bluuebunny/crossref_metadata_2025_split huggingface dataset:
Analysis of consultants' NHS and private incomes in England in 2003/4
Authors: Morris Stephen , Elliott Bob , Ma Ada , McConnachie Alex , Rice Nigel , Skåtun Diane , Sutton Matt 
Published: June 2008

Summary Objective Consultants employed by the NHS in England are allowed to undertake private practice to supplement their NHS income. Until the introduction of a new contract from October 2003, those employed on full-time contracts were allowed to earn private incomes no greater than 10% of their NHS income. In this paper we investigate the magnitude and determinants of consultants' NHS and private incomes. Design Quantitative analysis of financial data. Setting A unique, anonymized, non-disclosive dataset derived from tax returns for a sample of 24,407 consultants (92.3% of the total) in England for the financial year 2003/4. Main outcome methods The conditional mean total, NHS and private incomes earned by age group, type of contract, specialty and region of place of work. Results The mean annual total, NHS and private incomes across all consultants in 2003/4 were £110,773, £76,628 and £34,144, respectively. Incomes varied by age, type of contract, specialty and region of place of work. The ratio of mean private to NHS income for consultants employed on a full-time contract was 0.26. The mean private income across specialties ranged from £5,144 (for paediatric neurology) to £142,723 (plastic surgery). There was a positive association between mean private income and NHS waiting lists across specialties. Conclusions Consultants employed on full-time contracts on average exceeded the limits on private income stipulated by the 10% rule. Specialty is a more important determinant of income than the region in which the consultant works. Further work is required to explore the association between mean private income and waiting lists.
How fast is fast enough? An audit and league table of response times of acute hospital NHS Trust switchboards in England
Authors: Shokrollahi Kayvan , Tadiparthi Sujatha , Jayagopal Sathish 
Published: June 2008

Summary Objective To audit response times by all acute NHS hospital switchboards in England for external incoming calls. As with any audit, we set out to draw attention to efficiencies and deficiencies in the system, highlight problems, and suggest the first steps towards improving standards in a very important and poorly acknowledged part of our healthcare system. Design Telephone calls were made to hospital switchboards, and time to response was measured. The results were then audited. Setting Acute hospital NHS Trust switchboards in England. Main outcome measures Time to response by hospital switchboards. The target time was 20 seconds. Results Only 36% of 219 hospital switchboards met the 20 second target, with the average answering time across all switchboards being 45 seconds. The best performer was University Hospital North Durham (mean = 1 second) and the worst Bristol Royal Infirmary (mean = 381 seconds). We found that automated answer systems substantially increase the answer time to an operator; the fastest automated service was at Princess Royal University Hospital, which was ranked 69th. Conclusions We recommend a formal NHS-wide audit system for switchboard response times.
Neonatal septicaemia in Calabar, Nigeria
Authors: Anah M U , Udo J J , Ochigbo S O , Abia-Bassey L N 
Published: June 2008

SUMMARY A three-year survey of neonatal septicaemia (363 bacteriologically proven cases) in the University of Calabar Teaching Hospital, Calabar, has demonstrated that the dominant blood isolate was Staphylococcus aureus (53%) followed by unclassified Coliforms (20%), an unexpected Chromobacterium violaceum (5%). The incidence of neonatal septicaemia was 54.9 per 1000 live births for inborn infants. The predominant organisms were largely susceptible to gentamicin, ceftriazone and cefuroxime with a mortality rate of 19% with most (60.9%) of the fatalities being due to Gram-negative organisms.
Causes of gas gangrene seen at the University of Nigeria Teaching Hospital, Enugu, Nigeria
Authors: Nwankwo Okechukwu Emmanuel 
Published: June 2008

SUMMARY Gas gangrene (clostridial myonecrosis) is rarely seen and this rarity, coupled with its dramatic presentation and often devastating outcome, makes each case of gas gangrene a spectacular and memorable experience. This study analyses the cases managed, the causes and outcome. Gunshot wounds, compounded by late presentation with its accompanying florid infections, were seen as the causes in 14 cases of gas gangrene seen at the University of Nigeria Teaching Hospital, Enugu during the four-year study period from July 2000 to June 2004.
The prevalence of congenital malaria among neonates with suspected sepsis in Calabar, Nigeria
Authors: Ekanem A D , Anah M U , Udo J J 
Published: June 2008

