bluuebunny/crossref_metadata_2025_split huggingface dataset:
Patient involvement in clinical decision making: the effect of GP attitude on patient satisfaction
Authors: Carlsen Benedicte , Aakvik Arild 
Published: May 2006

AbstractObjective  This study investigates general practitioners’ (GPs) and patients’ attitudes to shared decision making, and how these attitudes affect patient satisfaction.Background  Sharing of information and decisions in the consultation is largely accepted as the ideal in general practice. Studies show that most patients prefer to be involved in decision making and shared decision making is associated with patient satisfaction, although preferences vary. Still we know little about how the interaction of GP and patients’ attitudes affects patient satisfaction. One such study was conducted in the USA, but comparative studies are lacking.Design  Questionnaire survey distributed through GPs.Setting and participants  The results are based on the combined questionnaires of 41 GPs and 829 of their patients in the urban municipality of Bergen in the western part of Norway.Main variables studied  The data were collected using a nine‐item survey instrument constructed to measure attitudes towards patient involvement in medical consultations. The patients were also asked to rate their satisfaction with their GP.Results and conclusions  The patients had a strong preference for shared decision making. The GPs also generally preferred shared decision making, but to a lesser degree than the patients, which is the opposite of the findings of the US study. There was a positive effect of the GP's attitude towards shared decision making on patient satisfaction, but no significant effect of congruence of attitudes between patient and GP on patient satisfaction. The suggested explanation is that GPs that are positive to sharing decisions are more responsive to patients’ needs and therefore satisfy patients even when the patient's attitude differs from the GPs’ attitude. Hence, although some patients do prefer a passive role, it is important to promote positive attitudes towards patient involvement in medical consultations.
Pre‐pouch ileitis: a disease of the ileum in ulcerative colitis after restorative proctocolectomy
Authors: Bell A. J. , Price A. B. , Forbes A. , Ciclitira P. J. , Groves C. , Nicholls R. J. 
Published: May 2006

AbstractObjective  Ileal inflammation in ulcerative colitis can occur as backwash ileitis or prestomal ileitis. After restorative proctocolectomy (RPC), ileal inflammation may be present in the pouch (pouchitis) but inflammation proximal to the pouch in the neo‐terminal ileum, so called pre‐pouch ileitis (PI), has also been observed. As pouchitis is increasingly common and PI can mimic it, our aim was to characterize this condition.Subjects and methods  A review of prospectively collected data on 571 inflammatory bowel disease patients undergoing follow‐up after RPC in a single centre over 22 years was performed. The histology of biopsy material was reviewed and staining for colonic mucosal phenotypic changes was undertaken. It was not routine practice to prospectively assess all patients for pre‐pouch ileitis when the database was constructed.Results  Of 19 patients with inflammation of the pre‐pouch neo‐terminal ileum (NTI) identified three had Crohn's disease and one a NSAID stricture. The remaining 15 had a characteristic diffuse inflammation extending from the NTI‐pouch junction proximally: pre‐pouch ileitis. The inflammation extended proximally for up to 50 cm. Fistula formation was seen in only one. Seven (47%) of 15 had pouchitis but only two had suffered backwash ileitis pre‐operatively. Seven responded to medical therapy and four to surgery. The histological appearances including staining for colonic phenotypic change were similar in PI and pouchitis.Conclusion  Pre‐pouch ileitis is uncommon. As the patients' previous diagnosis of UC was confirmed and there was no radiological or histological evidence of Crohn's disease, PI appears to have a distinct pathogenesis from Crohn's disease.
A Dukes/Jass combination – is it more discriminating?
Authors: Haslam A. C. , Pearson J. M. , Bisset D. L. , Michie H. R. , Hobbiss J. H. 
Published: May 2006

