bluuebunny/crossref_metadata_2025_split huggingface dataset:
Diagnosis of Skin Lesions by Trainee Surgeons: Experience Improves Accuracy
Authors: Pearl RA , Townley W , Stott D , Grobbelaar AO 
Published: August 2009

INTRODUCTION Accurate clinical diagnosis depends on the reliable recognition of signs and symptoms. This expertise comes from experience in seeing patients which has been traditionally gained over a long training period. Shortened specialist training (Modernising Medical Careers) has led to a greater reliance on structured teaching and skills transfer programmes. The accuracy of clinical diagnosis and the rate at which diagnostic skills improve during training is important for the assessment of trainees, and the delivery of care. PATIENTS AND METHODS This study assessed the accuracy of clinical diagnosis of skin lesions by two junior plastic surgery trainees. They were asked to diagnose 120 consecutive skin lesions seen in a pigmented skin lesion clinic in 2005, with the histological diagnosis being confirmed following subsequent excision. The process was repeated a year later in 2006 to enable the rate of correct diagnosis to be compared. RESULTS Initially, 53.3% of diagnoses were correct. A year later, this had risen to 65.0%. Twenty-two different skin pathologies were present in excised specimens, and skin cancers comprised 30%. The trainees demonstrated 93.8% sensitivity in their initial diagnosis of malignancy (95% CI, 79.2–99.2) and 97.4% a year later (95% CI, 86.5–99.9). However, specificity was 69.3% (95% CI, 58.6–78.7) in 2005 and 71.6% (95% CI, 60.5–71.4) in 2006. CONCLUSIONS Accuracy in the diagnosis of the wide range of skin conditions presenting to an out-patient clinic was shown to increase over a 1-year period. We feel that this improvement resulted from regular clinical exposure supported by a structured learning programme. The shortening of the specialist training period may affect the acquisition of diagnostic skills by trainees and impact on the confidence with which they commence consultant practice.
Use of the Internet by Patients Undergoing Elective Hernia Repair or Cholecystectomy
Authors: Tamhankar AP , Mazari FAK , Everitt NJ , Ravi K 
Published: August 2009

INTRODUCTION Patient-directed information available on the internet is not always regulated; it may be confusing and sometimes just overwhelming. We aimed to establish the proportion of patients undergoing two common surgical procedures, who searched the internet for information about their operations and to assess the usefulness of the information they received. PATIENTS AND METHODS A total of 105 consecutive patients undergoing elective abdominal wall hernia repair (n = 54) or laparoscopic cholecystectomy (n = 51) in a single surgical firm were included in the study. Patients were counselled about their operation in pre-operative assessment clinics and standard trust information leaflets were provided without any mention of this study. Patients were then asked to complete a questionnaire on the morning of their operation. RESULTS All patients completed the questionnaire. Of the patients, 59% stated that they had access to the internet and 77% of these accessed the internet over 2 h a week. Of the patients with internet access, 31% used it to acquire additional information about their operations and 58% used internet search engines. Of the patients who searched the internet regarding their operations, 26% were confused and/or worried by the information they received. CONCLUSIONS A significant proportion of patients undergoing common surgical procedures used the internet and about one-third of them specifically sought information about their operation on the internet. Such information can cause worry and confusion in patients. Our study highlights the need for regulated, comprehensible, patient information on hospital websites to which patients should be directed.
Supervised Exercise for Intermittent Claudication – An Under-Utilised Tool
Authors: Shalhoub Joseph , Hamish Maher , Davies Alun H 
Published: August 2009

