bluuebunny/crossref_metadata_2025_split huggingface dataset:
Intensive Case Management: A Cost-Effectiveness Analysis
Authors: Johnston Susan , Salkeld Glenn , Sanderson Kristy , Issakidis Catherine , Teesson Maree , Buhrich Neil 
Published: January 2008

Objective: The objective of this study was to compare the outcomes and costs of intensive case management with routine case management for a group of severely disabled patients with a mental illness. Method: A cost-effectiveness analysis was conducted alongside a randomised con trolled trial. Seventy-three patients, who reside in the eastern suburbs of Sydney, were randomly allocated to either intensive or routine case management. Staff pro viding intensive case management had substantially lower caseloads than staff pro viding routine case management. The main health outcome measured was patients' level of functioning as measured by the Life Skills Profile. Costing data were collect ed from hospital services, mental health services, general health services, community services and informal carers. Results: At 12 months, outcome and costing data were analysed on 58 patients and hospitalisation data were analysed on 68 patients. Significantly more patients in the intensive case management group remained in treatment (χ2 = 6.00, df = 1, p < 0.01) and showed a clinically significant improvement in functioning from base line to 12 months (χ2 = 4.50, df = 1, p < 0.05). The mean cost per patient was $7745 more in the intensive group than in the routine group (t = 1.49, df = 56, p > 0.01) over 12 months. The cost-effectiveness ratio indicated a cost of $27 661 per year for one additional patient in the intensive case management group to make a clinically significant improvement in functioning. Conclusion: Intensive case management led to an increased rate of retention in treatment and a clinically significant improvement in functioning. Further comparative cost-effectiveness studies are required to determine whether $27 661 per year for one patient to make a clinically significant improvement in functioning is a cost-effective use of mental health resources.
Liability in Prescribing Choice: The Example of the Antidepressants
Authors: Beerworth Ellen E. , Tiller John W.G. 
Published: January 2008

Objective: The aim of this study is to review issues of legal liability in prescribing choice. Prescribing not only occurs in a medical setting, but also in a social and legal context in this era of evidence-based medicine and greater consumer awareness. Prescribers may be unaware of the legal consequences of medical decision-making and prescribing choice. This issue affects all areas of medicine and can be illustrated by antidepressant choice for major depression. Method: A review was undertaken of liability issues that may arise in the context of prescribing, with particular reference to prescribing antidepressants. Results: There are legal precedents which illustrate prescribers' potential liability. These impose duties on the prescriber including those of care, to inform, and to respond to patients' wishes. In particular, the duty of care requires that if medicines are of equal efficacy, one should prescribe the best tolerated and least toxic medicine that is most likely to be taken at an effective dose for an adequate duration. While older and newer antidepressants are generally of equal efficacy, the newer agents have higher tolerability, lower toxicity and are less likely to be associated with treatment failure (due to sub-therapeutic dose regimens, or the patient discontinuing medication), disabling psychomotor impairment, dietary interaction or fatal overdose. Conclusions: There needs to be compelling reasons for prescribing medicines with a greater likelihood of adverse outcomes such as the older antidepressants (e.g. tri-cyclics) rather than the newer antidepressants such as RIMAs, SSRls, SNRls and 5HT2 receptor antagonists. The higher likelihood of an adverse outcome of treatment where an older antidepressant has been prescribed raises the potential for professional negligence claims to be brought against medical practitioners who prescribe such medicines for reasons other than established medical need.
Faith-Assisted Cognitive Therapy of Obsessive—Compulsive Disorder
Authors: Gangdev Prakash S. 
Published: January 2008

Objective: The aim of this paper is to report the rapid resolution of obsessions when the patient invoked Christ to treat her obsessions. Clinical picture: A 25–year-old female presented with obsessions (doubts) that: (i) while driving she will knock down a pedestrian; and (ii) she will be charged with sex abuse. Treatment and Outcome: Cognitive therapy (cognitive restructuring and thought-stopping) was offered. After a single session a complete remission was reported when she replaced her doubts with firm convictions that “Christ will help me drive safely” and “Christ will not let me do anything wrong”. She was reported to have remained well at the end of 5 months at which time she relocated and was then lost to follow-up. Conclusion: Religious faith can have a healing effect, and cognitive therapy is not incompatible with religion. Although unusual in standard clinical practice, rapid resolution of obsessions is possible.
Wei han zheng (Frigophobia): A Culture-Related Psychiatric Syndrome
Authors: Ng Beng-Yeong 
Published: January 2008

