiscriminately to patients with acute chest pain. Setting: Emergency department, coronary care unit and heart assessment centre in a large teaching hospital. Methods: The authors identified 100 patients who presented with acute chest pain and collected data on oxygen prescription, administration and documentation from clinical notes and observation charts. Results: Only 71% of patients in a hospital setting were correctly assessed for requiring oxygen therapy. After introducing local guidelines and a series of lectures, this rose to 94%. A third audit showed sustained change, with 96% of patients being appropriately assessed for needing oxygen therapy. Discussion: The introduction of local guidelines and a series of lectures improved handling of oxygen in patients presenting with acute chest pain.
Ciprofloxacin-induced oral facial dyskinesia in a patient with normal liver and renal function
Authors: Lee Chi-hang , Cheung Raymond Tak-fai , Chan Tak-mao 
Published: May 2014

A 49-year-old Chinese woman with good past health presented to a general practitioner with fever, chills, dysuria, and loin pain. Urinary tract infection was diagnosed and she was treated with oral ciprofloxacin. She was hospitalized because of persistent chills and fever. Physical examination showed hyperpyrexia of 38.6°C, together with suprapubic and bilateral loin tenderness. White cell count was 11.2×109/litre. Ultrasonogram of kidneys showed no structural abnormality. She was treated as having acute pyelonephritis with ciprofloxacin 200 mg intravenously twice daily. Her symptoms improved. Urine and blood culture yielded negative results. She developed involuntary facial grimacing 2 days after starting ciprofloxacin treatment. Neurological examination did not reveal other abnormal findings. Her only other medication was paracetamol 500 mg orally four times a day. She had no prior history of similar involuntary movements. The oral facial dyskinesia occurred intermittently every 4–6 hours, with each attack lasting about an hour. She maintained a clear sensorium during the involuntary movements. Computed tomography and magnetic resonance imaging of the brain, as well as lumbar puncture, yielded normal results. Electroencephalogram showed normal wave form. The levels of liver transaminases were raised transiently after starting ciprofloxacin treatment, with aspartate aminotransferase 82 U/litre (normal 12–28 U/litre) and alanine aminotransferase 176 U/litre (normal 5–31 U/litre). Serum albumin, bilirubin, prothrombin time and creatinine levels were normal. The involuntary movements improved slightly with clonazepam therapy, but did not subside completely. In view of the possibility of ciprofloxacin-induced neurotoxicity, ciprofloxacin was stopped and substituted with netromycin. Her oral facial dyskinesia stopped and did not recur. The patient had an uneventful recovery.
Giant urethral calculi
Authors: Shanmugam TV , Dhanapal V , Rajaraman T , Chandrasekar CPM , Balashanmugam K Pitchai 
Published: May 2014

A60-year-old man presented with a complaint of a hard mass in the subnavicular fossa for the past 10 years. He had had minimal discomfort in micturition for the past 2 years but was able to manage with it. He had a history of passing a calculus of 1 cm diameter 15 years ago. On examination, a hard mass of 7×5×4 cm was palpable in the subnavicular fossa (Figure 1). Rectal examination was normal. Urine culture and sensitivity showed no growth, the renal parameters, metabolic work-up, plain X-ray and ultrasound scans of the kidney, ureter and bladder area were all normal. X-ray of the penis showed a large calculus in the subnavicular fossa Meatotomy was done and a calculus of 6×4×3.5 cm was extracted (Figure 2), which weighed 40 g. The meatus was reconstructed with Blandy's flap. The postoperative period was uneventful.
A therapeutic dilemma: atrial fibrillation, transient ischaemic attacks and an unruptured intracranial aneurysm
Authors: Larner AJ , Humphrey PRD , Rose EL 
Published: May 2014

