bluuebunny/crossref_metadata_2025_split huggingface dataset:
Botulinum Toxin A and B: A Comparative Dosing Study for Spasmodic Dysphonia
Authors: Blitzer Andrew 
Published: December 2005

OBJECTIVEThe purpose of this study was to find the conversion factor, safety, and efficacy of type A to type B toxin for laryngeal muscles.METHODSThirty‐two patients with adductor spasmodic dysphonia with stable doses of A toxin to manage their symptom were given type B toxin starting at a conversion of 1 Uof BTX‐A to 50 U of BTX‐B. The patients were followed for 1 year, and doses adjusted according to response.RESULTSThe conversion factor was found to be 52.3 U:1 U. The onset of action of type B was more rapid (2.09 days vs 3.2 days [P = 0.028]), with a shorter duration of benefit (10.8 weeks vs 17 weeks [P = 0.002). The safety profile for A and B toxin appeared the same, with 3 patients receiving Myobloc reporting dry mouth.CONCLUSIONThis study shows that a conversion factor of 52.3:1 Myobloc (BTX‐B) to Botox (BTX‐A) and that Myobloc is an effective alternative to Botox (BTX‐A) for patients with spasmodic dysphonia.EBM RATING: B‐2
Implementation of brief alcohol intervention in primary health care: do nurses' and general practitioners' attitudes, skills and knowledge change?
Authors: AALTO MAURI , PEKURI PETTERI , SEPPÄ KAIJA 
Published: December 2005

AbstractBrief alcohol intervention reduces heavy drinking, but its implementation has been challenging. The purpose was to evaluate self‐reported changes in attitudes, skills and knowledge regarding brief intervention among nurses and general practitioners (GPs) during an implementation project. A questionnaire survey was used before and after the implementation to all nurses and GPs working at the time in the seven primary health‐care centres of the city of Tampere, Finland. Several positive changes indicate an increased amount of knowledge regarding brief intervention among the professionals during the implementation. This was found especially among the nurses. The success in increasing the knowledge can also be seen in a decrease of training needs. Instead, attitudes and skills among the professionals did not seem to develop positively. Increasing motivational skills especially seems to be the future challenge.
Process evaluation of an out‐patient detoxification service
Authors: SANNIBALE CLAUDIA , FUCITO LISA , O'CONNOR DANNY , CURRY KENNETH 
Published: December 2005

AbstractThis paper describes the process evaluation of an out‐patient detoxification service (ODS) established by Drug Health Services (DHS) to increase the supervised withdrawal options for substance users in a Sydney metropolitan Area Health Service. The ODS aimed to provide a safe and effective supervised withdrawal to substance users who were at low risk of severe withdrawal, engage those with severe dependence in further treatment and increase the involvement of general practitioners (GPs) in the medical care of ODS clients. During its first 10 months of operation, the ODS received 199 inquiries, assessed 82 individuals and admitted 76 clients for detoxification. Withdrawal treatment proceeded without complications and within the expected time frames. Fifty‐four clients completed withdrawal, 10 ceased treatment, 10 remained in treatment without completing withdrawal and two were transferred elsewhere. Clients who injected substances (mainly heroin) daily at admission, compared to others, were less likely to complete withdrawal and more likely to use a range of non‐prescribed substances during withdrawal. One‐fifth of clients went on to further treatment with DHS, attending at least once. Overall, the ODS met its goals, providing a safe and effective supervised withdrawal to local residents, especially women, young people and those withdrawing from benzodiazepines who had significant substance dependence, impairment and previous alcohol and other drug (AOD) treatment. Non‐injecting substance users benefited most from the ODS in terms of withdrawal completion and ongoing treatment. The level of GP involvement in the conjoint care of ODS clients remained constant over time. The development and expansion of the ODS are discussed.
Cannabis use in adolescents: the impact of risk and protective factors and social functioning
Authors: BEST DAVID , GROSS SAMANTHA , MANNING VICTORIA , GOSSOP MICHAEL , WITTON JOHN , STRANG JOHN 
Published: December 2005