AbstractBackground  In 1987 Jass described a modified staging system for colorectal cancer using two anatomical criteria in common with the Dukes system; extent of spread through the bowel wall and the presence or absence of lymph node involvement. Additionally it used two ‘biological’ criteria; the nature of the expanding margin of the tumour (pushing or infiltrating), and the presence or absence of lymphocytic infiltration within the tumour. This study aims to determine whether a combination of the Dukes and Jass staging systems provides a better predictor of five year survival in patients with colorectal cancer than Dukes stage alone.Method  The Dukes and Jass stages along with vital status at five years were recorded for all 612 patients undergoing resection for colorectal cancer at the Royal Bolton Hospital and the Beaumont (BMI) Hospital, Bolton between 1991 and 1998. Kaplan‐Meier survival curves with log rank test were used to show how survival correlated with Jass group stratified by Dukes stage.Results  Both the Dukes B and the Dukes C tumours could be divided into groups with significantly different five year survival rates when stratified by Jass group. Five year survival for Dukes stage B, Jass group II tumours was 73.74% compared to Dukes B Jass III tumours whose survival was 51.38% (P = 0.0018). Five year survival for Dukes C Jass III tumours was 43.18% and for Dukes C Jass IV survival was 24.39% (P = 0.0029).Conclusion  By combining the biological criteria of the Jass staging system with the anatomically based Dukes system, both Dukes B and C tumours can be divided into groups with significantly different five year survival figures.
Prognostic significance of CEA levels and positive cytology in peritoneal washings in patients with colorectal cancer
Authors: Kanellos I. , Zacharakis E. , Kanellos D. , Pramateftakis M.‐G. , Betsis D. 
Published: May 2006

AbstractObjective  The aims of this prospective study were to determine carcinoembryonic antigen (CEA) levels and incidence of cytology in peritoneal washings of patients with colorectal cancer, correlate the results with various histopathological factors and determine their significance as prognostic factors of the disease.Methods  From 1992 to 1999, 98 patients with adenocarcinoma of the colon or intraperitoneal rectum underwent curative surgery and enrolled in this study.Results  Overall, 25 (26.3%) of 95 patients were found to have positive cytology. The proportion of patients with positive cytology was higher in the recurrence group (36.4%) than in the groups of 5‐year survival and hepatic metastases (24.6% and 26.3%, respectively), but this difference was not significant. The 5‐year survival group had the lowest peritoneal CEA levels compared with the other groups, but this difference was not significant. Peritoneal cytology and CEA level alone were not sensitive, specific or accurate enough indicators in predicting survival, hepatic metastases or local recurrence. The analysis of patients with positive cytology and high peritoneal CEA level revealed that their combination can predict local recurrence with accuracy of 85%.Conclusions  The presence of free malignant cells, as detected by cytology and CEA level, in the peritoneal cavity of patients with resectable colorectal cancer had no detectable impact on survival, hepatic metastases or local recurrence rate. However, local recurrence can be predicted with accuracy of 85% in patients who have positive cytology and high peritoneal CEA level at the same time.
Public and Private Pension Spending: Principles, Practice and the Need for Reform
Authors: BANKS JAMES , EMMERSON CARL 
Published: May 2006

AbstractThis paper surveys the issue of public spending on pensions. Drawing on evidence from systems around the world, but particularly in Britain, we outline the arguments for different types of public and private provision of pension income and consider how far they go towards meeting the objectives of pension provision. We discuss past trends in spending and look at future projections.
Interleukin‐6 Induction by Helicobacter pylori in Human Macrophages is Dependent on Phagocytosis
Authors: Odenbreit Stefan , Linder Stefan , Gebert‐Vogl Bettina , Rieder Gabriele , Moran Anthony P. , Haas Rainer 
Published: May 2006

AbstractBackground:  The colonization of the gastric mucosa with Helicobacter pylori is accompanied by elevated levels of proinflammatory cytokines, such as interleukin‐1 (IL‐1), IL‐6, and IL‐8. The aim of our study was to determine the mechanisms of IL‐6 stimulation in phagocytes upon H. pylori infection.Materials and Methods:  We investigated the secretion of IL‐6 by different professional phagocytes from murine and human origin, including granulocyte‐ and monocyte‐like cells and macrophages derived from human peripheral blood monocytes (PBMCs). The influence of viability, phagocytosis, and the impact of different subcellular fractions of H. pylori bacteria were evaluated.Results:  IL‐6 levels induced by H. pylori were low in cell lines derived from murine and human monocytes and in human granulocyte‐like cells. By contrast, macrophages derived from human PBMCs were highly responsive to both H. pylori and Escherichia coli. IL‐6 induction was blocked by inhibition of actin‐dependent processes prior to infection with H. pylori, but not with E. coli or E. coli lipopolysaccharide (LPS). Using cell fractionation, the most activity was found in the H. pylori membrane. H. pylori LPS exhibited a 103‐ to 104‐fold lower biologic activity than E. coli LPS, suggesting a minor role for toll‐like receptor 4 (TLR4)‐mediated signalling from the exterior.Conclusions:  From these data, we conclude that macrophages may be a major source of IL‐6 in the gastric mucosa upon H. pylori infection. The IL‐6 induction by H. pylori in these cells is a multifactorial process, which requires the uptake and presumably degradation of H. pylori bacteria.
Normalization of Quality of Life Three Years after Temporal Lobectomy: A Controlled Study
Authors: Mikati Mohamad A. , Comair Youssef G. , Rahi Amal 
Published: May 2006