SUMMARY We studied the prevalence of congenital malaria among neonates with suspected sepsis and its outcome at the University of Calabar Teaching Hospital, Calabar, Nigeria. All in-born neonates admitted to the newborn unit with clinical features suggestive of sepsis were recruited. They were screened for bacterial sepsis and malaria. The mothers of the neonates that had parasitaemia were further screened for malaria and anaemia. A total of 546 in-born neonates were admitted to the neonatal unit and 202 (37%) presented with clinical signs suggested of sepsis. Of these, 71 babies (35% of 202 or 13% of the total in-born nursery admissions) had congenital malaria and 14 also had sepsis. Sixty-three (88.7%) of the parasitaemic babies were delivered by mothers who received antenatal care at our centre. Eighty-six percent of the mothers of the 71 babies also had the malaria parasite in their blood. The majority (67%) of the 71 mothers were gravidae 2 and below. Thirty (42.3%) of the affected neonates were anaemic and 5 (7%) of them required a blood transfusion. Congenital malarial is not uncommon in Calabar among babies with suspected sepsis. It appears that the antenatal chemoprophylaxis with pyrimethamine (25 mg weekly) currently used for malaria in our centre no longer protects the mother and fetus. An alternative is needed in order to stem maternal, fetal and neonatal morbidity and wastage. Babies with features of sepsis should be routinely screened for malaria.
The clinical spectrum of chronic liver disease in children presenting to a tertiary level teaching hospital in New Delhi
Authors: Rajeshwari K , Gogia S 
Published: June 2008

SUMMARY We report on the clinical spectrum of chronic liver disease (CLD) in children presenting to a tertiary level teaching hospital. Children aged <14 years with suspected CLD presenting to the paediatric gastroenterology department of Maulana Azad Medical College between January 1999 and December 2004, were prospectively studied. They were all given liver function tests, abdominal ultrasonography, endoscopy, viral markers and were checked for Wilson's disease, autoimmune hepatitis and liver biopsy wherever feasible. Other tests for metabolic liver diseases were done when indicated. CLD was diagnosed in 174 children over the six-year period. Cryptogenic cirrhosis was the most common entity, followed by hepatitis B-induced liver disease and Wilson's disease. Most patients presented late with evident portal hypertension.
The role of antibiotic prophylaxis in mesh repair of primary inguinal hernias using prolene hernia system: a randomized prospective double-blind control trial
Authors: Jain S K , Jayant M , Norbu C 
Published: June 2008

SUMMARY Antibiotic prophylaxis is being commonly used in mesh repair of inguinal hernia but its role has been questioned in a recent Cochrane analysis performed in 2003. Routine use of antibiotic prophylaxis in mesh repair of inguinal hernia can lead to bacterial resistance and increase in cost. In a present double-blind placebo controlled trial involving 120 patients undergoing inguinal hernia repair using prolene hernia system, we did not find any benefit of the routine use of antibiotic prophylaxis in terms of wound infection rate.
Diarrhoeal outbreak of Vibrio cholerae 01 Inaba in Delhi
Authors: Rajeshwari K , Gupta Ashish , Dubey A P , Uppal Beena , Singh M M 
Published: June 2008

SUMMARY V. cholerae O1 Eltor serotype Ogawa has been causing most of the cholera outbreaks in India till recently. However this communication reports the occurrence of Vibrio Cholerae O1 Inaba in Delhi in 2005, as a predominant causative organism of cholera in children. All strains isolated were sensitive to gentamicin and a high level of resistance towards nalidixic acid and amoxicillin was seen. There was no case fatality.
Child maltreatment at a violence recovery centre in Kenya
Authors: Saidi Hassan , Odula Paul , Awori Kirsten 
Published: June 2008

SUMMARYKenyan media reports indicate escalating levels of child maltreatment, but the characteristics of the offence are undefined. At the Gender and Violence recovery Center of the Nairobi Women's Hospital, we analysed 342 consecutive children for age, gender, perpetrator characteristics, time and scene of assault and the nature of injuries between February 2003 and April 2004. The children comprised 43.5% of all assault survivors. The mean age was 10.0 years and about 20% of the children were ≤5 years. Most (71.5%) of the child sexual abuse (CSA) was perpetrated by people known to the victim. Intra-family CSA (incest) was highest among the one to five year olds. The proportion of assaults committed against boys reduced with the age of the child. Older children were more likely to be assaulted later in the day and by multiple perpetrators. Most recorded injuries were perineal. The majority of children are assaulted by people they had trusted. The epidemiological correlates of maltreatment differ for younger and older children. More effort is needed to further characterize child violence and protect this vulnerable section of the population.
Clinical profile of pleural empyema and associated factors with prolonged hospitalization in paediatric tertiary centre in Angola, Luanda
Authors: de Britto Murilo Carlos Amorim , da Conceicao Silvestre Silvia Maria Mendes , do Carmo Menezes Duarte Maria , de Matos Bezerra Patricia Gomes 
Published: June 2008

