bluuebunny/crossref_metadata_2025_split huggingface dataset:
Outcomes of information provision to callers to a psychiatric medication helpline
Authors: Olofinjana Olubanke , Connolly Anne , Taylor David 
Published: September 2009

Aims and MethodTo examine outcomes of information received by callers to a psychiatric medication helpline. A questionnaire was completed over the telephone with 123 callers, asking about the reason for contacting the helpline, frequency of self-referral to a healthcare professional, action taken as a result of information received, and satisfaction with the service and quality of information received.ResultsAlmost half of callers reported changes to their medication (stopping, starting, switching or dose adjustment) after consulting the helpline, with the majority receiving reassurance, referral, review and monitoring. Over half contacted a healthcare professional afterwards. Satisfaction with the quality of information and service provided by the helpline was very high.Clinical ImplicationsInformation provided by a psychiatric medication helpline can result in changes to caller's treatment and increase contact with other healthcare professionals.
Quality standards for community mental health teams
Authors: Laugharne Richard , Shankar Rohit 
Published: September 2009

SummaryThere is an increasing requirement for mental health services to demonstrate the quality of care provided. We have developed a quality report of our local community mental health team in Cornwall and suggest quality measures that we believe are useful to patients and clinicians, and possible to implement without overwhelming busy team members. They include measures of satisfaction, accessibility, safe process and review, outcomes, evidence-based practice and staff performance. Different teams may need different standards but we hope this paper will stimulate discussion and debate.
Recruiting psychiatrists – a Sisyphean task?
Authors: Brown Nick , Vassilas Christopher A. , Oakley Clare 
Published: September 2009

SummaryIn 2009, the Royal College of Psychiatrists piloted a system for national recruitment to the first year of training (CT1) in England. This paper reviews the changes in recruitment of UK medical graduates to psychiatry over the past 20 years, both within the West Midlands and nationally. Fewer UK graduates are entering psychiatric training in the West Midlands despite the introduction of pre-registration training in psychiatry and the expansion of medical schools in the region; this picture is reflected nationally. Reasons for the continuing problems in recruitment are discussed and suggestions made for improving the attractiveness of psychiatry as a medical specialty. the latter include: engaging more closely with medical students, continuing to lobby politically with regard to overseas recruitment and presenting a unified vision of the profession.
Body Composition and Bone Mineral Density in Children with Premature Adrenarche and the Association of LRP5 Gene Polymorphisms with Bone Mineral Density
Authors: Utriainen Pauliina , Jääskeläinen Jarmo , Saarinen Anne , Vanninen Esko , Mäkitie Outi , Voutilainen Raimo 
Published: September 2009

Context: Precocious increase in adrenal androgen production is the hallmark of premature adrenarche (PA). Adrenal androgens have anabolic properties.
Objective: The objective of the study was to test whether body composition and bone mineral density (BMD) are altered in PA and study whether genetic variation in low-density lipoprotein receptor-related protein 5 (LRP5) affects BMD in PA.
Design: This was a cross-sectional study.
Setting: The study was conducted at a university hospital.
Subjects and Measures: The study included 126 prepubertal children (64 with PA, 10 boys; 62 non-PA controls, 10 boys). Femoral neck and lumbar spine areal and calculated volumetric BMD (dual energy X-ray absorptiometry), body composition (bioimpedance), serum 25-hydroxyvitamin D, and markers of bone turnover and calcium homeostasis were compared between the PA and control groups. Single-nucleotide polymorphisms of LRP5 were determined and associated with BMD.
Results: Children with PA had higher femoral neck and lumbar spine BMDareal than the controls (Z-score 0.56 vs. −0.09, P &lt; 0.001, and 0.20 vs. −0.31, P = 0.009, respectively). However, the mean BMDs did not differ significantly between the groups when adjusted for height or bone size. BMDareal correlated strongly with height sd score in both groups. Among the PA children, LRP5 single-nucleotide polymorphism E644E minor variant was associated with lower and F549F minor variant with higher BMD. Total body fat mass, fat percent, serum PTH, and alkaline phosphatase concentrations were higher and 25-hydroxyvitamin D lower in the PA group.
Conclusions: Prepubertal children with PA had higher BMDareal compared with healthy controls. This was mainly explained by their increased height. LRP5 polymorphisms may contribute to bone mass accrual in prepubertal PA children.
Children with premature adrenarche have increased areal bone mineral density determined by their enhanced growth in height.
Anterior cruciate ligament reconstruction using autologous hamstring double bundle graft compared with single bundle procedures
Authors: Ibrahim S. A. R. , Hamido F. , Al Misfer A. K. , Mahgoob A. , Ghafar S. A. , Alhran H. 
Published: September 2009

