bluuebunny/crossref_metadata_2025_split huggingface dataset:
Should patients with abnormal liver function tests in primary care be tested for chronic viral hepatitis: cost minimisation analysis based on a comprehensively tested cohort
Authors: Arnold David T , Bentham Louise M , Jacob Ruth P , Lilford Richard J , Girling Alan J 
Published: March 2011

Abstract

Background
Liver function tests (LFTs) are ordered in large numbers in primary care, and the Birmingham and Lambeth Liver Evaluation Testing Strategies (BALLETS) study was set up to assess their usefulness in patients with no pre-existing or self-evident liver disease. All patients were tested for chronic viral hepatitis thereby providing an opportunity to compare various strategies for detection of this serious treatable disease.

Methods
This study uses data from the BALLETS cohort to compare various testing strategies for viral hepatitis in patients who had received an abnormal LFT result. The aim was to inform a strategy for identification of patients with chronic viral hepatitis. We used a cost-minimisation analysis to define a base case and then calculated the incremental cost per case detected to inform a strategy that could guide testing for chronic viral hepatitis.

Results
Of the 1,236 study patients with an abnormal LFT, 13 had chronic viral hepatitis (nine hepatitis B and four hepatitis C). The strategy advocated by the current guidelines (repeating the LFT with a view to testing for specific disease if it remained abnormal) was less efficient (more expensive per case detected) than a simple policy of testing all patients for viral hepatitis without repeating LFTs. A more selective strategy of viral testing all patients for viral hepatitis if they were born in countries where viral hepatitis was prevalent provided high efficiency with little loss of sensitivity. A notably high alanine aminotransferase (ALT) level (greater than twice the upper limit of normal) on the initial ALT test had high predictive value, but was insensitive, missing half the cases of viral infection.

Conclusions
Based on this analysis and on widely accepted clinical principles, a "fast and frugal" heuristic was produced to guide general practitioners with respect to diagnosing cases of viral hepatitis in asymptomatic patients with abnormal LFTs. It recommends testing all patients where a clear clinical indication of infection is present (e.g. evidence of intravenous drug use), followed by testing all patients who originated from countries where viral hepatitis is prevalent, and finally testing those who have a notably raised ALT level (more than twice the upper limit of normal). Patients not picked up by this efficient algorithm had a risk of chronic viral hepatitis that is lower than the general population.
Confirmed local endemicity and putative high transmission of Schistosoma mansoni in the Sesse Islands, Lake Victoria, Uganda
Authors: Standley Claire J , Adriko Moses , Besigye Fred , Kabatereine Narcis B , Stothard Russell J 
Published: March 2011

Abstract
The Sesse Islands, in the Ugandan portion of Lake Victoria, have long been considered a low transmission zone for intestinal schistosomiasis. Based on observations of high prevalence of Schistosoma mansoni infection in the northern-most islands of this archipelago, a follow-up survey was conducted to ascertain whether transmission was endemic to this island group, combining parasitological and malacological surveys. Prevalence of intestinal schistosomiasis was again observed to be high, as was intensity of infections which, combined with low reported incidence of treatment, suggests that chemotherapy-based control initiatives are not being maximally effective in this region as high levels of population movement between islands and districts are confounding. The local disease transmission was confirmed by the observations of high abundance of Biomphalaria, as well as field-caught snails shedding S. mansoni cercariae. DNA sequencing of 12 cercariae revealed common mitochondrial cox 1 haplotypes, as well as, novel ones, consistent with the high genetic diversity of this parasite in Lake Victoria. Intestinal schistosomiasis is firmly endemic in parts of the Sesse Islands and more broadly, this island group provides an insight into the future challenges to be faced by the Ugandan National Control Programme in regularly reaching these rather remote, inaccessible and largely itinerant communities.
Extracorporeal cell therapy of septic shock patients with donor granulocytes: a pilot study
Authors: Altrichter Jens , Sauer Martin , Kaftan Katharina , Birken Thomas , Gloger Doris , Gloger Martin , Henschel Jörg , Hickstein Heiko , Klar Ernst , Koball Sebastian , Pertschy Annette , Nöldge-Schomburg Gabriele , Vagts Dierk A , Mitzner Steffen R 
Published: March 2011

