bluuebunny/crossref_metadata_2025_split huggingface dataset:
Rare and unusual dementias
Authors: Gupta Susham , Fiertag Olivia , Warner James 
Published: August 2009

SummaryOver 95% of cases of dementia are attributable to Alzheimer's disease, vascular, Lewy body and frontotemporal dementia, and a few other common causes. In this article we consider some of the rare and unusual causes that account for the remaining 5%. Categorising them according to aetiological group (degenerative, vascular and infectious causes, and human prion diseases), we discuss the presentation of these forms and reasons for variations in estimated prevalence rates in the general population.
Hoarding behaviour: building up the ‘R factor’
Authors: Gaston Romina Lopez , Kiran-Imran Farida , Hassiem Fairooz , Vaughan John 
Published: August 2009

SummaryHoarding seems to be a non-specific symptom, as it has been associated with a wide range of psychiatric disorders. Validating hoarding as pathological is controversial and its nosological status remains unresolved. ‘Diogenes syndrome’ has been paradigmatic in this area, but its clinical use seems limited. Hoarding is not explicitly covered in either DSM–IV or ICD–10 and literature suggests that diagnosis of mental illness may consequently be missed in this population. In the context of these theoretical uncertainties, clinicians still need to accurately assess and treat patients who show hoarding behaviour. To this end, we summarise the available evidence, and present assessment and management algorithms together with a multicomponent psychological intervention that aims to teach patients to successfully apply the three Rs (reduce, recycle, reuse).
Assessment of personality disorder
Authors: Banerjee Penny J. M. , Gibbon Simon , Huband Nick 
Published: August 2009

SummaryIn 2003 the Department of Health, in conjunction with the National Institute for Mental Health in England, outlined the government's plan for the provision of mental health services for people with a diagnosis of personality disorder. This emphasised the need for practitioners to have skills in identifying, assessing and treating these disorders. It is important that personality disorders are properly assessed as they are common conditions that have a significant impact on an individual's functioning in all areas of life. Individuals with personality disorder are more vulnerable to other psychiatric disorders, and personality disorders can complicate recovery from severe mental illness. This article reviews the classification of personality disorder and some common assessment instruments. It also offers a structure for the assessment of personality disorder.
In defence of professional judgement
Authors: Downie Robin , Macnaughton Jane 
Published: August 2009

SummaryA judgement may be defined as an assertion made with evidence or good reason in a context of uncertainty. In psychiatry the uncertainty is inherent in the professional context and the evidence derives from academic literature and scientific studies as they are applied to a specific patient. The nature of the uncertainty and the factors that should inform professional judgement are explored in this article. Professional judgement currently faces two serious challenges: an obsession with numbers, which comes from within medicine, and the ‘patient choice’ agenda, which is politically inspired and comes from outside medicine. In this article we strive to defend professional judgement in the clinic against both challenges.
Buprenorphine prescription, misuse and service provision: a global perspective
Authors: Ho Roger Chun Man , Chen Kai Yang , Broekman Birit , Mak Anselm 
Published: August 2009

SummaryBuprenorphine, a partial μ-opioid agonist and κ-opioid antagonist, is recommended as safe and effective maintenance treatment for opioid dependence. It offers the possibility of management in primary care settings. However, its prescription has led to diversion for illicit recreational use and resulted in medical complications and, rarely, fatal overdose in combination with other sedatives. The outcome of buprenorphine maintenance programmes varies from country to country and it is determined by the local therapeutic traditions, regulatory restrictions and existing service provision for opioid misusers. This article addresses the pharmacology of buprenorphine, the benefits and drawbacks of its prescription, service provision for opioid misuse around the world, policy recommendations, and prescribing training requirements.
Brain morphology and neurological soft signs in adolescents with first-episode psychosis
Authors: Janssen Joost , Diaz-Caneja Angeles , Reig Santiago , Bombín Igor , Mayoral María , Parellada Mara , Graell Montserrat , Moreno Dolores , Zabala Arantzazu , Vazquez Veronica García , Desco Manuel , Arango Celso 
Published: August 2009