A total of 218 patients with unilateral anterior cruciate ligament deficiency were randomly assigned to one of four groups. In group A an anatomical double bundle anterior cruciate ligament reconstruction was performed; group B were treated by a single bundle using an Endobutton for femoral fixation; in group C by a single bundle using RigidFix cross pins for femoral fixation; and in group D by a single bundle using a bioabsorbable TransFix II screw for femoral fixation. For tibial fixation a bioabsorbable Intrafix interference screw was used for all the groups and the graft was fashioned from the semitendinosus and gracilis tendons in all patients. In all, 18 patients were lost to follow-up. The remaining 200 were subjected to a clinical evaluation, with assessment of the anterior drawer, Lachman’s and the pivot-shift tests, and KT-1000 arthrometer measurement. They also completed the International Knee Documentation Committee, Lysholm knee and Tegner activity scores. At a mean of 29 months (25 to 38) follow-up there were no significant differences concerning time between injury and range of movement and Lysholm knee scores among the four groups. However, the double bundle method showed significantly better results for the pivot-shift test (p = 0.002). The KT 1000 measurements showed a mean difference between the reconstructed knee and the patients’ normal knee of 1.4 mm in the double bundle group and 2.4 mm in the single bundle group; which was statistically significant. The Lachman and anterior drawer tests also showed superior results for the double bundle method. The International Knee Documentation Committee scale showed no significant difference among the groups (p < 0.001). On clinical evaluation the double bundle group showed less laxity than the single bundle groups. However, regardless of the technique, all knees were improved by anterior cruciate ligament reconstruction compared with their pre-operative status.
Imageless computer navigation without pre-operative templating may lead to malpreparation of the femoral head in hip resurfacing
Authors: Olsen M. , Davis E. T. , Chiu M. , Gamble P. , Tumia N. , Boyle R. A. , Schemitsch E. H. 
Published: September 2009

The computed neck-shaft angle and the size of the femoral component were recorded in 100 consecutive hip resurfacings using imageless computer-navigation and compared with the angle measured before operation and with actual component implanted. The reliability of the registration was further analysed using ten cadaver femora. The mean absolute difference between the measured and navigated neck-shaft angle was 16.3° (0° to 52°). Navigation underestimated the measured neck-shaft angle in 38 patients and the correct implant size in 11. Registration of the cadaver femora tended to overestimate the correct implant size and provided a low level of repeatability in computing the neck-shaft angle.Prudent pre-operative planning is advisable for use in conjunction with imageless navigation since misleading information may be registered intraoperatively, which could lead to inappropriate sizing and positioning of the femoral component in hip resurfacing.
A prospective, cohort study comparing translaminar screw fixation with transforaminal lumbar interbody fusion and pedicle screw fixation for fusion of the degenerative lumbar spine
Authors: Grob D. , Bartanusz V. , Jeszenszky D. , Kleinstück F. S. , Lattig F. , O’Riordan D. , Mannion A. F. 
Published: September 2009