Abstract
Introduction
Neutrophil granulocytes are the first defense line in bacterial infections. However, granulocytes are also responsible for severe local tissue impairment. In order to use donor granulocytes, but at the same time to avoid local side effects, we developed an extracorporeal immune support system. This first-in-man study investigated whether an extracorporeal plasma treatment with a granulocyte bioreactor is tolerable in patients with septic shock. A further intention was to find suitable efficacy end-points for subsequent controlled trials.

Methods
The trial was conducted as a prospective uncontrolled clinical phase I/II study with 28-day follow-up at three university hospital intensive care units. Ten consecutive patients (five men, five women, mean age 60.3 ± 13.9 standard deviation (SD) years) with septic shock with mean ICU entrance scores of Acute Physiology and Chronic Health Evaluation (APACHE) II of 29.9 ± 7.2 and of Simplified Acute Physiology Score (SAPS) II of 66.2 ± 19.5 were treated twice within 72 hours for a mean of 342 ± 64 minutes/treatment with an extracorporeal bioreactor containing 1.41 ± 0.43 × 10E10 granulocytes from healthy donors. On average, 9.8 ± 2.3 liters separated plasma were treated by the therapeutic donor cells. Patients were followed up for 28 days.

Results
Tolerance and technical safety during treatment, single organ functions pre/post treatment, and hospital survival were monitored. The extracorporeal treatments were well tolerated. During the treatments, the bacterial endotoxin concentration showed significant reduction. Furthermore, noradrenaline dosage could be significantly reduced while mean arterial pressure was stable. Also, C-reactive protein, procalcitonin, and human leukocyte antigen DR (HLA-DR) showed significant improvement. Four patients died in the hospital on days 6, 9, 18 and 40. Six patients could be discharged.

Conclusions
The extracorporeal treatment with donor granulocytes appeared to be well tolerated and showed promising efficacy results, encouraging further studies.

Trial registration
ClinicalTrials.gov Identifier: NCT00818597
When things go wrong: a practical guide to dealing with complaints
Authors: Hodgson Richard , Mendis Santhushi , Storey Sandra 
Published: March 2011

SummaryComplaints inevitably accompany clinical care. This article explores complaints primarily in the context of the UK National Health Service complaints system. However, much of the content will apply to other settings, such as the independent sector. The infrequent but serious ramifications of complaints are also considered, including retraining and suspension. The article is written from a medical perspective but considers the roles of other professionals, the organisation and the complainant.
Peer reviewing made easy
Authors: Halder Neel , Ramsay Rosalind , Tyrer Peter , Casey Patricia 
Published: March 2011

SummaryPeer review in scientific journals has existed for over 200 years. This process is currently the accepted way of assessing scientific manuscripts prior to publication for most journals. Despite this, little has been written about the process of peer reviewing, with hardly anything specific to psychiatric journals. This article answers fundamental questions related to peer reviewing and includes practical tips to writing reviews. It will be helpful for those keen on improving their knowledge about the peer-review process. It will not only benefit those who are reviewers or thinking about becoming reviewers, but also authors, who can use the information to improve their chances of publication.
Management of acute agitation in psychosis: an evidence-based approach in the USA
Authors: Schleifer Justin J. 
Published: March 2011

SummaryAgitation in psychiatric settings, particularly in psychosis, presents a staggering challenge for clinicians, who must both manage the patient's acute symptoms and simultaneously make an accurate diagnosis. Too often, the management of the former confounds the latter. Patients are very often sedated medically, which masks their underlying condition, rendering accurate diagnosis delayed and inherently difficult. Significant data are available regarding both pharmacological and non-pharmacological interventions for agitation that maximise symptom control while minimising confounding side-effects. In this article, a review of the historical evolution of agitation management in psychotic illness is presented, followed by an evidence-based clinical guideline for managing agitation in psychosis in the USA.
Body dysmorphic disorder
Authors: Ross Jennifer , Gowers Simon 
Published: March 2011

