bluuebunny/crossref_metadata_2025_split huggingface dataset:
The development of healthcare services for drug misusers and prostitutes
Authors: Morrison C L , Ruben S M 
Published: December 2008

Abstract
With the advent of human immunodeficiency virus (HIV) and the increase of drug misuse in the UK, the Government wishes primary care to play a greater part in treating drug problems in the hope of preventing the spread of HIV. Drug misusers do not avail themselves of traditional services and many are not registered with general practitioners. In response to this Liverpool Health Authority and Family Health Service Authority commenced a new salaried post to provide primary care services to special groups such as injecting drug misusers and prostitutes. Judgemental attitudes towards drug misusers, their high mobility and being a transient population play a part in the reasons why drug misusers find it difficult to access primary healthcare. Drug misusers have high morbidity related to their drug misuse. Many of these conditions, if treated early, can prevent the need for more intensive intervention. Although drug misusers may present with a condition requiring immediate treatment, the opportunity is used to provide other healthcare such as hepatitis B vaccinations, sexually transmitted infection screening, contraception and HIV/hepatitis B testing. The sero prevalence of anti-HBc in injecting drug misusers is 45.5%. Due to their high morbidity and associated costs, the requirements of these groups may conflict with the objectives of budget-holding practices. If general practitioners are unable to respond to their problems, then health care providers and purchasers will have to consider similar schemes in areas which have a higher prevalence of drug misuse in order to provide appropriate healthcare for these vulnerable groups.
Successful pregnancy following aplastic anaemia
Authors: Leong K W , Teh A , Bosco J J , Lim J 
Published: December 2008

Abstract
Pregnancy following idiopathic aplastic anaemia is rare and is difficult to manage because of life-threatening episodes of bleeding and infections. Only a handful of cases has been reported in the literature. The pregnancies were unsuccessful in the majority. The present report describes a patient with moderately severe idiopathic aplastic anaemia who was managed with intensive haematological support leading to delivery of a healthy infant by caesarean section. Despite platelet transfusion refractoriness as a result of transfusions prior to pregnancy, adequate platelet transfusions prevented excessive bleeding. The literature is reviewed and management with platelet transfusions is discussed.
Battered granny or spontaneous fractures? A legal dilemma
Authors: Connolly V , McConnell A A , McGarrity G 
Published: December 2008

Abstract
A 70-year-old woman was admitted from a local nursing home with extensive bruising and bilateral hip discomfort. The referring doctor had reported the possibility of elder abuse to the police. Full examination showed that osteomalacia, precipitated by a poor diet and lack of exposure to sunlight, was sufficient to explain the patient’s condition. Caution is recommended in diagnosing elder abuse until other possibilities have been excluded.
The clinical skills unit
Authors: Bligh J 
Published: December 2008

Abstract
Clinical skills units offer exciting and innovative ways of learning about clinical skills. Links between theoretical knowledge and clinical practice are appropriate for both undergraduate and postgraduate training. Students and doctors can practice and acquire technical and examination skills in a standardised and protected environment without being concerned about the distress such learning may cause real patients. Models and simulators used in skills units are being developed to keep pace with demand, with a corresponding increase in standards of quality and durability. As undergraduate medical courses respond to the demands of modern clinical practice the use of such facilities will increase. This paper describes the functions of skills units and provides practical examples of educational strategies in use.
Routine nasal surgery: an audit of outpatient follow-up
Authors: Murthy P , McKerrow W S 
Published: December 2008