In a prospective observational study we compared the two-year outcome of lumbar fusion by a simple technique using translaminar screws (n = 57) with a more extensive method using transforaminal lumbar interbody fusion and pedicular screw fixation (n = 63) in consecutive patients with degenerative disease of the lumbar spine. Outcome was assessed using the validated multidimensional Core Outcome Measures Index. Blood loss and operating time were significantly lower in the translaminar screw group (p < 0.01). The complication rates were similar in each group (2% to 4%). In all, 91% of the patients returned their questionnaire at two-years. The groups did not differ in Core Outcome Measures Index score reduction, 3.6 (sd 2.5) (translaminar screws) vs 4.0 (sd 2.8) (transforaminal lumbar interbody fusion) (p = 0.39); ‘good’ global outcomes, 78% (translaminar screws) vs 78% (transforaminal lumbar interbody fusion) (p = 0.99) or satisfaction with treatment, 82% (translaminar screws) vs 86% (transforaminal lumbar interbody fusion) (p = 0.52). The two fusion techniques differed markedly in their extent and the cost of the implants, but were associated with almost identical patient-orientated outcomes. Extensive three-point stabilisation is not always required to achieve satisfactory patient-orientated results at two years.
Blood metal ion concentrations after hip resurfacing arthroplasty
Authors: Langton D. J. , Sprowson A. P. , Joyce T. J. , Reed M. , Carluke I. , Partington P. , Nargol A. V. F. 
Published: September 2009

There have been no large comparative studies of the blood levels of metal ions after implantation of commercially available hip resurfacing devices which have taken into account the effects of femoral size and inclination and anteversion of the acetabular component. We present the results in 90 patients with unilateral articular surface replacement (ASR) hip resurfacings (mean time to blood sampling 26 months) and 70 patients with unilateral Birmingham Hip Resurfacing (BHR) implants (mean time 47 months). The whole blood and serum chromium (Cr) and cobalt (Co) concentrations were inversely related to the size of the femoral component in both groups (p < 0.05). Cr and Co were more strongly influenced by the position of the acetabular component in the case of the ASR, with an increase in metal ions observed at inclinations > 45° and anteversion angles of < 10° and > 20°. These levels were only increased in the BHR group when the acetabular component was implanted with an inclination > 55°. A significant relationship was identified between the anteversion of the BHR acetabular component and the levels of Cr and Co (p < 0.05 for Co), with an increase observed at anteversion angles < 10° and > 20°. The median whole blood and serum Cr concentrations of the male ASR patients were significantly lower than those of the BHR men (p < 0.001). This indicates that reduced diametral clearance may equate to a reduction in metal ion concentrations in larger joints with satisfactory orientation of the acetabular component.
Limb lengthening with a submuscular locking plate
Authors: Oh C.-W. , Song H.-R. , Kim J.-W. , Choi J.-W. , Min W.-K. , Park B.-C. 
Published: September 2009

Ten patients, who were unsuitable for limb lengthening over an intramedullary nail, underwent lengthening with a submuscular locking plate. Their mean age at operation was 18.5 years (11 to 40). After fixing a locking plate submuscularly on the proximal segment, an external fixator was applied to lengthen the bone after corticotomy. Lengthening was at 1 mm/day and on reaching the target length, three or four screws were placed in the plate in the distal segment and the external fixator was removed. All patients achieved the pre-operative target length at a mean of 4.0 cm (3.2 to 5.5). The mean duration of external fixation was 61.6 days (45 to 113) and the mean external fixation index was 15.1 days/cm (13.2 to 20.5), which was less than one-third of the mean healing index (48 days/cm (41.3 to 55). There were only minor complications. Lengthening with a submuscular locking plate can successfully permit early removal of the fixator with fewer complications and is a useful alternative in children or when nailing is difficult.
Factors determining quality of life and level of sporting activity after internal fixation of an isolated acetabular fracture
Authors: Giannoudis P. V. , Nikolaou V. S. , Kheir E. , Mehta S. , Stengel D. , Roberts C. S. 
Published: September 2009

We investigated whether patients who underwent internal fixation for an isolated acetabular fracture were able to return to their previous sporting activities. We studied 52 consecutive patients with an isolated acetabular fracture who were operated on between January 2001 and December 2002. Their demographic details, fracture type, rehabilitation regime, outcome and complications were documented prospectively as was their level and frequency of participation in sport both before and after surgery. Quality of life was measured using the EuroQol-5D health outcome tool (EQ-5D). There was a significant reduction in level of activity, frequency of participation in sport (both p < 0.001) and EQ-5D scores in patients of all age groups compared to a normal English population (p = 0.001). A total of 22 (42%) were able to return to their previous level of activities: 35 (67%) were able to take part in sport at some level. Of all the parameters analysed, the Matta radiological follow-up criteria were the single best predictor for resumption of sporting activity and frequency of participation.
One-stage versus two-stage bilateral unicompartmental knee replacement
Authors: Chan W. C. W. , Musonda P. , Cooper A. S. , Glasgow M. M. S. , Donell S. T. , Walton N. P. 
Published: September 2009

