bluuebunny/crossref_metadata_2025_split huggingface dataset:
Audit of Surgical and Pneumatic/Hydrostatic Treatment of Achalasia in a Defined Population
Authors: Mayberry J F , Smart H L , Atkinson M 
Published: July 2022

A retrospective survey was made of all the patients resident in the Nottingham area who presented with achalasia between 1959 and 1983. Initial treatment consisted of pneumatic bag dilatation in 26, hydrostatic bag dilatation in one and surgical cardiomyotomy in 22. Those treated by dilatation were older (mean age 52 years) than those treated by cardiomyotomy (mean age 42 years). Seven patients died without receiving active treatment because of old age and infirmity and in 6 this occurred before the introduction of endoscopic dilatation to the area. Initial treatment by cardiomyotomy was associated with a lower recurrence rate than treatment by bag dilatation but with a longer stay in hospital and a higher incidence of complications including empyema, chest infections and oesophageal stricture.
Hearing Loss in Chronic Renal Failure-Hearing Threshold Changes following Haemodialysis
Authors: Gatland D , Tucker B , Chalstrey S , Keene M , Baker L 
Published: July 2022

The prevalence of sensorineural hearing loss, measured by pure tone audiometry, was determined in 66 patients with chronic renal failure and threshold changes following haemodialysis were measured in 31 patients. The incidence of hearing loss was 41% in the low, 15% in the middle and 53% in the high frequency ranges respectively. No correlations with weight changes, haematocrit, metabolic bone disease or ototoxic drug history were found. Of 62 ears studied, 38% had a decrease in low frequency threshold after dialysis and 9% had an increase. Threshold in 22/31 ears with pre-existing low frequency loss altered after dialysis with little change in other frequencies and no correlation with weight changes. In conclusion, we find a high incidence of low and high frequency hearing losses in chronic renal failure patients. Fluctuation in low frequencies with dialysis is common. Possible mechanisms include treatment induced changes in fluid and electrolyte composition of endolymph.
Impact of an Extensive in Situ Component on the Presence of Residual Disease in Screen Detected Breast Cancer
Authors: Campbell I D , Theaker J M , Royle G T , Coddington R , Carpenter R , Herbert A , Moore I , Rubin C , Taylor I , Guyer P B 
Published: July 2022

This study investigates the histopathological characteristics of a consecutive series of 100 screen detected breast cancers in relation to residual disease. Tumour type, size, grade, resection margins and extent of primary or associated in situ disease were all assessed by one pathologist. Thirty-seven women underwent further surgery (wider excision or mastectomy) and the resected specimen was examined for residual in situ or invasive cancer. In total, 36 cancers had an extensive in situ component, of which 69% were predominantly intra-duct carcinoma of comedo type. Of the 37 women who underwent further resection, 21 (57%) women had residual cancer. Of those with initial disease at the resection margin, 16/25 (64%) had residual disease. Five of 12 (42%) with disease close to (within 2–3 mm) but not at the margin had residual disease. Of those with an extensive in situ component, 18/25 (72%) had residual disease, whereas only 2/12 (17%) women with none or some in situ disease had residual cancer. In screen detected breast cancer, residual cancer was present in 72% of women with an extensive in situ component at initial surgery. These women comprise a group in whom conservation surgery may be inappropriate if completeness of excision is considered a prerequisite for breast conserving surgery.
Is Undergraduate Otoscopy Teaching Adequate?-An Audit of Clinical Teaching
Authors: Fisher E W , Pfleiderer A G 
Published: July 2022

Otoscopy is an important skill for the general practitioner, yet skill in the technique is rarely assessed formally at undergraduate level. This study aimed to assess the effect of teaching on the acquisition of otoscopic skill. Thirty-five medical students were assessed prospectively during their ENT attachments. Seventeen students were randomized to the standard course and 18 attended an additional seminar on otoscopy. Students' confidence was assessed for various aspects of otoscopy using a visual analogue scale, and clinical skill was assessed in examining four patients. Assessments took place at the beginning and end of the course. Students gained in their confidence and skill for all parameters, although the clinical ability to distinguish normal from abnormal tympanic membranes changed little from baseline levels. Extra teaching produced better gains in confidence (P<0.05) and skill (P<0.01) in identifying specific features of the tympanic membrane and eliminated errors of the ‘false negative’ variety. A minimal investment in teaching effort produces appreciable gains in students' otoscopic skills. This has implication for the planning of undergraduate ENT courses and vocational training for general practice.
An Audit of University Education in Trauma and Orthopaedic Surgery in Great Britain
Authors: O'Dowd J K , Spencer J D 
Published: July 2022

