bluuebunny/crossref_metadata_2025_split huggingface dataset:
A reader’s guide to the evaluation of screening studies
Authors: Earle C , Hebert P C 
Published: December 2008

AbstractIn this article we will review how a reader should evaluate a screening study. A clinical problem involving screening mammography is presented. We then outline criteria to determine whether screening is appropriate for a given condition. A search for relevant articles is described followed by an outline of the steps used to appraise a screening study critically. An applicable study is examined in detail for such things as the quality of randomisation and outcomes measured. The results of this study are then applied to a patient considered for screening.
Counselling for an HIV test
Authors: Moss S , Williams O E , Hind C R 
Published: December 2008

Abstract
Doctors may feel uncomfortable with the prospect of discussing a human immunodeficiency virus (HIV) antibody test with their patient. This is in part because they do not enquire about high risk activity as part of a medical history. With increasing medical and public awareness of both the clinical manifestations and social implications of HIV infection, it is important that all doctors receive guidance on how to deal with these issues. Counselling is not the usual term used to describe obtaining informed consent. In the general medical setting, tests for hepatitis B and syphilis are routinely carried out without specific consent even though results of these tests may have profound effects on both the patient and their sexual partners. However society and ethical considerations have made HIV testing different. HIV testing will inevitably become more widespread, and thus become a more routine part of patient investigation and management.
A reader’s guide to the evaluation of causation
Authors: Podrebarac T , Tugwell P , Hébert P C 
Published: December 2008

Abstract
In this article, we review the criteria used to establish a causal association. A literature search strategy will be outlined. We present a clinical scenario that was formulated to examine the evidence for nonsteroidal anti-inflammatory drugs as a possible cause of gastrointestinal ulceration and bleeding. Several of the studies identified in the literature search were critically appraised and the criteria needed to confirm a causal link were then applied. These guidelines may be employed to not only demonstrate the aetiology of a disease but have wider applicability in terms of determining whether a medication may be causing certain adverse events.
Reflux oesophagitis and Helicobacter pylori infection in elderly patients
Authors: Liston R , Pitt M A , Banerjee A K 
Published: December 2008

Summary
Helicobacter pylori is associated with gastritis, peptic ulcers and gastric malignancies. Little attention has been paid to the possibility that it may also have a role in the pathogenesis of reflux oesophagitis. This is especially true in elderly patients who have life-long infection and provide an ideal group to study the mucosal changes associated with the organism. The aim of this study was to determine if H pylori is associated with reflux oesophagitis in elderly patients. Consecutive gastroscopy patients were recruited. Multiple biopsies were taken from oesophagus, stomach, antrum and duodenum for histology and rapid urease tests. Patients also had IgG ELISA antibodies and 13C-urea breath tests performed. Patients with macroscopic or microscopic evidence of reflux oesophagitis were compared to patients with macroscopically normal upper gastrointestinal tracts and no microscopic evidence of reflux. A total of 114 patients were recruited, average age 78.9 years (+/- 5.4). There were 37 refluxers and 33 non-refluxers. We found no evidence for an association between the presence of H pylori and reflux oesophagitis in elderly patients. The high prevalence of H pylori in patients with reflux oesophagitis can be explained by the presence of incidental gastritis.
The seroprevalence of hepatitis B, hepatitis C and human immunodeficiency virus infections in paediatric oncology patients in Turkey
Authors: Berberoğlu S 
Published: December 2008

SummaryOne hundred and two newly diagnosed children with malignancy followed up at the Pediatric Oncology Department of Ankara Oncology Hospital were investigated for hepatitis B, hepatitis C and human immunodeficiency virus markers. The ages ranged between seven months and 17 years with a median of 10 years; 62 were male. Twenty-four patients had Hodgkin’s disease, 11 had non-Hodgkin’s lymphoma and 67 patients had other solid tumours. Four patients had positive HBs-Ag, 15 developed immunity against hepatitis B and had anti-HBs antibodies. One patient had a previous infection with positive anti-HBc. Hepatitis C virus antibodies were positive in only one patient. HIV serology was negative in all patients. These results show the high prevalence of hepatitis B virus infection in paediatric oncology patients. In countries where hepatitis B is endemic, strict screening of blood donors, usage of disposable equipment and vaccination of patients is recommended. Although the incidence of hepatitis C and human immunodeficiency virus infections are rising, infection with hepatitis B is still by far the most common.
Renal lymphoma: an unusual cause of extrahepatic biliary obstruction
Authors: Abbas Z , Johnston D A , Murray F E 
Published: December 2008