We retrospectively studied the major complications occurring after one- and two-stage bilateral unicompartmental knee replacements (UKR). Between 1999 and 2008, 911 patients underwent 1150 UKRs through a minimally invasive approach in our unit. Of these, 159 patients (318 UKRs) had one-stage and 80 patients (160 UKRs) had two-stage bilateral UKRs. The bilateral UKR groups were comparable in age and American Society of Anaesthesiology grade, but more women were in the two-stage group (p = 0.019). Mechanical thromboprophylaxis was used in all cases. Major complications were recorded as death, pulmonary embolus, proximal deep-vein thrombosis and adverse cardiac events within 30 days of surgery. No statistical differences between the groups were found regarding the operating surgeon, the tourniquet time or minor complications except for distal deep-vein thrombosis. The anaesthetic times were longer for the two-stage group (p = 0.0001). Major complications were seen in 13 patients (8.2%) with one-stage operations but none were encountered in the two-stage group (p = 0.005). Distal deep-vein thrombosis was more frequent in the two-stage group (p = 0.036). Because of the significantly higher risk of major complications associated with one-stage bilateral UKR we advocate caution before undertaking such a procedure.
Endoprosthetic reconstruction of the distal tibia and ankle joint after resection of primary bone tumours
Authors: Shekkeris A. S. , Hanna S. A. , Sewell M. D. , Spiegelberg B. G. I. , Aston W. J. S. , Blunn G. W. , Cannon S. R. , Briggs T. W. R. 
Published: September 2009

Endoprosthetic replacement of the distal tibia and ankle joint for a primary bone tumour is a rarely attempted and technically challenging procedure. We report the outcome of six patients treated between 1981 and 2007. There were four males and two females, with a mean age of 43.5 years (15 to 75), and a mean follow-up of 9.6 years (1 to 27). No patient developed a local recurrence or metastasis. Two of the six went on to have a below-knee amputation for persistent infection after a mean 16 months (1 to 31). The four patients who retained their endoprosthesis had a mean musculoskeletal tumour society score of 70% and a mean Toronto extremity salvage score of 71%. All were pain free and able to perform most activities of daily living in comfort. A custom-made endoprosthetic replacement of the distal tibia and ankle joint is a viable treatment option for carefully selected patients with a primary bone tumour. Patients should, however, be informed of the risk of infection and the potential need for amputation if this cannot be controlled.
Use of Combination Therapy with a β-Blocker and Milrinone in Patients with Advanced Heart Failure
Authors: Jennings Douglas L , Thompson Melissa L 
Published: September 2009

Objective: To review the literature evaluating the clinical effects of combination therapy with a β-blocker and milrinone in patients with severe heart failure (HF). Data Sources: Literature was accessed through MEDLINE (1950–June 2009), PubMed (1966–June 2009), and International Pharmaceutical Abstracts (1970–June 2009), with combinations of the following terms: positive inotrope, milrinone, dobutamine, and β-receptor blocker. In addition, reference citations from publications identified were reviewed. Study Selection and Data Extraction: All articles that examined the effect of combination therapy with a β-blocker and milrinone on clinical endpoints in patients with advanced HF were assessed. Data Synthesis: A search of the literature revealed 4 studies examining the clinical effects of combination therapy with a β-blocker and milrinone. Three of these studies were retrospective reviews, while one was a post hoc subgroup analysis from the OPTIME-CHF study. Concomitant therapy with milrinone and a β-blocker was well tolerated, with no significant increase in adverse events or deterioration in clinical status in any study. Tolerability rates for combination therapy ranged from 88% to 92%. In 2 of the studies, roughly 50% of the patients in the combination arm were able to be weaned off milrinone. One study suggested a mortality reduction in favor of combination therapy over milrinone alone, while another study suggested no difference in mortality with combination therapy versus milrinone monotherapy. One study suggested a potential increase in mortality when β-blocker therapy was withdrawn in patients who were started on milrinone. None of the studies demonstrated any significant differences in hospitalization rates. All of the studies were limited by their retrospective nature and small sample size. Conclusions: Data are insufficient to make firm conclusions on the clinical benefit of combination therapy with a β-blocker and milrinone in patients with advanced HF, although it appears that this regimen is well tolerated and may allow weaning of inotropic support.
Auditory Brainstem Evoked Responses in Newborns With Down Syndrome
Authors: Kittler Phyllis M. , Phan Ha T. T. , Gardner Judith M. , Miroshnichenko Inna , Gordon Anne , Karmel Bernard Z. 
Published: September 2009