Summary:  Purpose: The goal of epilepsy surgery is not merely to control previously intractable seizures, but also to improve quality of life (QOL). Our goals were to assess, in our Middle Eastern population, the QOL of adults with temporal lobe epilepsy (TLE) 3 years after temporal lobectomy as compared with matched TLE patients who did not undergo surgery and with healthy individuals in the same community. Methods: Twenty consecutive TLE patients who underwent temporal lobectomy 3 years previously were matched in the following variables: age, sex, seizure frequency, seizure duration, age at onset of epilepsy, duration of epilepsy, and number of medications, with 17 TLE patients who underwent the presurgical evaluation and subsequent optimization of medical therapy but did not undergo surgery. They were also matched for age, sex, educational level, income, and residence with 20 healthy individuals. All groups were interviewed by using the ESI‐55 questionnaire. Results: Compared with the nonsurgery group, QOL was significantly better in the surgery group (85% seizure free) in the well‐being, functioning, and role‐limitation domains. QOL was similar in the surgery and healthy control groups in all domains and scales. The nonsurgery group scored significantly lower than healthy controls in the functioning and role‐limitation domains. Conclusions: Intractable TLE was associated with marked impairments in QOL despite continued attempts to optimize medical therapy. Three years after temporal lobectomy QOL in our patient population achieved levels similar to those of matched healthy individuals. To our knowledge, this is the first study to report normalization of QOL after temporal lobectomy, in any population.
Diffusion Tensor Imaging Findings and Their Correlation with Neuropsychological Deficits in Patients with Temporal Lobe Epilepsy and Interictal Psychosis
Authors: Flügel Dominique , Cercignani Mara , Symms Mark R. , O'Toole Annette , Thompson Pamela J. , Koepp Matthias J. , Foong Jacqueline 
Published: May 2006

Summary:  Purpose: To examine frontotemporal white‐matter integrity in patients with temporal lobe epilepsy (TLE) and interictal psychosis. Method: Patients with TLE and interictal psychosis (IP; n = 20) were compared with age‐matched TLE patients without psychosis (NIP; n = 20). Patients had either no focal lesions or hippocampal sclerosis on conventional MRI. Complete diffusion tensor imaging (DTI) data were available in 18 IP and 20 NIP patients. A region‐of‐interest (ROI) approach was used to determine the DTI measures, fractional anisotropy (FA) and mean diffusivity (MD), in the middle frontal and middle temporal gyri. The relation between the DTI measures and neuropsychological tests previously identified as impaired in the IP group was examined. Results: The IP group had significantly lower FA values in both frontal and temporal regions and significantly higher MD in bilateral frontal regions. We found that performance on some neuropsychological tests was significantly related to frontotemporal FA reductions. Conclusions: Our findings suggest that subtle abnormalities in the frontotemporal white matter of patients with interictal psychosis may be undetectable on conventional MRI. These abnormalities may contribute to the cognitive deficits detected in these patients.
Voxel‐based Morphometry Reveals Excess Gray Matter Concentration in Patients with Focal Cortical Dysplasia
Authors: Bonilha Leonardo , Montenegro Maria Augusta , Rorden Chris , Castellano Gabriela , Guerreiro Marilisa Mantovani , Cendes Fernando , Li Li Min 
Published: May 2006