Summary
This report describes a case of lymphoma arising in a kidney subjected to previous pyelolithotomy, lithotripsies and percutaneous nephrolithotomy. The tumour had invaded the pancreas and duodenum, resulting in extrahepatic biliary and gastric outlet obstructions. Fine-needle apiration cytology guided by computed tomography failed to suggest the diagnosis which was confirmed only on laparotomy and open biopsy. Drainage procedures were performed to relieve the obstructions. To our knowledge this is the first case report of renal lymphoma presenting with extrahepatic biliary obstruction.
The one-stop coronary cholesterol clinic: a multidisciplinary approach to implementing evidence-based treatment
Authors: Giles P D , Ramachandran S , Whitaker A J , Phillips A W , Fell S J , Mitchell A , Coleman T D 
Published: December 2008

Summary
We describe a ‘one-stop’ cholesterol clinic implementing a regime based on the Scandinavian Simvastatin Survival Study (4S) in patients with established coronary heart disease in a district general hospital. The clinic has been established in collaboration with the cardiac rehabilitation centre. It was commissioned as an audit project by the purchasing authority, Walsall Health, a need having been shown in a previous audit. In the new clinic, audit is inbuilt, rather than being carried out as a separate retrospective exercise, and undertaken prospectively for all patients. Central to this is a database, used for routine correspondence and administration, as well as monitoring outcome. This application of information technology has improved clinical practice. Attendance at the clinic has been excellent. Half the consultations have resulted in therapeutic interventions, many of which may otherwise have been missed. Over 50% of patients were eligible for lipid-lowering medication under the protocol. Cholesterol targets based on 4S were achieved but with much lower drug doses, which may have major cost implications. Cholesterol levels measured within 24 hours of admission for myocardial infarction were poor predictors of results obtained after convalescence. After the clinic visit, most patients were taking aspirin plus one or two other secondary prevention treatments. Guidelines have been issued to primary care. Future plans for audit links with general practitioners, integration of the metabolic and cardiological assessment of survivors of myocardial infarction, and for long-term monitoring of clinical events in treated patients are discussed.
Transoesophageal echocardiography
Authors: Sanderson J E , Chan W W 
Published: December 2008

Summary
Transoesophageal echocardiography gives unparalleled views of the posterior structures of the heart. It is the investigation of choice for the diagnosis of acute dissection of the aorta, in patients with endocarditis, management of the hypotensive patient in the intensive care unit, and in the search for a potential cardiac source of thromboembolism. However, it is a semi-invasive procedure, and proper training is required to carry it out safely, to ensure that maximum information is obtained at the time of examination, and to avoid diagnostic pitfalls.
Avoidable attendance at accident and emergency by the elderly in Hong Kong
Authors: Lau E M C , Woo J , Chan J T S 
Published: December 2008

Summary
Twenty per cent of Accident and Emergency department attendance by the elderly in a regional hospital in Hong Kong were deemed ‘avoidable’ by the attending doctors. The ‘avoidable’ attendants were younger and physically more independent than the appropriate attendants, and more of them were illiterate. Half of them attended the Accident and Emergency department for somatic complaints. Strategies to reduce these ‘avoidable’ attendances should be formulated.
The acceptability of personal learning plans in vocational training
Authors: Siriwardena A N 
Published: December 2008