BackgroundAdolescents with first-episode psychosis have increased severity of neurological soft signs when compared with controls, but it is unclear whether increased severity of neurological soft signs is an expression of specific structural brain deficits.AimsTo examine whether increased severity of neurological soft signs was associated with decreased brain volumes in adolescents with first-episode psychosis.MethodBrain scans were obtained for 70 adolescents (less than 18 years of age) with first-episode psychosis (duration of positive symptoms less than 6 months). Volumes were assessed using voxel-based morphometry and through segmentation of anatomical structures.ResultsIncreased severity of sensory integration neurological soft signs correlated with smaller right and left thalamus volume, whereas increased severity of sequencing of complex motor acts neurological soft signs correlated with smaller right caudate volume.ConclusionsNeurological soft signs may be an easy-to-assess marker of region-specific structural brain deficits in adolescents with first-episode psychosis.
Adverse reactions to antidepressants
Authors: Uher Rudolf , Farmer Anne , Henigsberg Neven , Rietschel Marcella , Mors Ole , Maier Wolfgang , Kozel Dejan , Hauser Joanna , Souery Daniel , Placentino Anna , Strohmaier Jana , Perroud Nader , Zobel Astrid , Rajewska-Rager Aleksandra , Dernovsek Moica Z. , Larsen Erik Roj , Kalember Petra , Giovannini Caterina , Barreto Mara , McGuffin Peter , Aitchison Katherine J. 
Published: August 2009

BackgroundAdverse drug reactions are important determinants of non-adherence to
antidepressant treatment but their assessment is complicated by overlap
with depressive symptoms and lack of reliable self-report measures.AimsTo evaluate a simple self-report measure and describe adverse reactions
to antidepressants in a large sample.MethodThe newly developed self-report Antidepressant Side-Effect Checklist and
the psychiatrist-rated UKU Side Effect Rating Scale were repeatedly
administered to 811 adult participants with depression in a
part-randomised multicentre open-label study comparing escitalopram and
nortriptyline.ResultsThere was good agreement between self-report and psychiatrists' ratings.
Most complaints listed as adverse reactions in people with depression
were more common when they were medication-free rather than during their
treatment with antidepressants. Dry mouth (74%), constipation (33%) and
weight gain (15%) were associated with nortriptyline treatment. Diarrhoea
(9%), insomnia (36%) and yawning (16%) were more common during treatment
with escitalopram. Problems with urination and drowsiness predicted
discontinuation of nortriptyline. Diarrhoea and decreased appetite
predicted discontinuation of escitalopram.ConclusionsAdverse reactions to antidepressants can be reliably assessed by
self-report. Attention to specific adverse reactions may improve
adherence to antidepressant treatment.
Imaginal desensitisation plus motivational interviewing for
pathological gambling: randomised controlled trial
Authors: Grant Jon E. , Donahue Christopher B. , Odlaug Brian L. , Kim Suck Won , Miller Michael J. , Petry Nancy M. 
Published: August 2009

SummarySixty-eight individuals were randomised to either six sessions of imaginal
desensitisation plus motivational interviewing (IDMI) or Gamblers Anonymous.
Individuals assigned to IDMI had significantly greater reductions in
Yale–Brown Obsessive Compulsive Scale Modified for Pathological Gambling
total scores, gambling urges and gambling behaviour. People who failed to
respond to Gamblers Anonymous reported significantly greater reduction in
pathological gambling symptoms following later assignment to IDMI.
Abstinence was achieved by 63.6% during the acute IDMI treatment period.
Adherence to substitute opioid prescribing: survey of inner-London drug services
Authors: Dunn John , Haskew Michael , Pant Anshuman 
Published: August 2009

Aims and MethodTo investigate non-adherence to substitute opioid treatment, using a cross-sectional study design, with 630 patients from three London community drug services. Adherence was measured as the number of doses collected from the pharmacy as a proportion of the total number of doses stipulated on the prescription during a 28-day period and was further investigated through laboratory urine drug screens.ResultsOverall, 30.5% (n= 191) of individuals failed to pick up at least one dose of medication from the pharmacy over 1 month, but only 1.6% (n= 10) missed 50% or more of their doses. Non-adherence was associated with supervised consumption, more frequent pick-up, shorter duration of treatment, younger age, a lower dose of methadone and a recent urinalysis result positive for opiates.Clinical ImplicationsTreatment services need to monitor levels of adherence to treatment and develop strategies to improve it so that treatment can be optimised effectively.
From a sector-based service model to a functional one: qualitative study of staff perceptions
Authors: Khandaker Golam , Cherukuru Srinivasarao , Dibben Claire , Ray Manaan Kar 
Published: August 2009