Within 1 month, a 69-year-old right-handed man had three episodes of weakness of sudden onset affecting the left arm and face, followed by complete recovery within 10 minutes to 2 hours. He was a non-smoker, but had been diagnosed with hypertension 4 months earlier, treated with bendrofluazide. The neurological examination was normal, but he was in atrial fibrillation (ventricular rate >100/min) with a blood pressure of 160/70 mmHg. There were no carotid bruits. Transthoracic echocardiogram, carotid doppler ultrasonography and computed tomography (CT) of the brain were all normal. A diagnosis of transient ischaemic attacks (TIAs) was made, probably caused by emboli of cardiac origin. He was commenced on sotalol (40 mg twice daily) to attempt to prevent further attacks of atrial fibrillation. The use of anticoagulation was also considered. In the past medical history, an episode of right-sided weakness of sudden onset, lasting 5 hours with complete recovery, had occurred 8 years earlier. CT brain scan at that time showed a high density lesion in the left internal capsule; it was not possible to decide whether this was haemorrhage into an infarct or a primary intracerebral haemorrhage from a left middle cerebral artery aneurysm. Cerebral angiography showed a small saccular aneurysm close to the trifurcation of the right (sic) middle cerebral artery. This lesion was thought incidental to the clinical history and, because of its size, surgery was not advised. Interval magnetic resonance angiography 3 and 6 years later showed no change in aneurysm size (<2 mm) and management remained conservative. Despite the evidence supporting anticoagulation to prevent stroke in patients with atrial fibrillation, it was initially thought that this treatment would be contraindicated by the presence of an unruptured intracranial aneurysm. However, in the absence of evidence specific to this clinical situation (see discussion), the available data suggested that benefits of anticoagulation (stroke prevention) outweighed (haemorrhagic) risk in this patient. These issues were discussed with the patient who decided to opt for anticoagulation. Close monitoring to maintain an international normalized ratio between 2.0 and 2.5 was the aim. After 12 months of follow up the patient remained well with no further TIAs and no complications.
Mistaken identity: calcific tendinitis in the finger
Authors: Huntley JS , Mr TW 
Published: May 2014

A42-year-old woman presented to the emergency department with pain and restricted movement in her right (dominant) index finger. The symptoms had been present for 10 weeks but were increasing in severity. There had been no antecedent trauma or repetitive use. She had a past history of low back pain and stiffness which had been investigated by the rheumatology department. Her white cell count, plasma viscosity, Creactive protein level and lumbar spine radiographs were all normal. She was not HLAB27 positive. On examination she was apyrexial with no lymphadenopathy. There was minor swelling and focal tenderness on the volar side of the proximal interphalangeal joint of the right index finger, but the finger had a complete range of movement. A radiograph (Figure 1a) showed two small areas of sclerosis volar to the proximal interphalangeal joint, coincident with the site of tenderness. The diagnosis of a fracture through a sesamoid bone was postulated. Laboratory investigations, including serum urate, were unrevealing. The patient was referred to the fracture clinic where this diagnosis was initially accepted, but no specific treatment instigated. She was followed up 3 months later, by which time her symptoms had completely resolved. A repeat radiograph (Figure 1b) showed that the calcification had disappeared, allowing the retrospective diagnosis of calcific tendinitis
Examine the patient first, then look at the X-ray
Authors: Anderson WR , Davies RJ , Cave APD 
Published: May 2014

A56-year-old woman was admitted acutely with sepsis of unknown origin. She described a 2-day history of offensive-smelling urine, rigors and lower abdominal pain. Her axillary temperature was 39.6°C, her white cell count was 24.2x109/litre and a midstream urine analysis showed a large numbers of white cells. She was treated with intravenous antibiotics and subsequent urine culture grew Escherichia coli and Proteus species. An abdominal ultrasound scan revealed a highly echogenic linear structure within the bladder (Figure 1). Plain abdominal radiography indicated that this was a clinical thermometer (Figure 2). Once clinically stable, she proceeded to cystoscopy under general anaesthetic, with endoscopic extraction of an intact but highly-encrusted mercury thermometer (Figure 3). Her subsequent recovery was uneventful. The patient adamantly denied placing the thermometer within her own bladder. Instead, she believed that someone had mistaken her urethra for her anus when measuring her rectal temperature several years earlier. However, the most interesting feature of this case is not the X-ray appearance itself. Most notably, it was discovered that, while living elsewhere, her previous GP had organized a plain abdominal X-ray 1 year beforehand to investigate her recurrent urinary tract infections. This film was reported as being normal, but the following comment was made: ‘The patient appears to have been lying on a thermometer when the X-ray was taken. This is an artefact.’ No further tests were ordered at that time as her symptoms subsequently settled.
Cerebral sinus thrombosis in a young adult with activated protein C resistance and homocysteinaemia
Authors: Ghalib Mohammad BM , Hassan Imad SA 
Published: May 2014