SUMMARY In a case series of 152 children aged from 2 to 132 months will pleural emphema from a paediatric tertiary hospital in Luanda, Angola between September 2004 and March 2005, the authors found a high prevalence of anaemia and malnutrition. The most prevalent bacteria in pleural fluid were: D pneumoniae, Haemophyllus and S aureus. The median for hospital stay was 25 days. The lethality was 7.8% and was not statistically associated with malnutrition, although this variable was associated, in multivariate analysis, with prolonged hospitalization time.
Health-care seeking behaviour for TB symptoms in two provinces of Uzbekistan
Authors: Hasker Epco , Khodjikhanov Maksad , Usarova Shakhnoza , Yuldasheva Umida , Uzakova Gulnoza , Veen Jaap 
Published: June 2008

SUMMARY In Uzbekistan, mass X-ray screening for TB is still used. The groups targeted are broad and include at least 50% of the population. Of all pulmonary TB cases, 73% are reported to be detected by this method. However, in this study of 85 randomly selected pulmonary TB patients, only 16% confirmed were been detected through this method. Having known risk factors for TB did not increase the likelihood of its being detected, which highlights the need to revise the current screening policy.
The use of the condom-catheter for the treatment of postpartum haemorrhage – the Sokoto experience
Authors: Airede Lydia R , Nnadi Daniel C 
Published: June 2008

SUMMARY Postpartum haemorrhage (PPH) is the most common cause of maternal mortality globally. In about 50% of cases PPH is due to uterine atony. When conservative and medical methods of treating PPH due to uterine atony fail, surgical intervention is required to save the woman's life. As an alternative in such cases, intrauterine tamponade has been used successfully to stop bleeding, thus avoiding surgery. We report four cases of PPH due to uterine atony in which intrauterine tamponade with an inflated condom was effective in arresting haemorrhage. We advocate the use of a similar device in carefully selected cases, especially in low-resource settings.
Assessment of the therapeutic efficacy of chloroquine in the treatment of uncomplicated Plasmodium falciparum malaria in a tribal block of the Kalahandi district of Orissa, India
Authors: Kerketta A S , Mohapatra S S S , Kar S K 
Published: June 2008

SUMMARY The study on therapeutic efficacy of chloroquine was carried out in a tribal dominated block of Kalahandi district of Orissa, India. It revealed 94% treatment failure with standard dose of chloroquine in the treatment of uncomplicated P. falciparum malaria cases. The study warrants the change to alternate antimalarials in this region.
Improvised cost-effective halo vest brace using a recycled Ilizarov ring and a threaded rod
Authors: Jayaram Manju , Kumar Pankaj , Khanal Guru Prasad , Singh M P , Singh Girish Kumar , Karn Navin Kumar , Shrestha Aman 
Published: June 2008

SUMMARY We designed less expensive halo vest brace using an Ilizarov ring and a threaded rod, which is as effective as the normal halo vest. It can be used in any orthopedic set-up.
A simple and improved method for diagnosis of tuberculosis using hypertonic saline and sodium hydroxide to concentrate and decontaminate sputum
Authors: Ricaldi Jessica N , Guerra Humberto 
Published: June 2008

SUMMARY We report the use of hypertonic saline and sodium hydroxide (HS-SH) for concentration-decontamination of sputum samples for the diagnosis of tuberculosis. This method increases detection of mycobacteria in smears compared to examination of direct smears, is comparable and reduces contamination in cultures compared to NALC-NaOH.
Perinatal outcome of primiparous teenagers in northern Namibia
Authors: van Dillen Jeroen , van Beijeren Eline , van Roosmalen Jos 
Published: June 2008