An audit of undergraduate trauma and orthopaedic surgery teaching was carried out in 24 of the 27 medical schools in Great Britain and major differences were found between the medical schools. The range of time spent in teaching trauma and orthopaedic surgery for undergraduates varied from 3 weeks to 12 weeks and in five out of 27 medical schools trauma and orthopaedic surgery tuition was split between various years of the clinical curriculum. In some schools there were 30 students on a firm and in others only one. The opportunity for undergraduates to give feedback to their teachers, the use of objective assessment at the end of such an appointment by the teachers, varied between medical schools. To avoid some of these very basic differences between our medical schools, the teaching of clinical subjects to undergraduates in medicine should be reviewed nationally and minimum standards set.
How Long is Your Waiting List? Experience of a Urological Waiting List Initiative
Authors: Mobb Gillian E , Pugh Felicity , Peeling Brian 
Published: July 2022

Experience with a urological waiting list initiative is presented, wherein a list of 231 non-urgent cases was cleared over a 5 month period by a single operator. Some patients had waited 10 years for surgery. Following a postal request, the waiting list was validated; 31.2% of patients wished to be removed. The remaining 68.8% desired surgery and consisted of 51 requiring minor surgical procedures and 108 who needed more major surgery mostly for the relief of bladder outflow obstruction. Minor cases received dates for surgery; however, only 68.2% of this group attended despite being given more than one date for admission. Major cases were reviewed in a pre-admission clinic. General and urological condition was assessed, improved where necessary and surgery booked or delayed accordingly. A small number of patients did not attend or only attended to be reassured that surgery was not needed. Following clinical review, 18.5% of this group did not require operation. The long urological waiting list is a unique situation where patients listed may no longer require surgery. Reviewing these patients not only reduces numbers but also markedly increases percentage attendance for surgery.
Informed Consent: What Do Patients Want to Know?
Authors: Dawes Patrick J D , Davison Pauline 
Published: July 2022

Informed consent is an important aspect of surgery, yet there has been little inquiry as to what patients want to know before their operation. This study has questioned 50 patients within 3 months of an ENT (ear, nose and throat) operation. We found that most were happy to allow doctors to determine their treatment but they wanted to know about their condition, the treatment, and the important side effects. Fifty per cent of patients admitted worrying about some aspect of their recent surgery. More than two-thirds thought signing a consent form primarily signified agreement to undergo treatment and that it was a legal document; 54% thought there was an important medico-legal aspect. Over half thought information sheets would be reassuring, one-third thought they would provoke anxiety and 8% thought they would frighten them from having surgery. Closer examination of the answers to our questions showed that those who were most worried about aspects of their surgery had a higher mean anxiety score, as did those who thought an information sheet would be either frightening or anxiety provoking. However, a higher anxiety score was not associated with a desire to know less about the proposed treatment.
Glutathione Synthetase Deficiency: A Family Report
Authors: Pejaver R Kumar , Watson A H 
Published: July 2022

Glutathione synthetase deficiency is a rare inborn error of metabolism. Low levels of and at times unstable molecules of glutathione synthetase leads to glutathione deficiency affecting various systems of the body. The inheritance is thought to be of autosomal recessive variety. We diagnosed the condition in a neonate and proceeded to investigate the family. The results are discussed below.
Junior Doctors' Hours: What Do They Really Think?
Authors: West S , Weight S , Jenkins B J , Stephenson T P 
Published: July 2022

Junior doctors' hours are one of the most controversial topics under debate in the health service today. We undertook a detailed postal questionnaire of hospital doctors in training within a major teaching unit in order to assess the awareness and perceived implications of the incipient changes and to elucidate how it was felt these changes would affect both the doctors and patients. The questionnaire focused specifically on the effect of the changes on quality and continuity of patient care, junior training and socio-economic factors relating to the medical staff. The questionnaire was entirely anonymous and carried only the first author name but provision was made to determine current grade, speciality, age, sex and career plans of the respondents. Importantly, space was included at the end for pertinent comments. All junior staff in training in all specialities in the Cardiff area were circulated. Three hundred and twenty-six questionnaires were sent out and 202 were returned of which 192 were properly completed (59%). Almost everyone was au fait with the proposed changes. There was a surprisingly high level of support for changes among non-surgical trainees, and half felt that quality of care would improve, though the more senior the trainee, the less enthusiastic they were in all aspects. Many felt that far too little consultation with junior staff had taken place and there was generalized criticism of general practitioner trainees by their specializing counterparts, partly because of a perceived lack of commitment and partly because of blame of this group for the inception of the changes. Most importantly, there was solid opposition among surgeons in training because of a perceived reduction in patient care, compromise in quality of training and a belief that the system is unworkable [only 9% of registrars and senior registrars and 25% of senior house officers (SHOs) and housemen planning a surgical career were in favour of change]. It is clear that different specialities need to be assessed separately. For example, the requirements for covering a partial shift system for special baby care, or anaesthetics are very different from the on call requirements of dermatology or urology. It is inappropriate to put every speciality under the same umbrella and this should be rethought before the introduction of the 72 h week results in unnecessary but predictable chaos.
Acoustic Rhinometry in Rhinological Practice: Discussion Paper
Authors: Fisher Edward W , Lund Valerie J , Scadding Glenis K 
Published: July 2022