A man of 28 years of age with no past history of note was admitted with a history of progressive severe diffuse headache, nausea, vomiting, blurring of vision and diplopia of 3 weeks' duration. He denied any fever or recent head trauma and had no preceding ear, nose or throat symptoms. He occasionally experienced oral ulcers, usually when he missed his routine daily brushing of his teeth. He denied having any genital ulcers. He never smoked and did not drink alcohol. He had a brother who died at a young age from possible thrombosis. His mother developed leg deep venous thrombosis after her first child was born. His father was diabetic. He worked as an interpreter. On examination, he looked ill and was slightly drowsy. He was afebrile, in sinus rhythm and normotensive. The major findings were confined to the nervous system. He had bilateral sixth nerve palsy and bilateral papilloedema, more pronounced on the right side. There were no other neurological signs. Ear, nose and throat examinations were normal. Magnetic resonance imaging of the brain showed a right sigmoid and superior sagittal sinus thrombosis with no cerebral infarction (Figures 1, 2 and 3). Full blood count, erythrocyte sedimentation rate, liver, renal and thyroid function and glucose levels were all normal. His vitamin B12 level was 694 pg/ml (normal 180–710 pg/ml). Autoantibodies including antinuclear antibodies, double-stranded DNA and antineutrophil cytoplasmic antibodies were negative. Cryoglobulins, anticardiolipin antibody, haemoglobin electrophoresis, immunoglobulin levels, antithrombin III, protein C and protein S were all normal or negative. Homocysteine level was markedly raised (confirmed on repetition) at 48.5 μmol/litre (normal <10.3 μmol/litre). Activated protein C ratio was low (less than 2) suggesting resistance. Genotypic confirmation for factor V Leiden mutation was not possible. He was fully anticoagulated with intravenous heparin and later warfarin was started. The international normalized ratio was kept between two and three. Dexamethasone at a dose of 4 mg intravenously 6-hourly was added initially and slowly tapered over a 3-week period. He gradually improved with complete resolution of his headaches, ocular palsies and papilloedema.
Vaccination metastasis following percutaneous endoscopic gastrostomy
Authors: Raman S , Siddiq TO , Joseph A , Jones AH , Masoud AG , Haray PN 
Published: May 2014