INTRODUCTION The use of supervised exercise in the management of intermittent claudication is well supported by level I evidence upon which are based grade A recommendations by the TASC II Inter-Society Consensus for the Management of Peripheral Arterial Disease and the Scottish Intercollegiate Guidelines Network (SIGN). These include that supervised exercise should be made available as part of the initial treatment for all peripheral arteriopaths. SUBJECTS AND METHODS A questionnaire, comprising 10 questions, was drawn up to address the issues pertinent to supervised exercise in intermittent claudication. This was distributed by post, along with a pre-stamped return envelope, to all ordinary members of the Vascular Society of Great Britain and Ireland (VSGBI). All returned and received questionnaires had their responses entered onto a pre-prepared spreadsheet. RESULTS Of the 186 questionnaires posted to UK resident surgeons, 84 were returned. This equates to a response rate of 45%. Of the responders, only 24% had access to supervised exercise. There was a large spread in the proportion of eligible patients which were referred to a programme, with only 14% of VSGBI members recommending 100% of eligible patients. Rates of non-compliance varied greatly. Contra-indications to supervised exercise included cardiac (27%), and vascular, musculoskeletal, geographic, and respiratory (8% each). Most supervised exercise sessions (85%) were 1 h in duration. The majority (65%) of programmes comprised one session per week. With regards the duration of programme, 55% were 3 months. Almost all classes were led by either a physiotherapist (41%) or a nurse (48%). In centres where no supervised exercise programme was available, verbal advice was given by 63%, with 34% offering leaflets. A supervised exercise set up has not been achieved due to lack of resource in 72%. CONCLUSIONS These results are contrary to the recommendations offered by the TASC II Inter-Society Consensus and SIGN, in particular in terms of availability and referral to supervised exercise, as well as frequency of the classes where programmes were in place. The offer of information either verbally or via leaflet is commended; however, this has been shown as inferior to supervised exercise. Quoting resource as the reason for non-implementation goes against the published quality-of-life and pharmaco-economic data, which promote supervised exercise as both functionally and financially effective. This work highlights the importance of translating the results of research into evidence-based clinical practice.
How is Adrenocortical Cancer being Managed in the UK?
Authors: Aspinall Sebastian R , Imisairi AH , Bliss RD , Scott-Coombes D , Harrison BJ , Lennard TWJ 
Published: August 2009

INTRODUCTION Adrenocortical carcinomas are rare. This case series is reported to give an overview of how adrenocortical carcinoma is currently managed in the UK. PATIENTS AND METHODS A retrospective review was made of case notes from patients with adrenocortical carcinomas presenting to the authors (TWJL, RDB, BJH, and DS-C) over the past 10 years in Newcastle, Sheffield and Cardiff. RESULTS Newcastle treated twelve, Sheffield eleven and Cardiff seven cases. The median follow-up was 25.5 months (range, 1–102 months). All tumours were greater than 5 cm in diameter. The majority presented with symptoms of hormone excess. Adrenalectomy was performed in 83% – this was radical in 30% and followed by excision of recurrence in 13%. Adjuvant mitotane was given in 64% of patients, in combination with cytotoxic chemotherapy in 20%. One-third of patients did not receive any adjuvant therapy. There was no significant difference in survival between the three centres. The majority of patients (57%) died during the period of follow-up of this study. The median survival was 37 months (range, 2–102 months). CONCLUSIONS The size of tumour, stage and mode of presentation, age and overall survival of patients in this study are comparable to published series of adrenocortical carcinomas from major endocrine surgical centres world-wide. Despite controversies about benefits, adjuvant mitotane was used in the majority of cases, whereas cytotoxic chemotherapy was only used in the minority. The exact role of adjuvant therapy in the management of adrenocortical carcinoma is not as well established as for other more common malignancies. Establishing a database for adrenocortical carcinomas in the UK would contribute to our understanding of the management of this disease.
Specialised Chronic Compartment Measurement Clinic in a District General Hospital: Is it Worthwhile?
Authors: Zeineh Nedal , Ardolino Antonella , O'Connor David 
Published: August 2009