Acoustic rhinometry is a new technique which evaluates nasal obstruction by analysing reflections of a sound pulse introduced via the nostrils. The technique is rapid, reproducible, non-invasive and requires minimal cooperation from the subject. Unlike rhinomanometry it does not require airflow. A graph of nasal cross-sectional area as a function of distance from the nostril is produced, from which several area and volume estimates of the nasal cavity can be derived. The reliability of the method is greatest in the anterior nasal cavity, which is the site of the nasal valve. We have applied the technique to the study of normal nasal physiology in adults and children and to a range of pathological conditions. The role of acoustic rhinometry in diagnosis is somewhat limited compared to nasal endoscopy, but it is useful for nasal challenge and for quantifying nasal obstruction. Monitoring of medical and surgical therapy is a more promising application. In future, acoustic rhinometry is likely to be of particular help in evaluating childhood nasal obstruction, as it is well tolerated by children as young as 3 years old - a group of patients to whom objective tests have hitherto been difficult to apply.
A Comparison of Stress Test Referral Rates and Outcome between Asians and Europeans
Authors: Lear J T , Lawrence I G , Burden A C , Pohl J E F 
Published: July 2022

The Asian population is at greater risk from a myocardial infarction than their European counterparts. Fewer Asians are referred for coronary angiography. We studied referral rates for exercise stress testing following acute myocardial infarction in Asians and Europeans and also examined stress test outcome. A retrospective analysis was performed using hospital activity analysis data, ward admission book and stress test referral forms and reports. There were 962 acute myocardial infarctions with 90% being European. Fewer Asian patients were referred for stress testing (32.3% versus 45%, P>0.001). Asian patients were more likely to have a positive test (42.9% versus 31.3%, P>0.02). Fewer Asian patients completed the test (14.3% versus 31.3%, P>0.001). Possible reasons for the decreased referral rates include communication difficulties and real or perceived poor exercise tolerance. More Asian patients should be referred for stress testing. Interpreters and information leaflets in multiple languages may help achieve this aim.
Risk Factors for HIV Infection Overlooked in Routine Antenatal Care
Authors: Hawken Jennifer , Chard T , Costeloe Kate , Jeffries D J , Hudson C N 
Published: July 2022

We have ascertained the extent to which risk factors for HIV infection may escape detection by standard history-taking procedures in an antenatal clinic. This study was based on 1264 women from a multi-ethnic population in an inner London health district (City and Hackney). All had agreed to undergo attributable HIV testing and a detailed personal interview. Thirty-nine per cent (494 of 1264 women) reported risk factors contributed personally or by a partner. Most of these risk factors had not been earlier disclosed by routine history taking. In most cases the risk was residence and risk activity in a World Health Organization (WHO) Pattern 2 country. [HIV spread WHO categories: Pattern 1—principally homosexual/bisexual males and i.v. drug use (areas=North America, Western Europe, Australasia, parts of South America) with male to female ratio 10/1; Pattern 2—Heterosexual (areas=Sub Saharan Africa, Caribbean and part South America) with male to female 1/1.] Thirty-one subjects (2.4%) were aware that their partners had participated in bisexual activity. Only six subjects perceived themselves at risk through their own or partner's drug injecting activity. The frequency of risk factors was substantially greater than that ascertained by the routine history. The findings highlight the potential risk of heterosexual spread resulting from travel to or residence in high prevalence territories. The contribution by male partners is significant and is particularly difficult to detect during a routine interview. These data support the recommendation that voluntary HIV serum testing should be universal rather than a selective offer based on risk factors determined at a routine history.
Epidural Anaesthesia and Urinary Dysfunction: The Risks in Total Hip Replacement
Authors: Williams A , Price N , Willett K 
Published: July 2022

Epidural anaesthesia in total hip replacement is an established and safe practice. It may be used alone or in combination with general anaesthesia for analgesia. Urethral catheterization in the perioperative period is known to greatly increase the complication of deep sepsis following total hip replacement. We assessed the effect on the incidence of urinary catheterization of using bupivocaine epidural anaesthesia in addition to general anaesthesia in total hip replacement. A prospective study was made of 113 total hip replacements. The incidence of catheterization in male patients who received an epidural was 67% compared to only 12% who had no epidural [ P=0.001]. In women the corresponding rates were 30% and 23%. We conclude that in men the use of supplementary epidural anaesthesia with bupivocaine is associated with a worrying increased need for urinary catheterization. This must be balanced against the claimed benefits of this form of anaesthesia.
Development and Characteristics of Hearing Loss With the Progression of Endolymphatic Hydrops
Authors: Niu Yue , Chen Wei , Lin Mengyan , Sha Yan 
Published: July 2022