SUMMARY Internationally, teenagers are at risk for pregnancy-related morbidity and mortality. We assessed the obstetric and perinatal outcomes of teenage pregnancies compared with their older counterparts in northern Namibia. We made a retrospective study using birth records from February 2002 to August 2002. The data collected included perinatal mortality, delivery mode, birth weight, in-hospital days and frequency of antenatal care (ANC) attendance. They were compared with primiparous women in different age groups ( n = 612). No differences were found in obstetric and perinatal outcomes between the three different age groups. Overall ANC attendance was high. The perinatal outcome for pregnant teenagers was comparable with their older counterparts in northern Namibia. In this region, ANC succeeds in reaching pregnant teenagers and teenage pregnancies are not at an increased risk for obstetric complications.
Risk factors for drug resistant tuberculosis in southeast Turkey
Authors: Tanrikulu A Cetin , Hosoglu Salih , Ozekinci Tuncer , Abakay Abdurrahman , Gurkan Fuat 
Published: June 2008

SUMMARY We undertook a cross-sectional survey of 116 patients at Dicle Hospital, Turkey, who had with bacteriologically confirmed tuberculosis (TB). Demographic and clinical features, including age, gender, pulmonary TB history, associated diabetes mellitus, previous TB treatment, residential area and education, were collected from charts. Eighty-four of the strains were found to be susceptible to all drugs. The resistance to one or more drug(s) was found in 32 strains. Multi-drug resistant (MDR) TB was found in 13 strains (11.3% of the total and 40.7% of the drug resistant strains). The resistance to isoniazid was the most frequently seen (25 strains, 21.5%). In the multivariable analysis, only previous TB treatment ( P = 0.000) remained a significant predictor for drug resistance; in MDR, previous TB treatments ( P = 0.002) remained significant in the final model. The patient's educational status was found to be negatively correlated with the risk of MRD-TB ( P = 0.035). Previous TB treatment and low educational status were found to important risk factors for the development of MDR-TB.
A fatal case of streptococcal toxic shock syndrome
Authors: Doganci Levent , Tanyel Esra , Basıbuyuk Hakki , Darka Ozge 
Published: June 2008

SUMMARY In daily medical practice, streptococcal toxic shock syndrome is an infrequent clinical entity which carry a very high risk of fatality. Early recognition of this toxin mediated immunopathological disease is very important to apply necessary invasive procedures such as an prompt amputation of the effected areas to save the patient. Here, we report a 47 year-old male farmer with a fatal streptococcal toxic shock syndrome to highlight the importance of emergency care and aggresive surgical intervention in similar situations.
Endometrial resection/vaporization: a patient-friendly first-option treatment for menorrhagia in rural areas
Authors: Gnanaraj J , Lionel Jessie 
Published: June 2008

SUMMARY Hysterectomy, a major surgical procedure, is often an unacceptable procedure for many patients from rural areas who attend small rural hospitals. Near total endometrial resection/vaporization is a more acceptable procedure which can control menorrhagia. This procedure can be carried out with standard urology instruments.
Revenue Management for a Primary-Care Clinic in the Presence of Patient Choice
Authors: Gupta Diwakar , Wang Lei 
Published: July 2008

In addition to having uncertain patient arrivals, primary-care clinics also face uncertainty arising from patient choices. Patients have different perceptions of the acuity of their need, different time-of-day preferences, as well as different degrees of loyalty toward their designated primary-care provider (PCP). Advanced access systems are designed to reduce wait and increase satisfaction by allowing patients to choose either a same-day or a scheduled future appointment. However, the clinic must carefully manage patients' access to physicians' slots to balance the needs of those who book in advance and those who require a same-day appointment. On the one hand, scheduling too many appointments in advance can lead to capacity shortages when same-day requests arrive. On the other hand, scheduling too few appointments increases patients' wait time, patient-PCP mismatch, and the possibility of clinic slots going unused. The capacity management problem facing the clinic is to decide which appointment requests to accept to maximize revenue. We develop a Markov decision process model for the appointment-booking problem in which the patients' choice behavior is modeled explicitly. When the clinic is served by a single physician, we prove that the optimal policy is a threshold-type policy as long as the choice probabilities satisfy a weak condition. For a multiple-doctor clinic, we partially characterize the structure of the optimal policy. We propose several heuristics and an upper bound. Numerical tests show that the two heuristics based on the partial characterization of the optimal policy are quite accurate. We also study the effect on the clinic's optimal profit of patients' loyalty to their PCPs, total clinic load, and load imbalance among physicians.
Measurement of blood flow in the rotator cuff using laser Doppler flowmetry
Authors: Levy O. , Relwani J. , Zaman T. , Even T. , Venkateswaran B. , Copeland S. 
Published: June 2008