INTRODUCTION Chronic compartment syndrome is one of the conditions that cause exertional pain in the young. In this condition, a careful history taking is usually the key for making the correct diagnosis, but intracompartmental pressure measurement that has high sensitivity and specificity rates can add invaluable confirmation, especially when surgical decompression is indicated. In a district general hospital there is usually a logistical problem in performing compartmental pressure measurement. In this study, we describe our experience in dealing with such a problem by setting up a quarterly specialised clinic for intracompartmental pressure measurement that, according to our knowledge, is unique in the UK. PATIENTS AND METHODS We retrospectively reviewed the medical records of 42 patients referred to our specialised clinic and documented the referral patterns, clinical picture, additional investigations, pressure measurement results, final diagnosis and outcome of treatment. The intracompartmental measurement was recorded pre- and post-exercise on the treadmill for 1 min or 5 min and results were interpreted according to published criteria. RESULTS The mean age of the referred 42 patients was 33.1 years (range, 15–78 years). There were 16 positive results (38%) confirming the diagnosis of chronic compartment syndrome and four clinically characteristic cases of this condition with negative results. There were 22 negative results (53%), one borderline, and three patients were not tested for different reasons. All of the 10 patients who were treated surgically had positive pre-operative test results. CONCLUSIONS An inappropriate referral rate of approximately 52% was encountered that had a significant impact on the waiting time for the proposed test (5.7 months), which is far longer than the 18-week target for treatment in the NHS. We found that a positive test is a strong predictor of a successful outcome of surgical treatment. Such a specialised clinic, therefore, should only receive carefully assessed patients.
Clostridium difficile: How Much do Hospital Staff Know About it?
Authors: Aroori Somaiah , Blencowe Natalie , Pye Geoff , West Reuben 
Published: August 2009

INTRODUCTION The aim of this study was to determine the awareness of Clostridium difficile infection amongst healthcare professionals. SUBJECTS AND METHODS A total of 132 healthcare professionals (18 consultants, 40 trainee doctors, and 74 nursing staff) in our hospital were randomly surveyed using a questionnaire consisting of 17 questions covering various aspects of C. difficile. RESULTS More than 50% of healthcare professionals correctly identified C. difficile as an anaerobic bacillus. Half of the consultants and one-third of the trainees and nurses were aware that 5% of adults carry C. difficile in the gut. Overall, 80% of doctors and 40% of nursing staff (P = 0.001) were aware of the spectrum of illnesses caused by C. difficile. Seven (39%) consultants, 25 (63%) trainees, and 26 (37%) nurses correctly identified the various predisposing factors for the acquisition of C. difficile infection. Only one-third of doctors and 8% of nursing staff were aware that antibiotic restriction was the single most effective C. difficile infection control measure. In addition, 40% of doctors and 8% of nursing staff were aware that cytotoxin assay is the gold standard diagnostic test. Less than 30% of healthcare professionals were aware of the differences between the most common strain and the strain of C. difficile responsible for recent outbreaks. Only 6 (33%) consultants, 21 (53%) trainees (P = not significant), and 28 (38%) nursing staff were aware that hand washing with soap and water is the most effective way of preventing transmission of C. difficile infection. Results showed that 93% of trainees, 78% of consultants (P = 0.05) and 70% of nurses correctly answered that oral metronidazole is the drug of choice for the treatment of C. difficile infection. Compared to 73% of trainees, only two (11%) consultants (P < 0.0001) and 20 (27%) nursing staff correctly stated that oral vancomycin is the second-line treatment for persistent symptomatic C. difficile infection. CONCLUSIONS There is a significant lack of knowledge concerning C. difficile infection amongst healthcare professions, in particular amongst consultants and nurses in our hospital.
Audit of Anticoagulation After Embolectomy for Acute Ischaemia
Authors: Robinson T , Hunter I , Wathes R , Keeling D , Hands L 
Published: August 2009

INTRODUCTION Intravenous unfractionated heparin (UFH) is routinely used in patients after arterial embolectomy. Achieving and maintaining therapeutic levels requires a co-ordinated approach which may be difficult for busy junior doctors and laboratories. There is no current evidence regarding the use of subcutaneous low molecular weight heparin (LMWH) as an alternative. PATIENTS AND METHODS The study retrospectively examined all patients who had undergone any form of embolectomy during 2006 and 2007 by review of their medical records, an electronic laboratory database, and the patients' drug charts. RESULTS Overall, 45 patients were studied. A total of 389 activated partial thromboplastin time (APTT) tests were performed of which 146 (37.6%) were in the therapeutic range (50–90 s), 40.4% were < 50 s and 22.1% were > 90 s. Five patients (11.1%) had further surgical procedures. Significant bleeding occurred in two patients. CONCLUSIONS The results indicate that many patients are not appropriately anticoagulated. Whilst a new UFH protocol is being developed by our hospital trust, the authors believe the use of LMWH could provide a more effective and user-friendly alternative to UFH.
Non-Occlusive Small Bowel Necrosis in Association with Feeding Jejunostomy After Elective Upper Gastrointestinal Surgery
Authors: Spalding Duncan RC , Behranwala Kasim A , Straker Peter , Thompson Jeremy N , Williamson Robin CN 
Published: August 2009