AbstractThe study uses a school‐based sample to test the social and familial risk and protective factors relating to cannabis use. Based on a self‐completion survey of 2078 14–16‐year‐olds (mean age of 15 years) attending seven standard state‐run secondary schools in south London, an assessment was made of rates and risk factors for cannabis use. Twenty‐four per cent of the total sample had ever used cannabis, with 15% having done so in the month prior to assessment. In addition to greater likelihood of illicit drug use, lifetime cannabis users were less likely to spend time regularly with both their mothers and fathers, but more likely to spend free time with friends who smoked, drank alcohol and used illicit drugs, and with friends involved in criminal activities. Among those who had ever used cannabis, frequency of cannabis use was predicted (using linear regression) by two onset factors (earlier initiation of drinking and cannabis use were both linked to more frequent use) and two social factors (more time spent with drug‐using friends and less time spent with the mother). Overall, the study showed that early onset, itself predicted by social networks, is linked to more frequent use of cannabis and that this appears to be sustained by less time spent with parents and more with drug‐using peers.
The management of alcohol, tobacco and illicit drug use problems by general practitioners in Australia
Authors: DEGENHARDT LOUISA , KNOX STEPHANIE , BARKER BRIDGET , BRITT HELENA , SHAKESHAFT ANTHONY 
Published: December 2005

AbstractThe aim of this study was to document the frequency of the management of illicit drug, alcohol and tobacco problems in general practice in Australia. Data from the Bettering the Evaluation and Care of Health (BEACH) study of general practice, April 1998 to March 2003, were analysed. BEACH is an ongoing national study of general practice in Australia. Each year a random sample of approximately 1000 general practitioners (GPs) participate, each providing details of 100 patient encounters. Samples are drawn from the Medicare data held by the Health Insurance Commission. Patient demographic breakdowns, medication, other treatment, referrals and other medical procedures ordered were examined for all problems labelled by GPs as illicit, alcohol and tobacco problems. Annually in Australia, it was estimated that 615 000 GP encounters—or 0.6% of all encounters—involved the management of illicit drug use problems presumably most commonly for problematic heroin use. Despite a much higher population prevalence of use and use disorders, the management of alcohol or tobacco use problems was less common, with 0.4% and 0.3% of encounters, respectively, comprising treatment of these problems. Clear demographic differences existed across the groups. The management of problems also differed, with illicit drug use problems more likely to involve provision of medication, and alcohol and tobacco treatment more likely to involve counselling and/or health advice. Despite higher rates of alcohol and tobacco use problems among patients seeing GPs in Australia, the rate of treatment for such problems was relatively lower than it was for illicit drug use problems. More efforts need to be directed towards assisting GPs to identify and target problematic alcohol and tobacco use among their patients.
Drug ‘hot‐spots’, alcohol availability and violence
Authors: GORMAN D. M. , ZHU LI , HOREL SCOTT 
Published: December 2005

AbstractEcological studies have shown a relationship between alcohol outlet densities and violence and between the location of crimes related to illicit drug use (so‐called ‘hot spots’) and violence. To date, no study has compared the effects of alcohol outlets and drug hot spots on rates of violence. The present study examined this relationship in the City of Houston, Texas. An ecological study design was employed, using a sample of 439 census tracts from Houston, Texas. Neighborhood socio‐structural, alcohol outlet density, drug crime density and violent crime density data were collected from archival sources and analyzed using multivariate and spatial statistics. Using ordinary least‐squares analysis, the neighborhood socio‐structural covariates explained about 40% of the variability in violent crime. Adding alcohol outlet density in the target census tracts explained an additional 6%, while the addition of drug crime density explained an additional 32%. In the final model, that controlled for the effects of autocorrelated error, both drug crime density in the target and adjacent census tracts remained significant predictors of violent crime, while only off‐sale density in the target census tract remained significant in the model. The findings indicate that drug crime density explained a greater amount of variance in violent crime rates than the alcohol outlet density. The methodological and policy implications of these findings are discussed, along with the shortcomings of the analysis presented.
Mortality and population drinking: a review of the literature
Authors: NORSTRÖM THOR , RAMSTEDT MATS 
Published: December 2005