Abstract
The study objective was to assess the value of outpatient follow-up of patients who undergo routine uncomplicated nasal surgery. A total of 177 postoperative patients (117 males, 60 females) undergoing routine nasal surgery at the Raigmore Hospital, Inverness, was selected over a six-month period, 92 of whom (60 males, 32 females) were requested to return to the clinic for a follow-up session. A total of 72 (78.3%) patients attended for post-operative review. Of these, 55 patients (76.4%) had achieved a satisfactory result from surgery and 17 (23.6%) required additional treatment for persistent problems. The former group were pleased with the outcome of their operation and required no further treatment. Of the 25 patients who were prescribed medication at the time of discharge from hospital, 19 (76.0%) were still complying with the medication and required no further specialist assistance. The results suggest that routine follow-up of uncomplicated cases of nasal surgery is unnecessary. The good therapeutic results in the majority of cases indicate a need to decrease the number of routine reviews to reduce the high non-attendance rate and increase the proportion of new patients seen at outpatient clinics. The role played by general practitioners is vital to this cause. This would include minor postoperative care, monitoring of prescribed medication and review of patients with occasional postoperative problems.
A randomised, double-blind, placebo-controlled trial of L-carnitine in suspected acute myocardial infarction
Authors: Singh R B , Niaz M A , Agarwal P , Beegum R , Rastogi S S , Sachan D S 
Published: December 2008

Abstract
In a randomised, double-blind placebo-controlled trial, the effects of the administration of oral L-carnitine (2 g/day) for 28 days were compared in the management of 51 (carnitine group) and 50 (placebo group) patients with suspected acute myocardial infarction. At study entry, the extent of cardiac disease, cardiac enzymes and lipid peroxides were comparable between the groups, although both groups showed an increase in cardiac enzymes and lipid peroxides. At the end of the 28-day treatment period, the mean infarct size assessed by cardiac enzymes showed a significant reduction in the carnitine group compared to placebo. Electrocardiographic assessment of infarct size revealed that the QRS-score was significantly less in the carnitine group compared to placebo (7.4 +/- 1.2 vs 10.7 +/- 2.0), while serum aspartate transaminase and lipid peroxides showed significant reduction in the carnitine group. Lactate dehydrogenase measured on the sixth or seventh day following infarction showed a smaller rise in the carnitine group compared to placebo. Angina pectoris (17.6 vs 36.0%), New York Heart Association class III and IV heart failure plus left ventricular enlargement (23.4 vs 36.0%) and total arrhythmias (13.7 vs 28.0%) were significantly less in the carnitine group compared to placebo. Total cardiac events including cardiac deaths and nonfatal infarction were 15.6% in the carnitine group vs 26.0% in the placebo group. It is possible that L-carnitine supplementation in patients with suspected acute myocardial infarction may be protective against cardiac necrosis and complications during the first 28 days.
Pancreaticopleural fistula: a rare complication of chronic pancreatitis
Authors: Wakefield S , Tutty B , Britton J 
Published: December 2008

Abstract
Pancreaticopleural fistula is an uncommon sequelae of pancreatitis. The condition is often elusive, as respiratory rather than abdominal symptoms usually predominate and the fistula can be difficult to demonstrate radiologically. Confirmation is by demonstrating a high amylase content in the pleural aspirate relative to the serum. About half the fistulae will close with conservative treatment but persistent or recurrent effusions, often associated with stenosis or disruption of the main pancreatic duct, are an indication for surgery. The long-term outcome is good in 80-95% of cases. We report five patients with pleural effusion of pancreatic origin due to pancreaticopleural fistula.
The modernisation of general practice in the UK: 1980 to 1995 and beyond. Part I
Authors: Iliffe S 
Published: December 2008

Summary
The UK is unusual in providing universal free healthcare in which access to specialists is largely controlled by general practitioners with 24-hour responsibility, throughout the year, for a defined list of patients of all ages. It is generally considered that this gatekeeper function has contributed to the relatively low cost of the National Health Service, but major changes in the organisation and clinical role of general practitioners have occurred, culminating in a new contract that aims to re-orientate general practice towards health promotion, disease prevention and the management of chronic disease. The implications of these changes are discussed.
Clinician beliefs underlying autopsy requests
Authors: Birdi K S , Bunce D J , Start R D , Cotton D W 
Published: December 2008