INTRODUCTION Non-occlusive small bowel necrosis (NOSBN) has been associated with early postoperative enteral feeding. The purpose of this study was to determine the incidence of this complication in an elective upper gastrointestinal (GI) surgical patient population and the influence of both patient selection and type of feeding jejunostomy (FJ) inserted, based on the experience of two surgical units in affiliated hospitals. PATIENTS AND METHODS The records were reviewed of 524 consecutive patients who underwent elective upper GI operations with insertion of a FJ for benign or malignant disease between 1997 and 2006. One unit routinely inserted needle catheter jejunostomies (NCJ), whilst the other selectively inserted tube jejunostomies (TJ). RESULTS Six cases of NOSBN were identified over 120 months in 524 patients (1.15%), with no difference in incidence between routine NCJ (n = 5; 1.16%) and selective TJ (n = 1; 1.06%). Median rate of feeding at time of diagnosis was 105 ml/h (range, 75–125 ml/h), and diagnosis was made at a median of 6 days (range, 4–18 days) postoperatively. All patients developed abdominal distension, hypotension and tachycardia in the 24 h before re-exploratory laparotomy. Five patients died and one patient survived. CONCLUSIONS The understanding of the pathophysiology of NOSBN is still rudimentary; nevertheless, its 1% incidence in the present study does call into question its routine postoperative use especially in those at high risk with an open abdomen, planned repeat laparotomies or marked bowel oedema. Patients should be fully resuscitated before initiating any enteral feeding, and feeding should be interrupted if there is any evidence of feed intolerance.
Length of Stay Following Primary Total Hip Replacement
Authors: Foote Julian , Panchoo Kirby , Blair Peter , Bannister Gordon 
Published: August 2009

INTRODUCTION Much of the cost of primary total hip arthroplasty (THA) comprises the length of stay in hospital. Given the increasing drive for cost-effective surgery in today's National Health Service, the aim of this investigation was to determine the patient and surgical factors that most influence the length of stay following surgery. PATIENTS AND METHODS A large, population-based study of 675 consecutive patients in a regional orthopaedic centre in the South West of Britain. RESULTS The median length of stay was 8 days. The majority of patients (81.5%) left hospital within 2 weeks, 13.6% within 2–4 weeks and 4.9% after 4 weeks. On multivariate analysis, age above 70 years, ASA grades 3 and 4, prolonged operations and long incisions were highly significantly associated with hospital stay of over 2 weeks. CONCLUSIONS Prolonged stay after THA is largely predetermined by case mix and this should be taken into account when units are compared for performance and in the remuneration they receive for providing this service. Slick surgery through limited incisions may reduce the length of stay.
Measurement of Ribosomal RNA Turnover In Vivo by Use of Deuterium-Labeled Glucose
Authors: Defoiche Julien , Zhang Yan , Lagneaux Laurence , Pettengell Ruth , Hegedus Andrea , Willems Luc , Macallan Derek C 
Published: August 2009