Aims and MethodAn increasing number of mental health trusts in the UK are replacing the geographically sectorised model of service delivery with a functional one. We conducted a qualitative study of staff perception concerning this reorganisation in our Trust, to inform effective change management locally and elsewhere.ResultsPerceived benefits were quick decision-making, positive risk management and improvement in clinical leadership. Dedicated consultant time would lead to improvements in junior doctor training. Concerns included lack of continuity of care, disagreement between teams and de-skilling of staff. Communication was seen as the key to overcoming these difficulties.Clinical ImplicationsDetailed communication from management about the practicalities and reasons for change could facilitate effective transition.
Closed double-lumen suction irrigation in the management of chronic diaphyseal osteomyelitis
Authors: Caesar B. C. , Morgan-Jones R. L. , Warren R. E. , Wade R. H. , Roberts P. J. , Richardson J. B. 
Published: August 2009

Between November 1994 and June 1999, 35 patients referred to our Problem Fracture Service with chronic diaphyseal osteomyelitis were treated using a closed double-lumen suction irrigation system after reaming and arthroscopic debridement of the intramedullary canal. This is a modified system based on that of Lautenbach. Between June and July 2007 the patients were reviewed by postal questionnaire and telephone and from the case notes. At a mean follow-up of 101 months (2 to 150), 26 had no evidence of recurrence and four had died from unrelated causes with no evidence of recurrent infection. One had been lost to follow-up at two months and was therefore excluded. Four had persisting problems with sinus discharge and one had his limb amputated for recurrent metaplastic change. Our results represent a clearance of infection of 85.3% (29 of 34), with recurrence in 11.8% (4 of 34). They are comparable to the results of the Papineau and Belfast techniques, but with considerably less surgical insult to the patient.
Conservative treatment of scaphoid nonunion in children and adolescents
Authors: Weber D. M. , Fricker R. , Ramseier L. E. 
Published: August 2009

This is a retrospective study of six children with ununited scaphoid fractures treated conservatively. Their mean age was 12.8 years (9.7 to 16.3). Five had no early treatment. Radiological signs of nonunion were found at a mean of 4.6 months (3 to 7) after injury. Treatment consisted of cast immobilisation until clinical and radiological union. The mean clinical and radiological follow-up was for 67 months (17 to 90). We assessed the symptoms, the range of movement of the wrist and the grip strength to calculate the Modified Mayo Wrist score. The fracture united in all patients after a mean period of immobilisation of 5.3 months (3 to 7). Five patients were pain free; one had mild pain. All returned to regular activities, and had a range of movement and grip strength within 25% of normal, resulting in an excellent Modified Mayo Wrist score. Prolonged treatment with cast immobilisation resulted in union of the fracture and an excellent Modified Wrist Score in all patients.
Fixation and loosening of the cemented Müller straight stem
Authors: Clauss M. , Luem M. , Ochsner P. E. , Ilchmann T. 
Published: August 2009

The original forged Müller straight stem (CoNiCr) has shown excellent ten- to 15-year results. We undertook a long-term survival analysis with special emphasis on radiological changes within a 20-year period of follow-up.In all, 165 primary total hip replacements, undertaken between July 1984 and June 1987 were followed prospectively. Clinical follow-up included a standardised clinical examination, and radiological assessment was based on a standardised anteroposterior radiograph of the pelvis, which was studied for the presence of osteolysis, debonding and cortical atrophy.Survival of the stem with revision for any reason was 81% (95% confidence interval (CI), 76 to 86) at 20 years and for aseptic loosening 87% (95% CI, 82 to 90). At the 20-year follow-up, 15 of the surviving 36 stems showed no radiological changes. Debonding (p = 0.005), osteolysis (p = 0.003) and linear polyethylene wear (p = 0.016) were associated with aseptic loosening, whereas cortical atrophy was not associated with failure (p = 0.008).The 20-year results of the Müller straight stem are comparable to those of other successful cemented systems with similar follow-up. Radiological changes are frequently observed, but with a low incidence of progression, and rarely result in revision. Cortical atrophy appears to be an effect of ageing and not a sign of loosening of the femoral component.
Neutrophil CD64 expression in the diagnosis of local musculoskeletal infection and the impact of antibiotics
Authors: Tanaka S. , Nishino J. , Matsui T. , Komiya A. , Nishimura K. , Tohma S. 
Published: August 2009