Objective: The aim of this paper is to describe a clinical case of wei han zheng (frigophobia) in Singapore. Clinical picture: A 45–year-old Chinese housewife had morbid fears of cold, in terms of temperature, and food of a cold ( yin) nature, and a variety of somatic symptoms. She stopped working, adopted various measures to avoid exposure to cold air and wind, and took dietary precautions. Treatment and outcome: She received intermittent follow-ups over the following 8 years. An episodic, albeit recurrent, course was documented. Treatment consisted of symptomatic relief using low dose anxiolytics and antidepressants, and psycho logical interventions. Conclusion: Frigophobia is closely related to, and strongly influenced by, cultural beliefs. In therapy, it would be pertinent to consider the patient's own cultural beliefs about the illness as compared to the therapist's model of illness, and how matching of these could be negotiated.
The Diagnosis of Depression in Disorder
Authors: Van Praag H. M. 
Published: January 2008

Objective: My purpose is to critically evaluate psychiatry's current approach to the diagnosis of depression. Methods: I have closely examined trends in diagnosing depression, especially since DSM-III, and have considered alternative options. Results/Conclusions: Psychiatric taxonomy is currently based on invalid nosological premises that have worked as a straitjacket for conceptual progress and related biological and psychopharmacological research. A fresh approach that replaces nosological analysis with the concepts of functionalisation and verticalisation is essential.
Psychiatrists and Compulsion: A Map of Ethics
Authors: Rosenman Stephen 
Published: January 2008

Objective: The aim of this study is to analyse the ethical underpinning of involuntary treatment and to create a guide for psychiatric practice which clarifies its relationship with modern mainstream clinical ethics. Method: Literature on ethics, involuntary treatment, civil commitment, diagnosis and law was searched and examined. Result: Hospitalisation for involuntary treatment and control has blurred two important discriminations: the discrimination between clinical and social constructions of mental illness and the discrimination between therapeutic actions and policing control. Plotting these discriminations creates a map of ethics in involuntary treatment. Although there are clinical roles throughout involuntary treatment, the ethical issues vary according to whether clinical actions are taken on clinically or socially constructed diagnosis and whether the purpose of the actions is therapy or control. Conclusion: Paternalist involuntary treatment should be undertaken more readily when it is for clinically defined illness and for the benefit of the patient. Where the conditions are defined by social behaviours alone, where treatment is not useful to the patient, or where actions have policing intent, particular ethical approaches need to be taken to defend the patient, the clinician-patient relationship and the reputation of the profession.
Classification and phytogeographical differentiation of broad‐leaved ravine forests in southeastern Europe
Authors: Košir Petra , Ccaron;arni Andrazcaron; , Di Pietro Romeo 
Published: January 2008