AbstractBackground: Most methods for estimation of rates of RNA production are not applicable in human in vivo clinical studies. We describe here an approach for measuring ribosomal RNA turnover in vivo using [6,6-2H2]-glucose as a precursor for de novo RNA synthesis. Because this method involves neither radioactivity nor toxic metabolites, it is suitable for human studies.Methods: For method development in vitro, a lymphocyte cell line (PM1) was cultured in the presence of [6,6-2H2]-glucose. RNA was extracted, hydrolyzed enzymatically to ribonucleosides, and derivatized to either the aldonitrile tetra-acetate or the pentafluoro triacetate derivative of the pentose before GC-MS. We identified optimum derivatization and analysis conditions and demonstrated quantitative incorporation of deuterium from glucose into RNA of dividing cells.Results: Pilot clinical studies demonstrated the applicability of this approach to blood leukocytes and solid tissues. A patient with chronic lymphocytic leukemia received [6,6-2H2]-glucose (1 g/kg) orally in aliquots administered every 30 min for a period of 10 h. When we analyzed CD3– B cells that had been purified by gradient centrifugation and magnetic-bead adhesion, we observed deuterium enrichment, a finding consistent with a ribosomal RNA production rate of about 7%/day, despite the slow division rates observed in concurrent DNA-labeling analysis. Similarly, in 2 patients with malignant infiltration of lymph nodes, administration of [6,6-2H2]-glucose (by intravenous infusion for 24 h) before excision biopsy allowed estimation of DNA and RNA turnover in lymph node samples.Conclusions: Our study results demonstrate the proof-of-principle that deuterium-labeled glucose may be used to analyze RNA turnover, in addition to DNA production/cell proliferation, in clinical samples.
New ELISA for B Cell–Activating Factor
Authors: Le Pottier Laëtitia , Bendaoud Boutahar , Renaudineau Yves , Youinou Pierre , Pers Jacques-Olivier , Daridon Capucine 
Published: August 2009

Abstract
Background: The B cell–activating factor of the TNF family (BAFF) is upregulated in autoimmune diseases, but a number of conflicting results have cast doubts on the reliability of the ELISA protocols currently used for its quantification. This situation led us to develop a new ELISA for the measurement of BAFF.
Methods: BAFF was purified for use alongside nonglycosylated recombinant BAFF. Two monoclonal antibodies (mAbs) and two polyclonal antibodies (pAbs) to BAFF were used.
Results: The optimization process showed that the pAb format was preferable to the mAb format as capture antibody, because the pAbs recognized the glycosylated as well as the nonglycosylated forms of BAFF. The most efficient pair of Abs involved using the unconjugated form of a goat pAb to capture BAFF and the same biotinylated goat pAb to detect bound BAFF. This ELISA was not influenced by the presence of rheumatoid factor.
Conclusions: This new ELISA helped provide insights into why serum concentrations of BAFF vary between studies for a given population of patients. It is a reliable tool for the management of the diseases in which BAFF is an indication of response to therapy.
Free thyroxine is an independent predictor of subcutaneous fat in euthyroid individuals
Authors: Alevizaki Maria , Saltiki Katerina , Voidonikola Paraskevi , Mantzou Emily , Papamichael Christos , Stamatelopoulos Kimon 
Published: August 2009

ObjectiveThyroid function parameters have been associated with obesity, but associations with the type of adiposity have not been examined. We used ultrasound (US) to assess regional adiposity and investigated associations of thyroid function with parameters of central obesity.DesignCross-sectional study.MethodsA total of 303 apparently healthy individuals (age 42.9±8.8, body mass index (BMI) 19.0–43.3, median 26.2 kg/m2, 181 women) were examined for indices of the metabolic syndrome. BMI, waist and hip circumference, abdominal subcutaneous fat (SF), and preperitoneal fat (PF) layer was estimated. TSH, free thyroxine (fT4), triiodothyronine (T3), thyroid autoantibodies, insulin, glucose, and lipid levels were measured. Subjects receiving T4(9.2%) were excluded.ResultsSF and SF/PF ratio were inversely correlated with fT4levels (r=−0.169,P=0.023,r=−0.193,P=0.009 respectively). In multivariate analysis, fT4was a predictor of SF and SF/PF, independently of age, sex, and smoking. SF correlated with TSH levels (r=0.149,P=0.037). PF and SF were positively associated with T3levels (r=0.245,P=0.004 andr=0.189,P=0.019 respectively). T3levels were positively associated with BMI (r=0.257,P=0.0004), waist perimeter (r=0.324,P<0.0001), and waist-to-hip ratio (WHR;r=0.363,P<0.0001). The T3/fT4ratio was positively correlated with SF (r=0.182,P=0.028), WHR (r=0.267,P=0.0003), and BMI (r=0.146,P=0.043).ConclusionsIncreasing SF accumulation as assessed by US is associated with lower fT4and higher TSH levels among euthyroid slightly overweight individuals. These associations indicate that subtle variation in thyroid function may participate in regional adiposity.