The aim of this study was to define the microcirculation of the normal rotator cuff during arthroscopic surgery and investigate whether it is altered in diseased cuff tissue. Blood flow was measured intra-operatively by laser Doppler flowmetry. We investigated six different zones of each rotator cuff during the arthroscopic examination of 56 consecutive patients undergoing investigation for impingement, cuff tears or instability; there were 336 measurements overall. The mean laser Doppler flowmetry flux was significantly higher at the edges of the tear in torn cuffs (43.1, 95% confidence interval (CI) 37.8 to 48.4) compared with normal cuffs (32.8, 95% CI 27.4 to 38.1; p = 0.0089). It was significantly lower across all anatomical locations in cuffs with impingement (25.4, 95% CI 22.4 to 28.5) compared with normal cuffs (p = 0.0196), and significantly lower in cuffs with impingement compared with torn cuffs (p < 0.0001). Laser Doppler flowmetry analysis of the rotator cuff blood supply indicated a significant difference between the vascularity of the normal and the pathological rotator cuff. We were unable to demonstrate a functional hypoperfusion area or so-called ‘critical zone’ in the normal cuff. The measured flux decreases with advancing impingement, but there is a substantial increase at the edges of rotator cuff tears. This might reflect an attempt at repair.
The effect of quadriceps contraction during weight-bearing on four patellar height indices
Authors: Yiannakopoulos C. K. , Mataragas E. , Antonogiannakis E. 
Published: June 2008

The effect of weight-bearing on the height of the patellar using four radiological indices was studied in 25 healthy men using lateral radiographs of the knee in 30° of flexion non-weight-bearing and weight-bearing. The position of the patella was quantified using the Insall-Salvati, the modified Insall-Salvati, the Blackburne-Peel and the Caton indices. The contraction of the quadriceps on weight-bearing resulted in statistically significant proximal displacement of the patella with all four indices studied. The mean Insall-Salvati index was 0.919 (sd 0.063) before and 1.109 (sd 0.042) after weight-bearing (p = 0.001), while the mean modified Insall-Salvati index was 0.734 (sd 0.039) before and 0.896 (sd 0.029) after weight-bearing (p = 0.041). Similarly, the Blackburne-Peel index was 0.691 (sd 0.09) before and 0.807 (sd 0.137) after weight-bearing (p = 0.012). The mean Caton index was 0.861 (sd 0.09) before and 0.976 (sd 0.144) after weight-bearing (p = 0.023). The effect of quadriceps contraction should be considered in clinical studies where the patellar position indices are reported.
Pseudotumours associated with metal-on-metal hip resurfacings
Authors: Pandit H. , Glyn-Jones S. , McLardy-Smith P. , Gundle R. , Whitwell D. , Gibbons C. L. M. , Ostlere S. , Athanasou N. , Gill H. S. , Murray D. W. 
Published: June 2008

We report 17 patients (20 hips) in whom metal-on-metal resurfacing had been performed and who presented with various symptoms and a soft-tissue mass which we termed a pseudotumour. Each patient underwent plain radiography and in some, CT, MRI and ultrasonography were also performed. In addition, histological examination of available samples was undertaken. All the patients were women and their presentation was variable. The most common symptom was discomfort in the region of the hip. Other symptoms included spontaneous dislocation, nerve palsy, a noticeable mass or a rash. The common histological features were extensive necrosis and lymphocytic infiltration. To date, 13 of the 20 hips have required revision to a conventional hip replacement. Two are awaiting revision. We estimate that approximately 1% of patients who have a metal-on-metal resurfacing develop a pseudotumour within five years. The cause is unknown and is probably multifactorial. There may be a toxic reaction to an excess of particulate metal wear debris or a hypersensitivity reaction to a normal amount of metal debris. We are concerned that with time the incidence of these pseudotumours may increase. Further investigation is required to define their cause.
A technique of fusion for failed total replacement of the ankle
Authors: Thomason K. , Eyres K. S. 
Published: June 2008

Salvage of a failed total ankle replacement is technically challenging and although a revision procedure may be desirable, a large amount of bone loss or infection may preclude this. Arthrodesis can be difficult to achieve and is usually associated with considerable shortening of the limb. We describe a technique for restoring talar height using an allograft from the femoral head compressed by an intramedullary nail. Three patients with aseptic loosening were treated successfully by this method with excellent symptomatic relief at a mean follow-up of 32 months (13 to 50).