AbstractQuestion:How do broad‐leaved ravine forests in SE Europe differentiate phytogeographically? Do they differ from analogous European forests? What is their distribution pattern?Location:southeastern Europe, Apennine‐Balkan province.Methods:The initial data set of 2189 relevés was stratified geographically and phytosociologically; 614 relevés remaining after stratification were classified with aTWINSPAN and cluster analysis, wich resulted in four clusters and eight subclusters. Average Pignatti indicator values for releves of each subcluster were subjected to PCA to show ecological relationships among the clusters. The spectra of geoelements and sociological species groups of individual subclusters were calculated to show phytogeographical and sociological relationships between them. The diagnostic species combination was calculated by a fidelity measure (φ‐coefficient) and presented in a synoptic table.Results:Broad‐leaved ravine forests in southeastern Europe form a separate group within the European broad‐leaved ravine forests. They are well differentiated by the species with a southeast European distribution, as well as by many other species that reflect their different ecological affinities.Conclusions:The phytosociological and phytogeographical relationships between the Apennines and the Balkan peninsula that have already been recognized for other vegetation types have been confirmed for broad‐leaved ravine forests. According to the numerical analysis, two suballiances of broad‐leaved ravine forests in southeastern Europe are proposed, both belonging to the alliance Tilio‐Acerion. an amphi‐Adriatic xerothermo‐philous suballiance Ostryo‐Tilienion platyphylli suball. nova and a mesophilous suballiance Lamio orvalae‐Acerenion suball. nova, the latter appearing only on the Balkan Peninsula.
Indium-111 diethylene-triamine-pentaacetic acid scintigraphy in the evaluation of function and patency of baclofen intrathecal infusion systems
Authors: Pak Samuel , Jallo George I. , Biser Ann , Ziessman Harvey A. 
Published: January 2008

Object
Baclofen pump infusion systems are used for the treatment of patients with severe spasticity. When symptoms do not respond to infusion rate increases, the cause may be pump malfunction or catheter obstruction. The purpose of this investigation was to review the authors' experience with indium-111 diethylene-triamine-pentaacetic acid (In-111 DTPA) scintigraphy for evaluation of baclofen infusion system function and patency and to correlate scintigraphic findings with patient treatment and outcome to determine optimal methodology and diagnostic criteria.

Methods
Ten scintigraphic studies acquired in eight patients (five adults, three adolescents) were retrospectively reviewed. Imaging was routinely performed at 4, 24, 48, and 72 hours after injection of In-111 DTPA into the pump reservoir. The results of the studies were interpreted by two nuclear medicine physicians who had no knowledge of the patients' clinical history or outcome. The scintigraphic findings (for example, radiotracer detected in the basal cisterns, cervical or thoracolumbar regions, infusion catheter, and pump) were recorded and correlated with neuroimaging findings, patient history, treatment, and clinical response to therapy.

Results
In cases in which the basal cistern could be visualized at any time and those in which radiotracer was visualized in the thoracolumbar intrathecal region within 48 hours, the pump systems were functional and symptoms responded to an increase in infusion rate. One patient in whom activity was visualized in the thoracolumbar intrathecal region by 72 hours also experienced clinical improvement with a flow rate increase. Visualization of the pump alone or only the pump and the subcutaneous catheter was consistent with catheter obstruction or pump malfunction.

Conclusion
The use of In-111 DTPA scintigraphy of intrathecal baclofen infusion systems can play an important role in determining the functional status of these systems and guiding subsequent patient care.
The Eastern heart and Galen's ventricle: a historical review of the purpose of the brain
Authors: Baig Mirza N. , Chishty Faheem , Immesoete Phillip , Karas Chris S. 
Published: January 2008

✓The seat of consciousness has not always been thought to reside in the brain. Its “source” is as varied as the cultures of those who have sought it. At present, although most may agree that the central nervous system is held to be the root of individualism in much of Western philosophy, this has not always been the case, and this viewpoint is certainly not unanimously accepted across all cultures today.
In this paper the authors undertook a literary review of ancient texts of both Eastern and Western societies as well as modern writings on the organic counterpart to the soul. The authors have studied both ancient Greek and Roman material as well as Islamic and Eastern philosophy.
Several specific aspects of the human body have often been proposed as the seat of consciousness, not only in medical texts, but also within historical documents, poetry, legal proceedings, and religious literature. Among the most prominently proposed have been the heart and breath, favoring a cardiopulmonary seat of individualism. This understanding was by no means stagnant, but evolved over time, as did the role of the brain in the definition of what it means to be human.
Even in the 21st century, no clear consensus exists between or within communities, scientific or otherwise, on the brain's capacity for making us who we are. Perhaps, by its nature, our consciousness—and our awareness of our surroundings and ourselves—is a function of what surrounds us, and must therefore change as the world changes and as we change.
Section of the terminal filum for occult tethered cord syndrome: toward a scientific answer
Authors: Steinbok Paul , MacNeily Andrew E. 
Published: January 2008