Summary:  Purpose: Many patients with focal cortical dysplasia (FCD) continue to have seizures after surgical treatment. The usual explanation for the poor surgical outcome is the presence of residual dysplastic tissue missed by the preoperative neuroimaging investigation and therefore not resected during surgery. We apply a voxel‐based morphometry (VBM) analysis to the magnetic resonance imaging (MRI) scans from patients with epilepsy and visually detected FCD to investigate whether (a) VBM is able to detect gray‐matter concentration (GMC) abnormalities in patients with FCD, and (b) whether the extent of GMC abnormalities in the brain of these patients differs from the regions observed by using visual inspection. Methods: We studied 11 patients with visually detected FCD (eight of them with histologic confirmation of FCD). The GMC from each one of these patients was compared with the mean GMC from a control group of 96 normal healthy subjects by using an optimized VBM protocol. Results: Ten of 11 patients showed statistically significant GMC excess, and among patients with GMC excess, only one showed GMC excess that was not exactly correspondent to the visually detected FCD. Seven patients exhibited excess in GMC extending beyond the area of visually detected FCD. Conclusions: This preliminary neuroimaging study suggests that (a) VBM can detect GMC excess in patients with FCD, and (b) GMC excess in these patients can extend to brain areas not visually defined as abnormal. Abnormal areas detected by VBM can possibly correspond to mild malformations of cortical development, supporting the notion that the surgical refractoriness observed in patients with FCD can be due to the incomplete resection of the dysplastic tissue.
Unverricht‐Lundborg Disease, a Condition with Self‐limited Progression: Long‐term Follow‐up of 20 Patients
Authors: Magaudda Adriana , Ferlazzo Edoardo , Nguyen Vi‐Hong , Genton Pierre 
Published: May 2006

Summary:  Purpose: To assess the long‐term evolution of Unverricht–Lundborg disease (ULD), especially concerning myoclonus, seizures, and EEG characteristics. Methods: We retrospectively evaluated 20 patients (six women, 14 men; mean age, 37.9 years; range, 26–53 years) with ULD who had been closely followed up since the onset of the disease (mean age, 12.3 years; range, 6–17 years) for an average of 25.6 years (range, 13–41 years). ULD was confirmed by genetic tests in all. We used simplified myoclonus and seizure rating scales. Results: The geographic origin of the patients was Northern Africa in nine, France in two, Italy in six, and mixed European in three. Three patients were severely handicapped, six led fully autonomous lives, and 11 required various degrees of social support. Myoclonus progressed only during the first 5 years of disease. Major seizures occurred in 19. Three patients had a single seizure, and eight became seizure free, whereas six had rare seizures, and two had frequent attacks. Overall, seizures became much less frequent after 10 years of evolution. EEG changes abated during follow‐up: background activity remained stable or improved, spontaneous discharges disappeared, and photoparoxysmal responses were abolished in all patients but two. Conclusions: This study shows that ULD progresses only over a limited period and stabilizes thereafter. This self‐limited progression may be the consequence of age‐related apoptosis of selected neuronal populations.
Variation in Lamotrigine Plasma Concentrations with Hormonal Contraceptive Monthly Cycles in Patients with Epilepsy
Authors: Contin Manuela , Albani Fiorenzo , Ambrosetto Giovanni , Avoni Patrizia , Bisulli Francesca , Riva Roberto , Tinuper Paolo , Baruzzi Agostino 
Published: May 2006

Summary:  Purpose: This is the first report comparing intrasubject lamotrigine (LTG) plasma concentrations between hormonal contraceptive (HC) intake and week‐off phases in epilepsy patients receiving combined LTG and HC treatment. We describe the variation in LTG plasma concentrations with hormonal contraceptive (HC) monthly intake cycles in a series of eight patients with epilepsy. Methods: Venous blood samples were prospectively drawn from patients before their first morning dose of LTG, once between days 18 and 21 of HC intake and once between days 5 and 7 of the HC‐free week. Results: Median LTG plasma concentrations were significantly higher during the HC washout week than during the phase of HC intake (p = 0.02). The median value of intrasubject percentage increase was 27%, with a wide interpatient variability. Conclusions: These findings are in line with a preliminary report on healthy volunteers. Standardization of blood sampling in relation to HC intake cycles is advisable when planning LTG therapeutic monitoring in patients receiving HC.
Ecologically Sustainable Development in a ‘Quarry’ Economy: One Step Forward, Two Steps Back
Authors: MERCER DAVID , MARDEN PETER 
Published: May 2006