AbstractThe aim of this review was to review research addressing the relationship between population drinking and health, particularly mortality. The review is based primarily on articles published in international journals after 1994 to February 2005, identified via Medline. The method used in most studies is time‐series analysis based on autoregressive intergrated moving average (ARIMA) modelling. The outcome measures covered included the following mortality indicators: mortality from liver cirrhosis and other alcohol‐related diseases, accident mortality, suicide, homicide, ischaemic heart disease (IHD) mortality and all‐cause mortality. The study countries included most of the EU member states as of 1995 (14 countries), Canada and the United States. For Eastern Europe there was only scanty evidence. The study period was in most cases the post‐war period. There was a statistically significant relationship between per capita consumption and mortality from liver cirrhosis and other alcohol‐related diseases in all countries. In about half the countries, there was a significant relationship between consumption, on one hand, and mortality from accidents and homicide as well as all‐cause mortality on the other hand. A link between alcohol and suicide was found in all regions except for mid‐ and southern Europe. There was no systematic link between consumption and IHD mortality. Overall, a 1‐litre increase in per capita consumption was associated with a stronger effect in northern Europe and Canada than in mid‐ and southern Europe. Research during the past decade has strengthened the notion of a relationship between population drinking and alcohol‐related harm. At the same time, the marked regional variation in the magnitude of this relationship suggests the importance of drinking patterns for modifying the impact of alcohol. By and large, there was little evidence for any cardioprotective effect at the population level. It is a challenge for future research to reconcile this outcome with the findings from observational studies, most of which suggest a protective effect of moderate drinking.
Alcohol‐related associative strength and drinking behaviours: concurrent and prospective relationships
Authors: KELLY ADRIAN B. , MASTERMAN PAUL W. , MARLATT G. ALAN 
Published: December 2005

AbstractThe first part of this research assessed the longitudinal relationships between alcohol‐related associative strength and alcohol use measured at two time‐points, 6 months apart. Cross‐lagged results support the utility of alcohol‐related associative strength to predict drinking behaviours prospectively and vice versa. These results remained after competing explanations of previous use, autocorrelations between memory measures, sensation seeking and background variables of age and gender were accounted for. Findings offer further evidence for an implicit cognitions approach to drinking processes. In the second part of our study, cross‐sectional analysis investigated potential mediating mechanisms in the relation of associative strength to quantity and frequency dimensions of drinking. Mediational models provide preliminary evidence that implicit memory processes may have differential effects on quantity and frequency dimensions of drinking behaviours. The results point to the possibility that increasing awareness of implicit alcohol‐related associations may have utility in interventions for young adults.
Decreased energy expenditure during prolonged sub‐maximal exercise in a warm environment
Authors: Yamashita Yoichiro , Kaya Mitsuharu , Koyama Katsuhiro , Tsujita Junzo , Hori Seiki 
Published: December 2005