Summary
The aim of the study was to use psychological theory to identify and evaluate factors influencing clinical autopsy requests. A series of pilot interviews were conducted with 20 clinicians to identify beliefs about the benefits and drawbacks, social groups and circumstances influential in the decision to make an autopsy request. The most common beliefs, together with measures of intention to request autopsies, were incorporated into a questionnaire which was distributed among all appropriate clinicians in four hospitals. Statistical analyses identified which beliefs had the most influence on clinicians’ intentions to request autopsies. A total of 145 clinicians returned the questionnaire, a response rate of 42%. Clinicians were significantly more likely to request autopsy the more they thought that the outcome of requesting would be of educational value, would confirm clinical diagnoses, would not distress relatives, would not be time-consuming and that the request itself would receive support from their consultant. An autopsy request was unlikely in circumstances where clinicians felt uncomfortable when requesting relatives’ permission and when the patients were elderly. The fear of causing distress to relatives and the degree of support from the clinician’s consultant were found to be the strongest predictors of intention to request autopsies. These are two areas in which intervention could help to increase autopsy request rates.
Caval umbrella causing obstructive uropathy
Authors: Flanagan D , Creasy T , Chataway F , Kerr D 
Published: December 2008

Summary
A 49-year-old woman had a vena caval filters inserted having suffered multiple pulmonary emboli and a large upper gastrointestinal bleed. She re-presented five years later with loin pain and obstructive uropathy. She was found to have a right pelvi-ureteric obstruction due to inferior vena caval wall perforation from the vena caval filter.
Acute pancreatitis: assessment and management
Authors: Skaife P , Kingsnorth A N 
Published: December 2008

Summary
In the 1920s Moynihan described acute pancreatitis as "..the most terrible of all intra-abdominal calamities". He established a practice of immediate surgical intervention to remove the toxic products accumulating in the peritoneal cavity, and this treatment was endorsed by most centres, remaining the standard therapy for the next 20 years. In the 1940s, the mortality of patients treated surgically was shown to be far higher than those treated conservatively, and a more conservative line of management was recommended, comprising nasogastric stomach decompression, intravenous fluid therapy, opiate analgesia, and the administration of atropine. Despite half a century passing, a clinician would not be criticised for adopting such a regime today, which in part reflects the lack of understanding of this condition and the failure of seemingly appropriate therapy. Reduction in mortality is a consequence of advances in intensive care preventing the high early mortality of organ failure, but the area of specific therapy remains elusive. While this is so, the mortality rates for these patients will remain static, while the doctor continues to feel clinically impotent.
Deep cerebral venous thrombosis presenting as an encephalitic illness
Authors: Silburn P A , Sandstrom P A , Staples C , Mowat P , Boyle R S 
Published: December 2008

Summary
Three cases of deep cerebral vein thrombosis presenting as encephalitic illnesses are described. Thyrotoxicosis was present in one case, ulcerative colitis in one case and an anticardiolipin antibody was detected in two cases. All three patients were on oestrogen and progesterone. Magnetic resonance imaging and angiography allowed rapid confirmation of the diagnosis and permitted non-invasive follow up of this condition. The first two patients made complete clinical recoveries despite having thalamic infarction, in one case bilaterally, demonstrable radiologically.
Bilateral endogenous Escherichia coli endophthalmitis: a devastating complication in an insulin-dependent diabetic
Authors: Walmsley R S , David D B , Allan R N , Kirkby G R 
Published: December 2008

Summary
We report a case of bilateral endogenous Escherichia coli endophthalmitis in an insulin-dependent diabetic. This condition appears to occur almost exclusively in diabetics, and is invariably related to a urinary tract infection. Treatment of any infection in diabetics should be aggressive, and any deterioration in vision should be addressed promptly.
Insulin resistance and development of diabetes mellitus associated with megestrol acetate therapy
Authors: Jain P , Girardi L S , Sherman L , Berelowicz M , Smith L G 
Published: December 2008

Summary
We describe a case of diabetes mellitus induced by megestrol acetate in a patient with the acquired immunodeficiency syndrome. Metabolic studies including an arginine infusion test excluded an insulinopenic state and suggested insulin resistance as the underlying mechanism for hyperglycaemia. Withdrawal of megestrol acetate resulted in rapid correction of all metabolic abnormalities and eliminated the need for exogenous insulin therapy.
Somatostatin analogue treatment of neuroendocrine tumours
Authors: de Herder W W , van der Lely A J , Lamberts S W 
Published: December 2008