SummaryBody dysmorphic disorder is a distressing and often disabling condition characterised by a preoccupation with imagined or slight physical defects in appearance. It has been recognised as a mental disorder for many years (and named body dysmorphic disorder since 1980), but epidemiological studies and clinical trials have been few. To a large extent, the disorder has been ignored by the mental health community, who often fail to elicit the diagnosis. This article reviews the diagnostic criteria for the disorder, its validity and its relationship to other disorders such as obsessive-compulsive disorder, anorexia nervosa, social phobia and somatisation disorders. The course of the illness, its aetiology and treatment approaches are discussed. As research is growing alongside an increase in patient presentations, body dysmorphic disorder requires a coherent response from healthcare services.
Why psychiatry should engage with the media
Authors: Bithell Claire 
Published: March 2011

SummaryPsychiatry receives less media coverage than general medicine, and the coverage it does receive is four times as likely to be negatively framed. In addition, coverage of mental health problems is often negative in tone and mental health research tends to be underrepresented in the media. As the media is likely to be a key source of information for the general public about mental health and psychiatry, this is worrying. There are opportunities, however, to change this landscape; the UK national news media are keen to cover more stories about mental health problems and to feature more psychiatrists' comments in their coverage. By engaging with the media, psychiatrists have the chance to create better-informed media narrative.
Psychological services for women giving birth in a large Irish tertiary referral maternity unit
Authors: McAuliffe Aileen , Russell Noirin E. , Fenton Joanne 
Published: March 2011

Aims and methodTo investigate whether women were being asked about their current and previous mental health, and where risk factors for perinatal mental health problems were identified, to determine whether appropriate referral occurred. Individual case-note review was performed on women where present or past mental health problems were indicated.ResultsIn two-thirds of women where a history of mental health problems was indicated at the booking clinic this was not addressed in their obstetric case notes. Of the women who reported being depressed, nearly a third had no reference to this in their obstetric case notes and only 40% were referred to the Mental Health Liaison Clinic (MHLC). Two-thirds of the women who indicated a history of postnatal depression had no further comments documented in their obstetric case notes. One case of bipolar affective disorder and one case of puerperal psychosis were identified on booking questionnaires and neither had any comments documented in the obstetric case notes. In total 16% of women who reported a history of mental health problems were referred to the MHLC.Clinical implicationsMore robust procedures for the identification and management of perinatal mental health risk need to be implemented.
Predicting Relapse in Patients With Medulloblastoma by Integrating Evidence From Clinical and Genomic Features
Authors: Tamayo Pablo , Cho Yoon-Jae , Tsherniak Aviad , Greulich Heidi , Ambrogio Lauren , Schouten-van Meeteren Netteke , Zhou Tianni , Buxton Allen , Kool Marcel , Meyerson Matthew , Pomeroy Scott L. , Mesirov Jill P. 
Published: March 2011

Purpose Despite significant progress in the molecular understanding of medulloblastoma, stratification of risk in patients remains a challenge. Focus has shifted from clinical parameters to molecular markers, such as expression of specific genes and selected genomic abnormalities, to improve accuracy of treatment outcome prediction. Here, we show how integration of high-level clinical and genomic features or risk factors, including disease subtype, can yield more comprehensive, accurate, and biologically interpretable prediction models for relapse versus no-relapse classification. We also introduce a novel Bayesian nomogram indicating the amount of evidence that each feature contributes on a patient-by-patient basis. Patients and Methods A Bayesian cumulative log-odds model of outcome was developed from a training cohort of 96 children treated for medulloblastoma, starting with the evidence provided by clinical features of metastasis and histology (model A) and incrementally adding the evidence from gene-expression–derived features representing disease subtype–independent (model B) and disease subtype–dependent (model C) pathways, and finally high-level copy-number genomic abnormalities (model D). The models were validated on an independent test cohort (n = 78). Results On an independent multi-institutional test data set, models A to D attain an area under receiver operating characteristic (au-ROC) curve of 0.73 (95% CI, 0.60 to 0.84), 0.75 (95% CI, 0.64 to 0.86), 0.80 (95% CI, 0.70 to 0.90), and 0.78 (95% CI, 0.68 to 0.88), respectively, for predicting relapse versus no relapse. Conclusion The proposed models C and D outperform the current clinical classification schema (au-ROC, 0.68), our previously published eight-gene outcome signature (au-ROC, 0.71), and several new schemas recently proposed in the literature for medulloblastoma risk stratification.
‘Model’ or ‘tool’? New definitions for translational research
Authors: Sive Hazel 
Published: March 2011