A 72-year-old woman presented in April 2001 with a history of progressive dysphagia to solids of 4 months’ duration with associated weight loss. An initial gastroscopy was unsuccessful. Examination under anaesthetic by the ear, nose and throat surgeons revealed a fungating, posterior hypopharyngeal wall tumour extending to the lateral walls of both pyriform fossae and up to 22 cm of the cervical oesophagus distally (Figure 1). Histology of the lesion showed it to be a squamous cell carcinoma. Computed tomography of the neck showed bilateral involvement of level 3 and 4 cervical lymph nodes and the tumour was staged as T4 N2. A decision was made to treat the patient with chemoradiotherapy because the tumour was large and exophytic. On May 1 2001, a Freka® (Fresenius Kabi, Hamburg, Germany) percutaneous endoscopic gastrostomy (PEG) tube was placed under anaesthetic, using the pull (Ponsky-Gauderer) technique, for feeding purposes before the planned oncological management. Between May and December 2001, the patient underwent a course of chemoradiotherapy. This period was complicated by neutropenic sepsis, mucositis, confusional state and peripheral neuropathy (secondary to cisplatin therapy), but responded to conservative management. A computed tomography scan of the head excluded cerebral metastases. Follow up in January 2002 showed complete clearance of the hypopharyngeal tumour and hence a decision was made to wean her off the PEG feeding and encourage an oral diet. At the time of removal of PEG tube in April 2002, nearly a year after insertion, the PEG site appeared to show an overproliferation of granulation tissue (Figure 2). This was surgically debrided, and histology showed this to be a well-differentiated keratinizing squamous cell carcinoma (Figure 3) identical to the primary hypopharyngeal lesion, raising the possibility of tumour implantation secondary to the pull technique used for PEG tube insertion. Gastroscopy confirmed tumour infiltration (Figure 4) into the lumen of stomach, and biopsy of this also proved to be of squamous cell carcinoma. Further staging investigations revealed the advanced nature of the tumour with liver metastases and hence she was referred for palliative radiotherapy. Radiotherapy alleviated the malodour from the tumour and also bleeding and overproliferation. She died peacefully in October 2002, about 6 months after the diagnosis of the stomal site cancer.
Contact lens related microbial keratitis – avoidable blindness
Authors: Tallouzi Mohammad , Khodabukus Rehana 
Published: May 2014

Aim: The aim of this article is to review the literature on microbial keratitis, exploring the pathophysiology, causes, diagnosis, and management strategies of this ocular condition which can lead to blindness and can be avoided. The main focus is contact lens-related microbial keratitis. The author analyzed some statistics for this condition from his work place (Birmingham and Midland eye hospital) in order to provide an indication of the number of patients attending the eye hospital with contact lens-related microbial keratitis and non contact lens-related microbial keratitis. Methods: Extensive review of the literature on microbial keratitis and a retrospective review of all cases with contact lens-related microbial keratitis over a period of 4 months (August 2010 and November 2010). Case files were retrieved and relevant information was extracted and analyzed. Results: The data collected indicated that 192 patients attended the eye casualty with contact lens-related problems. Out of these 110 cases were diagnosed as infective microbial keratitis and were treated with intensive antibiotics. Conclusion: Microbial keratitis is one of the main eye traumas for people using contact lenses and can lead to blindness. One feature of bacterial keratitis is rapid progression if left untreated — microbial keratitis is a true ocular emergency that requires immediate and intensive evaluation and treatment. Understanding the pathophysiology of microbial keratitis and its relationship to contact lenses is key in choosing the right treatment and ensuring a good prognosis.
Contact lenses and teenagers
Authors: Speedwell Lynne 
Published: May 2014

Teenagers' contact lens requirements differ from those of adults. The reasons for wanting lenses are similar, but the emphasis varies. Extra caution is needed when fitting adolescents due to the difference in their attitude to lenses and lens care and also to hormonal effects. The practitioner must explain to both the patient and their parent about the choice of lenses and the importance of lens hygiene. Information must be given in a format that will be of interest to a teenager if it is to have the desired effect. On the whole teenagers do well with contact lenses, which not only provide a visual aid, but also improve self perceptions and boost self confidence as they mature. This article discusses the aspects that must be considered for teenage patients and ways of overcoming problems that can occur.
Assessing reading and visual processing skills of young struggling readers: a pilot study
Authors: Northway Nadia 
Published: May 2014

Aim: A pilot study was conducted between September 2010 and May 2011 to determine the nature of visual processing problems that might be affecting children aged 7–9 who were struggling to learn to read. Methods: A full eye test and binocular vision assessment were conducted. In addition assessment for visual stress using coloured overlays and a measure of reading level and speed were taken. Results: The results showed that about one fifth of the children had problems with binocular vision and/or visual stress and that correction of these visual difficulties had a positive effect on reading development. The possible benefits may differ depending on the nature of reading difficulties, for example slow but average readers gained in reading speed, whereas children with low reading levels saw improvements in level rather than speed gains. Conclusions: It would appear that assessing visual processing by eye care professionals is recommended due to the high number of children who had binocular vision problems and visual stress who were struggling to learn to read.
Fundus autofluorescence — with the Canon CR-2 PLUS
Authors: Månsson Mirjam , Brautaset Rune , Ramsay Marika Walberg , Nilsson Maria 
Published: May 2014