✓The concept of an occult tethered cord syndrome (OTCS), in which a normally located conus is tethered by the terminal filum, is controversial. Children with OTCS typically present with neurogenic urinary incontinence that has been refractory to medical management. Authors of a number of case series have suggested that section of the terminal filum may improve urinary symptoms, but the quality of the evidence supporting this treatment is not good.
The literature related to OTCS is reviewed and the progress toward a randomized controlled trial to assess the value of filum section in OTCS is detailed. A scientific answer to the question of filum section for OTCS awaits the results of an ongoing pilot randomized controlled trial and a more definitive trial to follow.
Pathophysiology of tethered cord syndrome and similar complex disorders
Authors: Yamada Shokei , Won Daniel J. , Pezeshkpour Gholam , Yamada Brian S. , Yamada Shoko M. , Siddiqi Javed , Zouros Alexander , Colohan Austin R. T. 
Published: January 2008

✓Tethered cord syndrome (TCS) is a stretch-induced functional disorder of the spinal cord due to the fact that its caudal portion is anchored by an inelastic structure. The functional lesion of TCS is generally situated in the lumbosacral cord, and many authors have shown that the syndrome is reversible via surgery to untether the cord. To clarify the expressions relevant to TCS, such as “cord tethering” and “tethered cord,” the authors have formulated three categories. These categories include cases that show the anatomical appearance of spinal cord stretching. Among them, Category 1 is isolated to represent the “true TCS.”
The authors focus their discussion of the pathophysiology of TCS on Category 1 to explain the impaired oxidative metabolism and electrophysiological derangements within the tethered spinal cord, which is the primary intrinsic cause of the dysfunction. Furthermore, they extend the discussion to the extrinsic (outside the spinal cord) factors and other complex conditions that mimic TCS.
Termination of the normal conus medullaris in children: a whole-spine magnetic resonance imaging study
Authors: Kesler Henry , Dias Mark S. , Kalapos Paul 
Published: January 2008

Object
The mean level of the conus medullaris (CM) has been estimated to lie opposite the L1/2 disc space in several previous studies using ultrasound, CT myelography, and magnetic resonance (MR) imaging, but these studies have been limited in examining only the lumbar spine and including patients being evaluated for back pain and sciatica (creating a selection bias). Moreover, significant variability was found in the termination of the CM, with a small subset of subjects having a CM as low as the mid-body of L4. The authors sought to determine the normal level of the CM and its variability.

Methods
Children with brain or spinal cord tumors who underwent whole-spine surveillance MR imaging were identified retrospectively. The level of the CM was identified in each subject by counting down from C1. Vertebral anomalies, such as lumbarized S1, sacralized L5, or fewer rib-bearing segments, and the presence of fatty filum were noted.

Results
Findings regarding the level of termination of the CM were tightly grouped; the average was at the lower third of L1 and the mode of the distribution was at the L1/2 disc space, with very little variation. No CM ended below the mid-body of L2. The level of the CM was not significantly different among individuals with lumbarized or sacralized vertebrae or 11 rib-bearing segments.

Conclusions
The CM terminates most commonly at the L1–2 disc space and in the absence of tethering, the CM virtually never ends below the mid-body of L2. A CM that appears more caudal on neuroimages should be considered tethered.
Progressive loss of glutamic acid decarboxylase, parvalbumin, and calbindin D28K immunoreactive neurons in the cerebral cortex and hippocampus of adult rat with experimental hydrocephalus
Authors: Tashiro Yuzuru , Chakrabortty Shushovan , Drake James M. , Hattori Toshiaki 
Published: January 2008