We examined the usefulness of neutrophil CD64 expression in detecting local musculoskeletal infection and the impact of antibiotics on its expression. Of 141 patients suspected of musculoskeletal infection, 46 were confirmed by microbiological culture to be infected and 95 had infection excluded. The median CD64 count of patients with localised infection was 2230 molecules per cell (interquartile range (IQR) 918 to 4592) and that of the patients without infection was 937 molecules per cell (IQR 648 to 1309) (p < 0.001). The level of CD64 correlated with the CRP level in patients with infection, but not in those without infection (r = 0.59, p < 0.01). Receiver operator characteristic curve analysis revealed that CD64 was a good predictor of local infection. When the patients were subdivided into two groups based on the administration of antibiotics at the time of CD64 sampling, the sensitivity for detecting infection was better in those who had not received antibiotics.These results suggest that measurement of CD64 expression is a useful marker for local musculoskeletal infection.
Short-term results of total hip replacements performed by visiting surgeons at an NHS treatment centre
Authors: White S. P. , John A. W. , Jones S. A. 
Published: August 2009

Between December 2004 and June 2006, 136 patients (156 total hip replacements), were sent from the waiting list of the Cardiff Vale NHS Trust to the NHS Treatment Centre, Weston-super-Mare, in an attempt to reduce the waiting time for total hip replacement. Because of concerns about their outcome, each patient was contacted and invited to attend a review appointment with a consultant specialising in hip and revision hip replacement. A total of 98 patients (113 hips) were reviewed after a mean of 23 months (11 to 30). There were 104 cemented hips, seven hybrid and two cementless. An acetabular inclination of > 55° was seen in 18 (16%). Radiolucent lines around the acetabular component were seen in 76 (67%). The femoral component was in more than 4° of varus in 47 (42%). The medial floor had been breached in 13 (12%) and there was a leg-length discrepancy of more than 1 cm in ten (9%). There were three dislocations, one femoral fracture, one pulmonary embolus, one deep infection and two superficial wound infections. To date, 13% (15 hips) have been revised and a further 4% (five hips) await revision, mostly for a painful loose acetabular component. The revision rate far exceeds the 0.5% five-year failure rate reported in the Swedish Registry for the components used. This initiative and the consequent need for correction of the problems created, has significantly increased the workload of our unit.
Tendon re-attachment to metal prostheses in an in vivo animal model using demineralised bone matrix
Authors: Sundar S. , Pendegrass C. J. , Oddy M. J. , Blunn G. W. 
Published: August 2009

We used demineralised bone matrix (DBM) to augment re-attachment of tendon to a metal prosthesis in an in vivo ovine model of reconstruction of the extensor mechanism at the knee. We hypothesised that augmentation of the tendon-implant interface with DBM would enhance the functional and histological outcomes as compared with previously reported control reconstructions without DBM. Function was assessed at six and 12 weeks postoperatively, and histological examination was undertaken at 12 weeks. A significant increase of 23.5% was observed in functional weight-bearing at six weeks in the DBM-augmented group compared with non-augmented controls (p = 0.004). By 12 weeks augmentation with DBM resulted in regeneration of a more direct-type enthesis, with regions of fibrocartilage, mineralised fibrocartilage and bone. In the controls the interface was predominantly indirect, with the tendon attached to the bone graft-hydroxyapatite base plate by perforating collagen fibres.
Total ankle replacement in moderate to severe varus deformity of the ankle
Authors: Kim B. S. , Choi W. J. , Kim Y. S. , Lee J. W. 
Published: August 2009