SummaryThe term ‘model’ often describes non-human biological systems that are used to obtain a better understanding of human disorders. According to the most stringent definition, an animal ‘model’ would display exactly the same phenotype as seen in the relevant human disorder; however, this precise correspondence is often not present. In this Editorial, I propose the alternative, broader term ‘tool’ to describe a biological system that does not obviously (or precisely) recapitulate a human disorder, but that nonetheless provides useful insight into the etiology or treatment of that disorder. Applying the term ‘tool’ to biological systems used in disease-related studies will help to identify those systems that can most effectively address mechanisms underlying human disease. Conversely, differentiating ‘models’ from ‘tools’ will help to define more clearly the limitations of biological systems used in preclinical analyses.
Extraction Ability and Selectivity for Lithium Ion of Macrocyclic Trinuclear (Alkylbenzene)ruthenium(II) Complexes Bridged by 2,3-Pyridinediolato Ligands
Authors: Katsuta Shoichi , Nomura Hajime , Egashira Takuya , Imoto Takahiro , Kudo Yoshihiro , Takeda Yasuyuki 
Published: March 2011

Abstract
A series of macrocyclic trinuclear complexes of (η6-alkylbenzene)ruthenium(II) bridged by 2,3-pyridinediolato ligands were synthesized and their liquid–liquid extraction properties for Li+ and Na+ were investigated at 25 °C. The alkylbenzenes used were p-cymene, 1,2,3-trimethylbenzene, 1,3,5-trimethylbenzene, 1,3,5-triethylbenzene, 1,2,4,5-tetramethylbenzene, and hexamethylbenzene. Most of the trinuclear complexes were stable for 48 h or more in a dichloromethane–water system. The extraction constants (Kex = [ML+A−]o/([M+][A−][L]o); M+: alkali metal ion, L: trinuclear complex, A−: counter anion (picrate), and o: organic phase (dichloromethane)) were determined from analysis of the extraction equilibria. Each trinuclear complex exhibited a larger Kex value for Li+ than for Na+; particularly large separation factor, SF = Kex(Li+)/Kex(Na+), was observed for the complexes of Ru(1,3,5-trimethylbenzene) (SF = 1.7 × 103) and Ru(1,2,4,5-tetramethylbenzene) (SF = 1.6 × 103). The extraction separation of Li+ from seawater could be achieved by using the trinuclear complex of Ru(1,3,5-trimethylbenzene) with the aid of washing the organic phase with water to remove co-extracted Na+.
Doctors who become chief executives in the NHS: from keen amateurs to skilled professionals
Authors: Ham Chris , Clark John , Spurgeon Peter , Dickinson Helen , Armit Kirsten 
Published: March 2011

Summary Objectives To investigate the experiences of doctors who become chief executives of NHS organizations, with the aim of understanding their career paths and the facilitators and barriers encountered along the way. Design Twenty-two medical chief executives were identified and of these 20 were interviewed. In addition two former medical chief executives were interviewed. Information was collected about the age at which they became chief executives, the number of chief executive posts held, the training they received, and the opportunities, challenges and risks they experienced. Setting All NHS organizations in the United Kingdom in 2009. Results The age of medical chief executives on first appointment ranged from 36 to 64 years, the average being 48 years. The majority of those interviewed were either in their first chief executive post or had stepped down having held only one such post. The training and development accessed en route to becoming chief executives was highly variable. Interviewees were positive about the opportunity to bring about organizational and service improvement on a bigger scale than is possible in clinical work. At the same time, they emphasized the insecurities associated with being a chief executive. Doctors who become chief executives experience a change in their professional identity and the role of leaders occupying hybrid positions is not well recognized. Conclusions Doctors who become chief executives are self-styled ‘keen amateurs’ and there is a need to provide more structured support to enable them to become skilled professionals. The new faculty of medical leadership and management could have an important role in this process.
Removal of Furfural from Aqueous Solutions by Adsorption Using Organobentonite: Isotherm and Kinetic Studies
Authors: Mebrek Ouassila Rachedi , Derriche Zoubir 
Published: March 2011