Summary
Personal learning plans have been advocated as a means of introducing the principles of adult learning into general practice vocational training. The aim of this study was to investigate attitudes amongst general practice trainers and registrars to the introduction and use of personal learning plans. A questionnaire was sent to general practice trainers and registrars in one vocational training scheme prior to the introduction of personal learning plans. Overall, doctors in the training scheme were positive to the idea of personal learning plans. Trainers were significantly more positive towards introducing learning plans than their registrars. Registrars in their final general practice posts were significantly more positive towards the idea of learning plans than their hospital counterparts. Doctors who had completed membership of the Royal College of General Practitioners, usually trainers or final year registrars, were also more positive in their attitude. This pilot study suggests that most trainers and registrars were positive in their attitude towards personal learning plans prior to their introduction in the Lincoln vocational training scheme. The study cautiously suggests a wider use and evaluation of personal learning plans in vocational training.
Maintenance pharmacological immunosuppressive strategies in renal transplantation
Authors: Vella J P , Sayegh M H 
Published: December 2008

Summary
Current maintenance immunosuppressive regimens for transplantation are based on three classes of drugs: corticosteroids, immunophilin-binding agents (eg, cyclosporin and tacrolimus), and antimetabolites (eg, azathioprine and mycophenolate). Drugs from the various classes inhibit the immune system at different points and are thus synergistic when used in combination.
The use of over-the-counter medication by elderly medical in-patients
Authors: Batty G M , Oborne C A , Swift C G , Jackson S H D 
Published: December 2008

Summary
Use of over-the-counter (OTC) medications by elderly patients is often not identified. This survey was performed to study the use of OTCs by medical in-patients aged 65 and over. Data on the use of OTC medications before and during hospital admission were collected by questioning patients and case notes were examined for documentation of their use of OTC medications. OTC medications were used by 44 of 138 (32%) patients interviewed. Patients used a total of 70 OTC medications before admission and six OTC medications were being used during hospital admission. There was no documentation of pre-admission and in-hospital OTC medicine use in the clinical notes and patients had little knowledge of the potential harm some products can cause. As more products become available over the counter, doctors should record their use in patients' notes and patients should be encouraged to seek professional advice before purchasing OTC medicines and to read the product information leaflets.
Caecal adenocarcinoma with multiple synchronous small intestinal adenocarcinoma
Authors: Lee J , Tamhane R , Parks T G 
Published: December 2008

Summary
We describe a patient who presented with iron deficiency anaemia in whom both upper and lower gastrointestinal investigation were initially negative. Management included successive blood transfusions. Repeat investigation six months later revealed caecal adenocarcinoma. At laparotomy, the patient was also found to have two separate primary synchronous adenocarcinomas of the proximal small bowel. Right hemicolectomy and excision of the small bowel lesions were carried out. The patient eventually succumbed to the disease six weeks after discharge from hospital.
Meningismus, fever and macular rash as presenting features of the primary antiphospholipid syndrome?
Authors: Houghton T , Davies A G 
Published: December 2008

Summary
We report here, we believe for the first time, the primary antiphospholipid syndrome, presenting with fever, meningismus and skin rash. Serology was positive for antiphospholipid antibodies but negative for antinuclear factor. Such presentations, once meningitis has been excluded, should be screened for antiphospholipid antibodies. If serology proves to be positive, anticoagulation for life should be considered to avoid thrombotic episodes and death due to pulmonary embolism.
Characteristics of patients with shingles admitted to a district general hospital
Authors: Morgan R , King D 
Published: December 2008

Summary
Little is known about why some patients with shingles are admitted to hospital. We reviewed 72 case notes from a list of 80 patients admitted to hospital with shingles over a six-year period. Pain was the main complaint of the patients admitted, most of whom were elderly and lived alone. The commonest site of involvement in hospital admissions was the eye (herpes zoster ophthalmicus). Diagnosis of shingles was made after admission in 12 patients, eight of whom had originally been diagnosed as having an acute medical or surgical condition. We conclude that the prodromal phase of shingles may lead to misdiagnosis.
Rapid recurrence of pulmonary hypertension following cessation of nifedipine
Authors: Gallagher M M , Hart C M , Vaughan C J , Fennell W H 
Published: December 2008