Summary
The long-acting analogues of somatostatin have an established place in the medical treatment of patients with neuroendocrine tumours. They act through binding with specific, high-affinity membrane receptors. Somatostatin analogue therapy is an effective and safe treatment for most growth hormone and thyrothropin-secreting pituitary adenomas. The potential therapeutic consequences of the presence of somatostatin receptors on clinically ‘nonfunctioning’ pituitary tumours are still uncertain. Somatostatin analogues are not useful in the treatment of patients with prolactinomas, or adrenocorticotropin (ACTH)-secreting adenomas. However, the somatostatin analogue octreotide suppressed pathological ACTH release in some patients with Nelson’s syndrome and ACTH and cortisol secretion in several patients with Cushing’s syndrome caused by ectopic ACTH secretion. Somatostatin analogues are effective in the sympatomatic treatment of most (metastatic) pancreatic islet cell tumours and most (metastatic) carcinoids. In some of these patients, they also induce tumour stabilisation or reduction. In some patients with (metastatic) medullary thyroid carcinomas, continuous treatment with very high doses of octreotide can be of temporary relief. The clinical effectiveness of somatostatin analogues in patients with small cell lung cancer is currently under investigation. Long-term therapy with somatostatin analogues of catecholamine-secreting (malignant) paragangliomas and phaeochromocytomas has not shown clinical benefits.
Serum bone Gla protein and carboxyterminal cross-linked telopeptide of type I collagen in patients with Cushing’s syndrome
Authors: Sartorio A , Conti A , Ferrario S , Passini E , Re T , Ambrosi B 
Published: December 2008

Summary
Serum bone Gla protein, a marker of bone formation, and carboxyterminal cross-linked telopeptide of type I collagen levels, an index of bone resorption, were evaluated in eight patients with active Cushing’s syndrome and in four with ‘preclinical’ Cushing’s syndrome, before and after surgery. In basal conditions, serum bone Gla protein levels were significantly lower (p &lt; 0.0001) in patients with active Cushing’s syndrome (1.0 +/- 0.35 ng/ml) than in controls (5.4 +/- 0.15 ng/ml); two out of four patients with the ‘preclinical’ form had reduced bone Gla protein levels, while in the other two cases levels were in the normal range. Serum levels of carboxyterminal cross-linked telopeptide of type I collagen (3.0 +/- 0.4 ng/ml), although slightly reduced, were similar to those recorded in controls (4.1 +/- 0.3 ng ml), both in patients with active and with preclinical Cushing’s syndrome. After surgery serum levels of both marker proteins significantly increased in seven out of eight patients with active Cushing’s syndrome; in one patient, who was not cured after surgery, bone Gla proteins levels remained lower than in normals, while levels of carboxyterminal cross-linked telopeptide of type I collagen had a transient increase after six months. In the two patients with a ‘preclinical’ Cushing’s syndrome who underwent surgery, a significant rise of the levels of both marker proteins was observed, similar to that observed in patients with active Cushing’s syndrome. It was concluded that serial determinations of these new markers of bone formation and resorption may be usefully employed to follow-up the clinical course of Cushing’s syndrome and provide information on the rate of bone turnover in response to medical and/or surgical therapies. Moreover, the evaluation of these markers in preclinical states of Cushing’s syndrome might suggest the need for surgery.
Treatment of thyrotoxicosis resistant to carbimazole with corticosteroids
Authors: Jude E B , Dale J , Kumar S , Dodson P M 
Published: December 2008

Summary
We report two patients whose thyrotoxicosis failed to respond to conventional treatment with carbimazole. The patients remained persistently hyperthyroid, both clinically and biochemically, despite several months of carbimazole therapy at the maximum recommended doses. Prednisolone 20 mg per day was then given in addition to the antithyroid drug and a dramatic response observed in both cases. They were then successfully treated with radioiodine. Prednisolone has not been previously used to treat patients with hyperthyroidism who have not responded to thionamide drugs. Our experience suggests that corticosteroids may be potentially useful for controlling thyrotoxicosis in combination with carbimazole before definite treatment can be instituted.
The Vogt-Koyanagi-Harada syndrome: association with autoimmune polyglandular syndrome type 1
Authors: Jovic N S , Nesovic M , Vranjesevic D N , Ciric J , Marinkovic D M , Bonaci B 
Published: December 2008