Objectives This study aims to explore how patients’ hearing loss developed with the progression of endolymphatic hydrops and the characteristics of hearing loss at different stages. Materials and Methods We collected 73 patients with definite or possible unilateral Meniere’s disease or sudden hearing loss who underwent magnetic resonance imaging after intravenous contrast agent injection. There were 25 cases of isolated cochlear hydrops, 24 cases of isolated vestibular hydrops, and 24 cases of cochlear and vestibular hydrops. Primary outcome analyses included their evaluation of endolymphatic hydrops and hearing thresholds at low and high frequencies. Results The overall hearing threshold of patients with vestibular and cochlear hydrops was significantly higher than that of patients with isolated cochlear hydrops and patients with isolated vestibular hydrops. There was a significant correlation between low-frequency hearing loss and cochlear hydrops, and the low-frequency hearing threshold was proportional to the grade of cochlear hydrops. At low frequency, the hearing threshold of patients with isolated vestibular hydrops was lower than that of patients with isolated cochlear hydrops and patients with both cochlear and vestibular hydrops. The audiogram configurations of patients with isolated cochlear hydrops consist largely of flat type and up-sloping type. The audiogram configurations of patients with isolated vestibular hydrops and patients with both cochlear and vestibular hydrops are mainly flat type and down-sloping type. Conclusions Patients present with low-frequency hearing loss in the early stage of endolymphatic hydrops. When the hydrops involves the whole cochlea and vestibule, the patients’ hearing is impaired at both low and high frequencies.
A large-scale study of patients with preoperative vocal cord paralysis associated with thyroid disease and related clinicopathological features
Authors: Li Wen-Hua , Zheng Wei-Hui , Zhao Jian-Qiang , Wang Ke-Jing , Han Chun 
Published: July 2022

Background The performance of thyroidectomies has been increasing over the last decade due to the growing prevalence of thyroid diseases. The purpose of this study was to investigate the clinical significance of preoperative vocal cord paralysis (VCP) associated with thyroid disease and other incidences of malignant or benign lesions, as well as different thyroid pathological features. Additionally, the epidemiological changes of thyroid diseases with preoperative VCP were investigated. Methods Ninety-nine out of 12,530 patients with preoperative VCP who had undergone thyroid surgery for various diseases in the Zhejiang Cancer Hospital from January 2007 to December 2015 were identified. Their clinicopathological data was recorded and case distributions from different years and intraoperative recurrent laryngeal nerve statuses were retrospectively analyzed. Results The incidence of preoperative VCP in 2007 was reported to be 1.53% (9/590) and had decreased to 0.53% (12/2,247) by 2015 ( P < 0.05). Among the 99 patients with preoperative VCP, 81 had malignancies (81.82%), while 18 (18.18%) had benign thyroid diseases. The incidences of preoperative VCP in malignant and benign diseases were 1.13% (81/7,159) and 0.35% (18/5,371), respectively ( P < 0.05). There were only 5 (0.04%, 5/12,530) cases of papillary thyroid microcarcinoma with preoperative VCP. There was no statistical difference between the incidence of preoperative hoarseness in malignant 69.14% (56/81) and benign diseases 61.11% (11/18) with preoperative VCP. Conclusions The preoperative VCP incidence rate had gradually decreased with an increased proportion of papillary thyroid cancer. Preoperative voice symptoms do not necessarily suggest a malignancy. Selective rather than routine preoperative laryngoscopic examinations should be performed on papillary thyroid microcarcinomas. The probability of preoperative VCP in malignancy was significantly higher than in benign lesions.
How are you getting by? Coping in developmental coordination disorder versus attention-deficit/hyperactivity disorder
Authors: Meachon Emily J , Alpers Georg W 
Published: July 2022

Objective Developmental Coordination Disorder (DCD) and Attention-Deficit/Hyperactivity Disorder (ADHD) persist into adulthood; however, little research exists to describe how adults with DCD and/or ADHD cope with their symptoms. Therefore, the purpose of this study was to investigate coping mechanisms reported by adults with DCD, ADHD, or both conditions. We expected there would be strategies specific to each condition and a broader scope of mechanisms reported by those with co-occurring DCD+ADHD. Method N = 161 participants completed the online survey, including n = 31 with DCD only, n = 116 with ADHD only, and n = 14 with DCD+ADHD. Results Most participants reported adaptive strategies. Of these, behavioral adaptations were most relevant to ADHD, while environmental modifications were common in DCD. Cognitive reframing and social support were similarly relevant to those with DCD and DCD+ADHD. Coping strategy categories were most uniform for the DCD+ADHD group. Conclusions Coping profiles highlight several noteworthy differences between DCD and ADHD which may be relevant for treatment.