Summary
In a young woman with primary pulmonary hypertension, treatment with low-dose nifedipine resulted in resolution of symptoms and of tricuspid regurgitation. On withdrawal of nifedipine, symptomatic pulmonary hypertension recurred within 48 hours and was controlled by reintroduction of low-dose nifedipine.
A collaborative audit of the management of hypertension in general practice
Authors: Raman G V , Neal A , Lewis C 
Published: December 2008

Summary
We carried out an audit of the management of essential hypertension in general practice, against standards based on current guidelines. We examined the records of 882 hypertensive subjects (on medication) in whom hypertension had been diagnosed between January 1989 and December 1993, from 14 general practices in the Portsmouth and South East Hampshire Health Authority. The overall prevalence of hypertension was 3.5%. Pretreatment blood pressure had been measured on three or more occasions in 87% of patients. Pretreatment blood pressure was equal to or greater than 150/95 mmHg in 96% and 160/100 mmHg in 86.5% of patients. A thiazide diuretic was the initial drug of choice in 30% of patients, with beta-blockers being the most popular initial treatment. Ninety per cent of patients had had their blood pressure measured at least once during the preceding year. In 82.5% of patients, current blood pressure was less than 150/95 mmHg, while 44% achieved a current blood pressure less than 140/90 mmHg. We conclude that the prevalence of hypertension in this population was lower than expected, suggesting the need for improved screening. We also propose that the initial treatment choice should be a thiazide in the majority, which would result in significant cost saving. The blood pressure control was suboptimal compared to current guidelines.
Medical treatment of erectile dysfunction
Authors: Burns-Cox N , Gingell C 
Published: December 2008

Summary
There has been a tremendous increase in demand for the treatment of erectile dysfunction in the last 10 years. This has occurred partly because of a greater understanding and awareness by both the general public and clinicians, and also because there now exists a range of effective treatments. The choice of treatments is increasing rapidly and novel delivery systems which may be more patient-friendly than intracavernosal injections are now becoming available. We review the published data on effectiveness and safety of the currently available treatments and discuss recent advances in oral therapy, as these drugs are likely to become available in the near future.
Intracoronary ultrasound
Authors: Hammond C , Causer J P , Perry R A 
Published: December 2008

Summary
Although contrast angiography is important in the diagnosis and treatment of atherosclerotic disease, it does have limitations. Intracoronary ultrasound more accurately assesses the amount of atherosclerosis and has given us new insights into the pathophysiology of coronary plaque accumulation and remodelling. It also allows the monitoring of therapeutic intervention. Intracoronary ultrasound is a new gold standard. It does not obviate the need for angiography but provides complementary information that enables us to perform optimal interventional procedures.
Hospital doctors' assessment of baseline spirometry
Authors: Stephenson N , Morgan R , Abdel-Rahman-Abdel-Wahab E , Turnbull C J 
Published: December 2008

Summary
Baseline spirometry is useful in diagnosing and managing pulmonary disease. In a questionnaire survey of 100 hospital doctors in two hospitals in the Mersey region, their views and ability to interpret baseline spirometry was assessed. Of the 70 doctors who responded, 65% felt they could accurately interpret baseline spirometry. However, only 12% accurately interpreted all five vitalographs in the questionnaire. The majority (72%) felt they had not had adequate teaching in interpretation of spirometry, and 63% would prefer a report from a respiratory technician. These result suggest that improvement needs to be made in interpretation of baseline spirometry.
Recent advances in the drug treatment of heart failure
Authors: McAlister F A , Teo K K 
Published: December 2008

SummaryA number of important questions surrounding the treatment of systolic congestive heart failure have been answered by randomised clinical trials completed within the past 2 years. In particular, these studies have established that high-dose angiotensin-converting enzyme (ACE) inhibition is more beneficial than low dose therapy, and that angiotensin II receptor antagonists are an acceptable alternative in patients unable to tolerate ACE inhibitors. Digoxin has been shown to be the only inotropic agent not associated with increased mortality, while amiodarone exerts a modest survival benefit in arrhythmiaprone patients. Beta-blockers appear to be beneficial for selected patients although their precise role remains to be defined by ongoing studies.
Systemic activity of inhaled and swallowed beclomethasone dipropionate and the effect of different inhaler devices
Authors: Trescoli C , Ward M J 
Published: December 2008