AbstractAn overview is presented of recent work on the environmental changes impacting on Australia and the policy responses of the State and Commonwealth governments, especially over the last ten years. This period has seen a remarkably stable phase of conservative government administration in Canberra and consistent resistance to a strong environmental policy agenda, both domestically and internationally. Attention is focused particularly on rural and regional Australia, rather than on urban areas. The paper discusses the role of environmental issues in recent elections and also details the results of relevant opinion polls charting changes in environmental attitudes. The problems posed by the federal system of administration are outlined as are recent analyses and counter‐analyses of the state of the Australian environment. A more fundamental problem with liberal democracy and environmental values is also addressed.
A Novel Enzyme-Linked Immunosorbent Assay for Diagnosis of
Mycobacterium avium
subsp.
paratuberculosis
Infections (Johne's Disease) in Cattle
Authors: Speer C. A. , Scott M. Cathy , Bannantine John P. , Waters W. Ray , Mori Yasuyuki , Whitlock Robert H. , Eda Shigetoshi 
Published: May 2006

ABSTRACT

Enzyme-linked immunosorbent assays (ELISAs) for the diagnosis of Johne's disease (JD), caused by
Mycobacterium avium
subsp.
paratuberculosis
, were developed using whole bacilli treated with formaldehyde (called WELISA) or surface antigens obtained by treatment of
M. avium
subsp.
paratuberculosis
bacilli with formaldehyde and then brief sonication (called SELISA). ELISA plates were coated with either whole bacilli or sonicated antigens and tested for reactivity against serum obtained from JD-positive and JD-negative cattle or from calves experimentally inoculated with
M. avium
subsp.
paratuberculosis
,
Mycobacterium avium
subsp.
avium
, or
Mycobacterium bovis
. Because the initial results obtained from the WELISA and SELISA were similar, most of the subsequent experiments reported herein were performed using the SELISA method. To optimize the SELISA test, various concentrations (3.7 to 37%) of formaldehyde and intervals of sonication (2 to 300 s) were tested. With an increase in formaldehyde concentration and a decreased interval of sonication, there was a concomitant decrease in nonspecific binding by the SELISA. SELISAs prepared by treating
M. avium
subsp.
paratuberculosis
with 37% formaldehyde and then a 2-s burst of sonication produced the greatest difference (7×) between
M. avium
subsp.
paratuberculosis
-negative and
M. avium
subsp.
paratuberculosis
-positive serum samples. The diagnostic sensitivity and specificity for JD by the SELISA were greater than 95%. The SELISA showed subspecies-specific detection of
M. avium
subsp.
paratuberculosis
infections in calves experimentally inoculated with
M. avium
subsp.
paratuberculosis
or other mycobacteria. Based on diagnostic sensitivity and specificity, the SELISA appears superior to the commercial ELISAs routinely used for the diagnosis of JD.
Evaluation of Various Methods of Maternal Placental Blood Collection for Immunology Studies
Authors: Othoro Caroline , Moore Julie M. , Wannemuehler Kathleen , Nahlen Bernard L. , Otieno Juliana , Slutsker Laurence , Lal Altaf A. , Shi Ya Ping 
Published: May 2006

ABSTRACTThe collection of maternal placental intervillous blood (IVB), without contamination of fetal blood and with an accurate mononuclear cell profile, is essential for immunological studies of placental malaria and other infectious diseases of the placenta. We have compared five documented methods of IVB collection: perfusion, incision, biopsy, tissue grinding, and puncture (prick) for fetal blood contamination and mononuclear cell profiles using flow cytometry. Twenty-five placentas were obtained fromPlasmodium falciparumand human immunodeficiency virus-negative primigravid and secundigravid women delivering at Nyanza Provincial Hospital in Kisumu, western Kenya. Each of the five methods was performed on the same placenta. Fetal red blood cell contamination was significantly lower for the prick and perfusion methods (4.1% and 8.3%, respectively) than for incision (59.5%), biopsy (42.6%), and tissue grinding (19.9%). Significant variation was noted among the five methods in the percentages of monocytes, total T cells, CD4+and CD8+T cells, B cells, and NK cells. Further, a pairwise comparison of prick and perfusion, the two methods with low fetal blood contamination, showed that they were not different for fetal red blood cell contamination levels; however, prick yielded significantly higher percentages of CD4 T cells and CD4 memory T cells than perfusion. Collection by prick was determined to be the best method of intervillous blood collection for immunology studies, and perfusion represented the next best method of choice due to high sample volume yield. Overall, in considering the advantages/disadvantages of the two methods with low fetal cell contamination, we conclude that a combination of prick and perfusion is most suitable for immunology studies.