Summary
We describe a young woman with primary adrenal insufficiency, hypoparathyroidism (autoimmune polyglandular syndrome type 1), Graves disease, vitiligo, and alopecia universalis. Five years after the diagnosis, she presented with recurrent ophthalmological and neurological disorders as features of Vogt-Koyanagi-Harada syndrome. A marked therapeutic response was noted on systemic high-dose corticosteroid treatment. To the best of our knowledge, such a spectre of autoimmune diseases has not been reported previously.
The advantages of problem-based curricula
Authors: Dolmans D , Schmidt H 
Published: December 2008

Summary
Problem-based curricula provide a learning environment in which competence is fostered not primarily by teaching to impart knowledge, but through encouraging an inquisitive style of learning. Preliminary discussion in small groups, contextual learning, integration of knowledge and an emphasis on patient problems, have several cognitive effects on student learning. These effects are increased retention of knowledge, enhancement of integration of basic science concepts into clinical problems, the development of self-directed learning skills, and the enhancement of students’ intrinsic interest in the subject matter. In this paper a number of studies will be reviewed that provide empirical evidence for these premises.
Junior hospital doctors’ views on their training in the UK
Authors: Panayiotou B N , Fotherby M D 
Published: December 2008

Summary
To ascertain the views of senior house officers and registrars on the educational and training component of their posts, a questionnaire was sent to all full-time doctors working in training posts in general and/or geriatric medicine at three district general and three teaching hospitals. Completed questionnaires were received from 64 (61%) of 105 doctors who were contacted. Most had a careers counsellor or tutor, although less than two-thirds thought they had benefited from this arrangement. The majority of doctors attended at least two medical tutorials or meetings per week; most wanted to attend more but were unable to because of other work commitments. Supervision by more senior staff on the ward was deemed by most to be satisfactory, but less so in out-patient clinics. Overall, one-third of doctors thought that training was inadequate and three-quarters wanted a greater amount of formal education. The majority of junior doctors’ time was spent on routine work and most considered :training’ constituted less than 10% of their working time. Doctors in training require more sessions designated as educational, with protected time to attend these.
The trauma team--a system of initial trauma care
Authors: Adedeji O A , Driscoll P A 
Published: December 2008

SummaryTrauma remains the leading cause of death under the age of 35 years. England and Wales lost 252,000 working years from accidental deaths, including poison, in 1992. In this country, preventable deaths from trauma are inappropriately high. In many hospitals there are not enough personnel; in the majority, there are no recognisable trauma care systems, which can reduce preventable deaths to a minimum. The appropriateness of trauma centres for this country is being assessed in Stoke-on-Trent, and a report is due out later this year. Even if the recommendation is made to establish such centres, it is unlikely that many will be set up. Consequently most hospitals will have to rely on their own resources to set up and run a trauma team. This type of trauma care system is the subject of this article.
Acromegaly presenting with diabetic ketoacidosis
Authors: Katz J R , Edwards R , Khan M , Conway G S 
Published: December 2008

Summary
Diabetes in acromegaly is usually non-insulin dependent and is secondary to insulin resistance caused by growth hormone excess. Diabetic ketoacidosis is a result of relative insulin deficiency and is a rare feature of acromegaly. We describe a case of acromegaly presenting with diabetic ketoacidosis. We demonstrate that growth hormone excess can cause diabetic ketoacidosis in the presence of relative, but not absolute insulin deficiency.
Stroke and transient ischaemic attacks in association with substance abuse in a young man
Authors: Lawson T M , Rees A 
Published: December 2008

Summary
A 22-year-old man with a five-year history of drug and alcohol abuse presented with a left hemiparesis preceded by three transient ischaemic attacks, two of which occurred whilst smoking cannabis. Substance abuse was the only identifiable risk factor for cerebrovascular disease.