Lubricant refineries are facing pollution problems associated with the occasional loss of furfural. This constitutes both an economic loss and an environmental hazard, especially for aquatic organisms. Some studies on the removal of furfural by adsorption onto hydrophobic polymeric resins (XAD-4 and XAD-7), activated carbon and the nanoporous material MCM-48 have been published, but none provides information on the adsorption of furfural onto clays. In the present work, we have studied the efficiency of sodium bentonite modified with the cationic surfactant cethyltrimethylammonium bromide (CTAB) in the adsorption of furfural. The structures of both natural and modified bentonites have been examined using XRD and FT-IR analyses. Adsorption studies were performed in a batch system, with the effects of various experimental parameters such as the contact time, the organobentonite concentration, pH, the initial furfural concentration and the temperature being evaluated. Kinetic results showed that furfural could be removed by CTAB–bentonite after contact for 6 h, with the adsorption process being well described by the pseudo-second-order reaction model. Furfural sorption onto CTAB–bentonite was characterized by a linear isotherm, with the adsorption capacity towards furfural being reduced by increasing temperature. A comparison of furfural adsorption capacities revealed that the capacities decreased in the following order: CTAB–bentonite > XAD-4 > XAD-7.
Arthroscopic femoral osteochondroplasty for cam femoroacetabular impingement in patients over 60 years of age
Authors: Javed A. , O’Donnell J. M. 
Published: March 2011

We reviewed the clinical outcome of arthroscopic femoral osteochondroplasty for cam femoroacetabular impingement performed between August 2005 and March 2009 in a series of 40 patients over 60 years of age. The group comprised 26 men and 14 women with a mean age of 65 years (60 to 82). The mean follow-up was 30 months (12 to 54).The mean modified Harris hip score improved by 19.2 points (95% confidence interval 13.6 to 24.9; p < 0.001) while the mean non-arthritic hip score improved by 15.0 points (95% confidence interval 10.9 to 19.1, p < 0.001). Seven patients underwent total hip replacement after a mean interval of 12 months (6 to 24 months) at a mean age of 63 years (60 to 70). The overall level of satisfaction was high with most patients indicating that they would undergo similar surgery in the future to the contralateral hip, if indicated. No serious complications occurred.Arthroscopic femoral osteochondroplasty performed in selected patients over 60 years of age, who have hip pain and mechanical symptoms resulting from cam femoroacetabular impingement, is beneficial with a minimal risk of complications at a mean follow-up of 30 months.
Fast-track surgery for bilateral total knee replacement
Authors: Husted H. , Troelsen A. , Otte K. S. , Kristensen B. B. , Holm G. , Kehlet H. 
Published: March 2011

Bilateral simultaneous total knee replacement (TKR) has been considered by some to be associated with increased morbidity and mortality. Our study analysed the outcome of 150 consecutive, but selected, bilateral simultaneous TKRs and compared them with that of 271 unilateral TKRs in a standardised fast-track setting. The procedures were performed between 2003 and 2009. Apart from staying longer in hospital (mean 4.7 days (2 to 16) versus 3.3 days (1 to 25)) and requiring more blood transfusions, the outcome at three months and two years was similar or better in the bilateral simultaneous TKR group in regard to morbidity, mortality, satisfaction, the range of movement, pain, the use of a walking aid and the ability to return to work and to perform activities of daily living. Bilateral simultaneous TKR can therefore be performed as a fast-track procedure with excellent results.