Our study describes the clinical outcome of total ankle replacement (TAR) performed in patients with moderate to severe varus deformity. Between September 2004 and September 2007, 23 ankles with a varus deformity ≥ 10° and 22 with neutral alignment received a TAR. Following specific algorithms according to joint congruency, the varus ankles were managed by various additional procedures simultaneously with TAR. After a mean follow-up of 27 months (12 to 47), the varus ankles improved significantly in all clinical measures (p < 0.0001 for visual analogue scale and American Orthopaedic Foot and Ankle Society score, p = 0.001 for range of movement). No significant differences were found between the varus and neutral groups regarding the clinical (p = 0.766 for visual analogue scale, p = 0.502 for American Orthopaedic Foot and Ankle Society score, p = 0.773 for range of movement) and radiological outcome (p = 0.339 for heterotopic ossification, p = 0.544 for medial cortical reaction, p = 0.128 for posterior focal osteolysis). Failure of the TAR with conversion to an arthrodesis occurred in one case in each group. The clinical outcome of TAR performed in ankles with pre-operative varus alignment ≥ 10° is comparable with that of neutrally aligned ankles when appropriate additional procedures to correct the deformity are carried out simultaneously with TAR.
Posterior intrafocal pinning for extension-type supracondylar fractures of the humerus in children
Authors: Fahmy M. A. L. , Hatata M. Z. , Al-Seesi H. 
Published: August 2009

We describe a method of pinning extension supracondylar fractures of the humerus in children. Following closed reduction, a posterior intrafocal wire is inserted and a second lateral wire added when needed for rotational stability. Between May 2002 and November 2005 we performed this technique in 69 consecutive patients. A single posterior wire was used in 29 cases, and two wires in 40. The mean follow-up was two years (21 to 30 months). The results were assessed according to Flynn’s criteria. In the single-wire group there were 21 excellent, five good and one poor result. Two patients were lost to follow-up. In the two-wire group there were 32 excellent, two good and three poor results. Three were lost to follow-up. The poor results were due to a failure to achieve adequate reduction, fixation or both. We conclude that the intact posterior periosteal hinge can be used successfully in the clinical situation, giving results that compare well with other techniques of pinning. The posterior route offers an attractive alternative method for fixation of supracondylar fractures of the humerus in children.
A correlation between the timing of biopsy after autologous chondrocyte implantation and the histological appearance
Authors: Gikas P. D. , Morris T. , Carrington R. , Skinner J. , Bentley G. , Briggs T. 
Published: August 2009

Autologous chondrocyte implantation is an option in the treatment of full-thickness chondral or osteochondral injuries which are symptomatic. The goal of surgery and rehabilitation is the replacement of damaged cartilage with hyaline or hyaline-like cartilage, producing improved levels of function and preventing early osteoarthritis. The intermediate results have been promising in terms of functional and clinical improvement. Our aim was to explore the hypothesis that the histological quality of the repair tissue formed after autologous chondrocyte implantation improved with increasing time after implantation. In all, 248 patients who had undergone autologous chondrocyte implantation had biopsies taken of the repair tissue which then underwent histological grading. Statistical analysis suggested that with doubling of the time after implantation the likelihood of a favourable histological outcome was increased by more than fourfold (p < 0.001).
SPECT-CT imaging in degenerative joint disease of the foot and ankle
Authors: Pagenstert G. I. , Barg A. , Leumann A. G. , Rasch H. , Müller-Brand J. , Hintermann B. , Valderrabano V. 
Published: August 2009

The precise localisation of osteoarthritic changes is crucial for selective surgical treatment. Single photon-emission CT-CT (SPECT-CT) combines both morphological and biological information. We hypothesised that SPECT-CT increased the intra- and interobserver reliability to localise increased uptake compared with traditional evaluation of CT and bone scanning together. We evaluated 20 consecutive patients with pain of uncertain origin in the foot and ankle by radiography and SPECT-CT, available as fused SPECT-CT, and by separate bone scanning and CT. Five observers assessed the presence or absence of arthritis. The images were blinded and randomly ordered. They were evaluated twice at an interval of six weeks. Kappa and multirater kappa values were calculated. The mean intraobserver reliability for SPECT-CT was excellent (κ = 0.86; 95% CI 0.81 to 0.88) and significantly higher than that for CT and bone scanning together. SPECT-CT had significantly higher interobserver agreement, especially when evaluating the naviculocuneiform and tarsometatarsal joints. SPECT-CT is useful in localising active arthritis especially in areas where the number and configuration of joints are complex.