Abstract
Auditory brainstem evoked responses (ABRs) were compared in 15 newborns with Down syndrome and 15 sex-, age-, and weight-matched control newborns. Participants had normal ABRs based upon values specific to 32- to 42-weeks postconceptional age. Although Wave III and Wave V component latencies and the Wave I–III interpeak latency (IPL) were shorter in ABRs of infants with Down syndrome, the Wave III–V IPL was not, pointing to anomalies in the lower rather than upper brainstem auditory pathways. Shorter Down syndrome ABR latencies have been reported at many ages. Extending these findings to newborns suggests that the underlying basis for this develops prenatally. ABR patterns in infants with Down syndrome were similar to reports for intrauterine growth restricted newborns.
Evidence for Slowing as a Function of Index of Difficulty in Young Adults With Down Syndrome
Authors: Lam Melanie Y. , Hodges Nicola J. , Virji-Babul Naznin , Latash Mark L. 
Published: September 2009

AbstractSpeed–accuracy trade-offs in persons with Down syndrome and typically developing controls were tested with a Fitts' task. Movement time scaled linearly with index of difficulty in both groups, and there were no accuracy differences. Persons with Down syndrome were slower than typically developing individuals. Regression analysis on movement time and index of difficulty showed a nearly two-fold higher regression coefficient and a nearly three-fold larger intercept value in the Down syndrome group. The dwell time on a target was much longer for Down syndrome persons but scaled with index of difficulty in about the same percentage for participants in both groups. Because of differences primarily related to scaling, we conclude that mechanisms of motor control are similar in Down syndrome and typically developing groups.
Should anterior pituitary function be tested during follow-up of all patients presenting at the emergency department because of traumatic brain injury?
Authors: van der Eerden Anke W , Twickler Marcel Th B , Sweep Fred C G J , Beems Tjemme , Hendricks Henk T , Hermus Ad R M M , Vos Pieter E 
Published: September 2009

ContextA wide range (15–56%) of prevalences of anterior pituitary insufficiency are reported in patients after traumatic brain injury (TBI). However, different study populations, study designs, and diagnostic procedures were used. No data are available on emergency-department-based cohorts of TBI patients.ObjectiveTo assess the prevalence of pituitary dysfunction in an emergency-department-based cohort of TBI patients using strict endocrinological diagnostic criteria.MethodsOf all the patients presenting in the emergency department with TBI over a 2-year period, 516 matched the inclusion criteria. One hundred and seven patients (77 with mild TBI and 30 with moderate/severe TBI) agreed to participate. They were screened for anterior pituitary insufficiency by GHRH–arginine testing, evaluation of fasting morning hormone levels (cortisol, TSH, free thyroxine, FSH, LH, and 17β-estradiol or testosterone), and menstrual history 3–30 months after TBI. Abnormal screening results were defined as low peak GH to GHRH–arginine, or low levels of any of the end-organ hormones with low or normal pituitary hormone levels. Patients with abnormal screening results were extensively evaluated, including additional hormone provocation tests (insulin tolerance test, ACTH stimulation test, and repeated GHRH–arginine test) and assessment of free testosterone levels.ResultsScreening results were abnormal in 15 of 107 patients. In a subsequent extensive endocrine evaluation, anterior pituitary dysfunction was diagnosed in only one patient (partial hypocortisolism).ConclusionBy applying strict diagnostic criteria to an emergency-department-based cohort of TBI patients, it was shown that anterior pituitary dysfunction is rare (<1%). Routine pituitary screening in unselected patients after TBI is unlikely to be cost-effective.