The authors investigated functional neuronal changes in experimental hydrocephalus using immunohistochemical techniques for glutamic acid decarboxylase (GAD) and two neuronal calcium-binding proteins: parvalbumin (PV) and calbindin D28K (CaBP).
Hydrocephalus was induced in 16 adult Wistar rats by intracisternal injection of a kaolin solution, which was confirmed microscopically via atlantooccipital dural puncture. Four control rats received the same volume of sterile saline. Immunohistochemical staining for GAD, PV, and CaBP and Nissl staining were performed at 1, 2, 3, and 4 weeks after the injection. Hydrocephalus occurred in 90% of kaolin-injected animals with various degrees of ventricular dilation. In the cerebral cortex, GAD-, PV-, and CaBP-immunoreactive (IR) interneurons initially lost their stained processes together with a concomitant loss of homogeneous neuropil staining, followed by the reduction of their total number. With progressive ventricular dilation, GAD- and PV-IR axon terminals on the cortical pyramidal cells disappeared, whereas the number of CaBP-IR pyramidal cells decreased, and ultimately in the most severe cases of hydrocephalus, GAD, PV, and CaBP immunoreactivity was almost entirely diminished. In the hippocampus, GAD-, PV-, and CaBP-IR interneurons demonstrated a reduction of their processes and terminals surrounding the pyramidal cells, with secondary reduction of CaBP-IR pyramidal and granular cells. On the other hand, Nissl staining revealed almost no morphological changes induced by ischemia or neuronal degeneration even in the most severe cases of hydrocephalus.
Hydrocephalus results in the progressive functional impairment of GAD-, PV-, and CaBP-IR neuronal systems in the cerebral cortex and hippocampus, often before there is evidence of morphological injury. The initial injury of cortical and hippocampal interneurons suggests that the functional deafferentation from intrinsic projection fibers may be the initial neuronal event in hydrocephalic brain injury. Although the mechanism of this impairment is still speculative, these findings emphasize the importance of investigating the neuronal pathophysiology in hydrocephalus.
Modified open-door cervical expansive laminoplasty for spondylotic myelopathy: operative technique, outcome, and predictors for gait improvement
Authors: Lee Thomas T. , Manzano Glen R. , Green Barth A. 
Published: January 2008

Twenty-five patients underwent an expansive cervical laminoplasty for nontraumatic cervical spondylosis with myelopathy during the period from June 1990 to November 1994, and all had a minimum of 18 months of follow-up review. The open-door laminoplasty procedure presently reported consisted of the same approach evaluated by Hirabayashi in 1977, except that the authors of this report used three rib allografts to anchor the “open door,” rather than spinous process sutures or autologous bone grafts. Posterior foraminotomies and decompression were performed in patients with clinical radiculopathy and radiographic evidence of foraminal stenosis.
Preoperatively, gait disturbance was present in all patients. All 25 patients (100%) had long-tract signs on presentation. Nondermatomal upper-extremity symptoms (numbness, tingling, weakness, and pain) were quite common in this group of patients. Bowel, bladder, and/or sexual dysfunction was found in 13 (52%) of 25 patients. Preoperative radiographic studies showed a mean midline anteroposterior diameter spinal canal/vertebral body (SC/VB) ratio of 0.623 and a mean compression ratio (sagittal/lateral diameter ratio X 100%) of 37%.
This procedure was quite successful in relieving preoperative symptoms and few complications occurred. Gait disturbance was improved in 21 (84%) of 25 patients and hand numbness and tingling were improved in 13 (87%) of 15 patients. Bowel or bladder function improved in 10 (77%) of 13 patients. Radiculopathy, when present, was alleviated in all four patients after the decompressive procedure. The postoperative SC/VB ratio, as measured by plain lateral radiographs and/or computerized tomography scans, was improved to 0.871, a 38% improvement. In a comparison with the preoperative SC/VB ratio using the two-tailed t-test, alpha was less than 0.001. The compression ratio improved to 63% postoperatively, which yielded an alpha less than 0.005 according to the two-tailed t-test. Only one postoperative complication, an anterior scalene syndrome, was encountered.
Various predictors of surgical outcome based on gait improvement were evaluated. Age greater than 60 years at the time of presentation, duration of symptoms more than 18 months prior to surgery, preoperative bowel or bladder dysfunction, and lower-extremity dysfunction were found to be associated with poorer surgical outcome. Even when these conditions were present, gait improvement was noted in at least 70% of the patients.