The aim of this report is to describe the principles of the fundus autofluorescence (FAF) technique, and to illustrate common findings in normal and abnormal ocular conditions by presenting both colour and FAF images captured with the Canon CR-2PLUS™. The colour and FAF images are discussed in relation to scientifically published reports on FAF findings in similar ocular conditions and with other FAF cameras. Based on our experience the FAF images should be regarded as a supplement to colour fundus images and has highest relevance when it comes to slow progressing conditions rather than acute conditions. At present the knowledge about what FAF shows and how it should be interpreted is broad, and it seems likely that the technique will have a future not only in research and highly specialized retinal evaluations, but also in daily clinical work.
A study of staff support mechanisms within children’s hospices
Authors: Baverstock Anna C , Finlay Fiona O 
Published: May 2014

Objective: To establish what staff support mechanisms are currently in place within children’s hospices in the UK looking specifically at ‘individual’ staff support including mentoring and ‘team’ staff support including the use of debriefs. Design: A self-administered postal questionnaire study. Setting: Children’s hospices in the UK. Main outcome measures: Looking at: use of team meetings; use and content of team debrief; availability of a bereavement counsellor for staff; availability of individual staff mentor and/ or clinical supervisor and availability of internal and external training for staff. Results: There was a 76% response rate. Of the hospices that responded 100% of these held team meetings, had access to a bereavement counsellor and ‘in house training’ and 88% held a debrief after a significant or traumatic event. Conclusions: Looking after staff who care for dying children and their families is a priority. Children’s hospices have good support structures in place for staff – the acute sector has much to learn.
Developing an educational programme in paediatric palliative care
Authors: Price Jayne , McNeilly Patricia 
Published: May 2014

Paediatric palliative care has increasingly been recognised as a specialist area of practice. Essentially it is a holistic approach to care that embraces a range of elements concerned with not only the management of symptoms but also the psychosocial and spiritual needs of the child and family through death and bereavement. Children requiring palliative care represent a diverse patient group whose illness trajectories are often prolonged and unpredictable and this creates much stress for children themselves, their families and professionals who support them (Price and McFarlane, 2006). Such an approach to care is unique and the development of paediatric palliative care educational programmes requires careful and thorough planning, with the specific needs of the child and family being pivotal to the process. This article recounts the development of the first paediatric palliative care programme in Ireland using the curricular cycle described by Peyton (1998).
A practical guide for nurses in diluent selection for subcutaneous infusion using a syringe driver
Authors: McLeod Fiona , Flowers Charne 
Published: May 2014

Appropriate diluent selection in continuous subcutaneous infusion optimises symptom management and client well-being. The responsibility of diluent selection is commonly one of the attending nurse. This paper was developed with the intention of providing nurses with practical instruction for diluent selection when preparing medications for administration subcutaneously using a syringe driver. A literature review was undertaken of published journal databases and published guidelines sites. Recommendations regarding diluent choice were reviewed in two iterations by an expert panel of palliative care nurse clinicians. The principles for diluent selection are presented. They are based primarily on expert opinion level of evidence given a lack of primary research evidence in the area of diluent selection. There is a pressing need for manufacturers’ guidance on diluent selection and independent research to establish the impact of diluents on drug and drug combinations when using syringe drivers. Until such time that this evidence is available to guide practice, clinicians need to be trained to inspect solutions and assess the effectiveness of the medication in controlling symptoms. The capacity of this paper to provide practical instruction has been limited by the lack of rigorous evidence available, and indeed, the process of developing this guide identified perhaps more questions than answers available at the present time.