AbstractThe purpose of this study was to investigate the influence of a warm environment on thermoregulation and energy expenditure during sub‐maximal prolonged exercise in humans. Six healthy male subjects cycled for 120 min at an intensity of 60% maximal oxygen uptake (Vo2max) at three environmental temperatures (10°C, CT; 20°C, MT; and 30°C, WT). Although oxygen uptake at WT showed a significantly lower value compared to those at MT and CT, no significant differences of respiratory exchange ratio were observed among the three environmental trials. A remarkable decrease in total energy expenditure during the 120‐min exercise at WT was observed in comparison with those at MT and CT (p<0.05). Changes in rectal temperature, mean skin temperature, and mean body temperature at WT were significantly higher than those at both MT and CT. Although increases in mean body temperature from rest every five minutes during exercise were not different among three environmental temperatures, mean energy expenditures every five minutes at WT were lower compared with those at MT and CT (p<0.05). These results suggest that the increase in energy expenditure for physical exertion is substantially reduced during prolonged sub‐maximal exercise in a warm environment. This acute alteration in the energy metabolism may contribute to inhibition of excess heat production and enable prolonged exercise in a warm environment.
Development and Validation of an Objective Instrument to Measure Surgical Performance at Tonsillectomy
Authors: Roberson David W. , Kentala Erna , Forbes Peter 
Published: December 2005

AbstractObjectives: The goals of this project were 1) to develop and validate an objective instrument to measure surgical performance at tonsillectomy, 2) to assess its interobserver and interobservation reliability and construct validity, and 3) to select those items with best reliability and most independent information to design a simplified form suitable for routine use in otolaryngology surgical evaluation.Design: Prospective, observational data collection for an educational quality improvement project.Methods: The evaluation instrument was based on previous instruments developed in general surgery with input from attending otolaryngologic surgeons and experts in medical education. It was pilot tested and subjected to iterative improvements. After the instrument was finalized, a total of 55 tonsillectomies were observed and scored during academic year 2002 to 2003: 45 cases by residents at different points during their rotation, 5 by fellows, and 5 by faculty. Results were assessed for interobserver reliability, interobservation reliability, and construct validity. Factor analysis was used to identify items with independent information.Results: Interobserver and interobservation reliability was high. On technical items, faculty substantially outperformed fellows, who in turn outperformed residents (P < .0001 for both comparisons). On the “global” scale (overall assessment), residents improved an average of 1 full point (on a 5 point scale) during a 3 month rotation (P = .01). In the subscale of “patient care,” results were less clear cut: fellows outperformed residents, who in turn outperformed faculty, but only the fellows to faculty comparison was statistically significant (P = .04), and residents did not clearly improve over time (P = .36). Factor analysis demonstrated that technical items and patient care items factor separately and thus represent separate skill domains in surgery.Conclusions: It is possible to objectively measure surgical skill at tonsillectomy with high reliability and good construct validity. Factor analysis demonstrated that patient care is a distinct domain in surgical skill. Although the interobserver reliability for some patient care items reached statistical significance, it was not high enough for “high stakes testing” purposes. Using reliability and factor analysis results, we propose a simplified instrument for use in evaluating trainees in otolaryngologic surgery.
Urgent Surgical Airway Intervention: A 3 Year County Hospital Experience
Authors: Altman Kenneth W. , Waltonen Joshua D. , Kern Robert C. 
Published: December 2005

AbstractObjectives: To review the indications, complications, and outcomes of patients undergoing urgent surgical airway intervention.Methods: The inpatient and outpatient charts of patients who underwent awake tracheostomy or were converted from cricothyrostomy to tracheostomy at our institutional‐affiliated County Hospital over a 3 year period were reviewed.Results: Ninety patients underwent awake tracheotomy, and seven were converted from cricothyrostomy to tracheostomy. Indications for awake tracheotomy included impending airway obstruction from malignancy of the aerodigestive tract or that causing extrinsic compression of the airway in 72 (80%) patients, neck abscess in 4 (4.4%), subglottic stenosis in 3 (3.3%), and a variety of other etiologies in 11 (12.2%). Thirty‐eight (42%) patients were noted to have stridor. On fiberoptic laryngoscopy, 66 (80%) patients had moderate or severe airway obstruction, whereas 17 (20%) had mild or no obstruction. Of the 72 patients with squamous cell carcinoma, only 6 (8%) have been subsequently decannulated. Among the remainder, 13 of 18 (72%) have been decannulated. Complications occurred in seven (7.8%) patients after awake tracheotomy, none with untoward sequelae. Three severe complications occurred among the seven patients converted from cricothyrostomy to tracheostomy: anoxic brain injury in each, leading to death in two.Conclusions: Awake tracheostomy should be considered in any patient with impending or ongoing airway obstruction or with potential for difficult intubation. This should be performed in a timely manner before an emergent situation arises because the complications of emergency surgical airway can be devastating.
Investigation of C‐Arm Cone‐Beam CT‐Guided Surgery of the Frontal Recess
Authors: Rafferty M A. , Siewerdsen J H. , Chan Y , Moseley D J. , Daly M J. , Jaffray D A. , Irish J C. 
Published: December 2005