Summary
Inhaled glucocorticoids such as beclomethasone dipropionate, which are used in the treatment of asthma, may be associated with systemic adverse effects. To determine whether any systemic absorption following the inhalation of beclomethasone was a result of drug being absorbed from the lung (inhaled fraction) or the gastrointestinal tract (swallowed fraction), we studied normal subjects after the inhalation or swallowing of 2 mg beclomethasone dipropionate. Systemic activity was assessed using early morning cortisol suppression. Both inhaled and swallowed fractions produced significant systemic activity, the degree of which depended on the inhaler device used. Systemic activity was greater using a dry powder inhaler (52%) than using a metered dose inhaler with a large volume spacer (28%). These findings suggest that to limit potential adverse effects from high-dose beclomethasone dipropionate it is better to use a metered dose aerosol with large volume spacer than a dry powder.
Clostridium difficile-associated diarrhoea
Authors: Wight N , Curtis H , Hyde J , Borriello S P , Mahida Y R 
Published: December 2008

Summary
At our hospital, the number of cases of Clostridium difficile-associated diarrhoea increased from 29 in 1993 to 210 in 1995. The case notes of 110 patients with C difficile-associated diarrhoea during the first 6 months of 1995 were analysed retrospectively. The majority of the patients (106) had received antibiotics before the onset of diarrhoea; 46 had received three or more different antibiotics and 28 had received metronidazole. In 19 patients, the first stool sample after the onset of diarrhoea was negative for C difficile cytotoxin, with a mean delay of 8.2 days before a positive stool sample. We conclude that C difficile-associated diarrhoea was associated with the usage of multiple antibiotics, and that metronidazole did not protect against colonisation by C difficile. We also recommend that more than one stool sample should be tested for the C difficile cytotoxin.
The Association Between Ankle Brachial Pressure Index and Pulse Wave Velocity: Clinical Implication of Pulse Wave Velocity
Authors: Khandanpour Nader , Armon Matthew P. , Jennings Barbara , Clark Allan , Meyer Felicity J. 
Published: December 2008

Objective: The aim of this study was to assess the relationship between ankle brachial pressure index and pulse wave velocity in patients with peripheral arterial disease. Methods: Brachial-knee and brachial-ankle pulse wave velocity were measured by pneumoplethysmography using cuffs in a standard technique. Correlation between pulse wave velocity and Doppler-ankle brachial pressure index was assessed by Spearman correlation and receiver operating curves. Results: A total of 133 claudicants were assessed. Analysis by developing receiver operating curves for ankle brachial pressure index and pulse wave velocity showed that patients with ankle brachial pressure index over 0.6 were more likely to have a bk-pulse wave velocity over 9.2 m/s and ba-pulse wave velocity over 9.5 m/s. Conclusion: These results show for the first time that nondiabetic vascular patients may have measurable significant arterial stiffness independent of an impaired ankle brachial pressure index. These data suggest that pulse wave velocity may be valuable in screening and evaluating the severity of peripheral arterial disease.
Sense of coherence and mental health rehabilitation
Authors: Griffiths Christopher Alan 
Published: December 2008

Objective: To provide an understanding of Antonovsky's sense of coherence theory in relation to rehabilitation and to explain how applying his theory in rehabilitation practice can be beneficial. The focus of this paper will be on the rehabilitation and recovery of those with mental health issues. Findings: Sense of coherence theory helps explain the process of recovery for those with mental health issues. There is substantial evidence that sense of coherence plays a central role in coping with stressors in the rehabilitation/recovery process and that it contributes to mental health and psychosocial functioning. If rehabilitation services adopt a salutogenic approach and seek to enhance a client's sense of coherence then this can be beneficial in terms of the client's rehabilitation and recovery. Conclusion: Rehabilitation services should ensure that they have rehabilitation goals that strengthen individuals' sense of coherence. Further investigation is required into the development of rehabilitation programmes with sense of coherence theory as part of their foundation.