AbstractObjective/Hypothesis: A cone‐beam CT (CBCT) imaging system based on a mobile C‐arm (Siemens PowerMobil) incorporating a high‐performance flat‐panel detector (Varian PaxScan) has been developed in our laboratory. We hypothesize that intraoperative C‐arm CBCT provides image quality and guidance performance sufficient to assist surgical approach to the frontal recess.Study Design: A preclinical prospective study was conducted using six cadaver heads to assess the performance characteristics and the potential clinical utility of this imaging system.Methods: The mobile C‐arm was employed for intraoperative CBCT guidance of the endoscopic approach to twelve frontal recesses.Results: The imaging system is capable of sub‐mm 3D spatial resolution with bone and soft‐tissue visibility and a field of view sufficient for guidance of head and neck surgery. The system can generate intraoperative, volumetric CT images rapidly with an acceptably low radiation exposure to the patient and with image quality sufficient for most surgical tasks. Moreover, the system is portable and compatible with the surgical setup, providing excellent access to the patient. Finally, the accuracy of the system is not bound to a registration process.Conclusions: The ability to create updated images as surgery progresses introduces the concept of ‘near‐real‐time’ CT guidance for head and neck surgery. We found that the use of CBCT increased surgical confidence in accessing the frontal recess, resolved ambiguities with anatomical variations, and provided valuable teaching information to surgeons in training in both preoperative planning and correlation between tri‐planar CT scans and intraoperative endoscopic findings.
Abnormalities of Axon Growth in Human Olfactory Mucosa
Authors: Holbrook Eric H. , Leopold Donald A. , Schwob James E. 
Published: December 2005

AbstractObjectives/Hypothesis: Random biopsies of the human adult olfactory mucosa often demonstrate degenerative changes in the olfactory epithelium (OE) in both dysosmic and normosmic patients and, consequently, have limited diagnostic usefulness. However, detailed analysis of the subepithelial tissue with specific attention to the fascicles of the olfactory nerve and abnormalities of axonal growth may improve the correlation of histopathology with sensory function.Study Design: Retrospective review of human OE biopsies.Methods: Mucosal biopsies from the olfactory area obtained from 27 subjects were examined by light and electron microscopy, with particular attention to the olfactory nerve fascicles; results were correlated with clinical status. Immunohistochemical analysis was used to characterize the extent of axonal depletion, relative maturity of the parent population, and aberrant axonal growth.Results: As expected, there are areas of respiratory metaplasia and neuronal depletion in normosmic as well as dysosmic patients. The degree of axon degeneration within the fascicles correlates better with individual olfactory status. Immature neurons predominate, and re‐entrant neuromas develop in patients with olfactory loss caused by disconnection from the olfactory bulb. Individuals with olfactory loss caused by epithelial damage as with chronic rhinosinusitis display evidence of nerve fascicle degeneration and intraepithelial neuromas.Conclusion: The status of olfactory axons provides useful information on the overall condition of the olfactory periphery and improves the diagnostic usefulness of mucosal biopsies. In addition to an assessment of the epithelium per se, the fascicles of the olfactory nerve need to be characterized for a complete analysis of the olfactory mucosa.