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Year of Publication
1.  Knowledge, skills and attitude of evidence-based medicine among obstetrics and gynaecology trainees: a questionnaire survey 
JRSM Short Reports  2013;4(12):2042533313498719.
Objectives
To determine current evidence-based medicine skills and practice among trainees.
Design
Questionnaire study.
Setting
Electronic survey was sent to all obstetrics and gynaecology trainees in East Midlands South Deanery, and responses collected were anonymous.
Participants
All obstetrics and gynaecology trainees in East Midland South Deanery.
Main outcome measures
Self-reported attitude, skills and knowledge in various components of evidence-based medicine.
Results
69 trainees were included in the study of which 35 responded. Among all respondents, almost 72% of trainees use non-evidence-based methods to find answers for their clinical questions, whereas only 18% use appropriate evidence-based medicine practice for such queries. Just 35% of trainees have minimum skills of literature searching. Most of the trainees struggle to understand various components of evidence-based medicine. Nearly 80% of trainees do not have formal education or training with regard to evidence-based medicine.
Conclusions
This study highlights the inadequacy of evidence-based medicine skills among trainees and urges that evidence-based medicine be incorporated in formal training along with specialty study modules.
doi:10.1177/2042533313498719
PMCID: PMC3899731  PMID: 24475342
evidence-based medicine; obstetrics and gynaecology; medical education
2.  Severe inflammatory response and vasculitis leading to quadruple limb amputations 
JRSM Short Reports  2013;4(12):2042533313505510.
Lesson
A systemic inflammatory response causing multi-organ failure and requiring multiple amputations was refractory to all treatments except Anakinra, and the cause remains unclear.
doi:10.1177/2042533313505510
PMCID: PMC3899732  PMID: 24475343
3.  A rare case of submandibular abscess complicated by stroke 
JRSM Short Reports  2013;4(12):2042533313505513.
doi:10.1177/2042533313505513
PMCID: PMC3899733  PMID: 24475344
4.  Are the pituitary gonadotrophins determinants of complete molar pregnancy? An investigation using the method of least squares 
JRSM Short Reports  2013;4(12):2042533313505514.
Objective
To look for a relationship between the maternal age-specific incidence of complete molar pregnancy and the age-specific mid-follicular levels of circulating follicle stimulating hormone and luteinizing hormone.
Design
Calculation of correlation coefficients between the incidence of complete mole and the circulating levels of follicle stimulating hormone and luteinizing hormone using the method of least squares.
Setting
England and Wales.
Participants
All mothers between 23 and 49 years delivering in England and Wales between 2000 and 2009 inclusive and a sample of women between 23 and 49 years from Sheffield (1987).
Main outcome measures
The bivariate correlation coefficients between the incidence of complete mole and the mid-follicular plasma levels of the pituitary gonadotrophins.
Results
Exponential correlation between the incidence of complete mole and mid-follicular plasma follicle stimulating hormone, r = 0.965, r 2 = 0.932.
Linear correlation between the incidence of complete mole and mid-follicular plasma luteinizing hormone, r = 0.972, r 2 = 0.944.
Multivariate exponential regression between the incidence of complete mole and the combination of follicle stimulating and luteinizing hormones. This does not improve the prediction of the incidence of complete mole and it shows that luteinizing hormone is not a significant predictor of the incidence of complete mole in the presence of follicle stimulating hormone.
Conclusions
There is a strong positive exponential correlation between the maternal age-specific incidence of complete mole in England and Wales and the age-related mid-follicular levels of follicle stimulating hormone in a sample of English women.
doi:10.1177/2042533313505514
PMCID: PMC3899734  PMID: 24475345
determinants of complete hydatidiform mole; follicle stimulating hormone; luteinizing hormone
5.  Lumbar puncture, chronic fatigue syndrome and idiopathic intracranial hypertension: a cross-sectional study 
JRSM Short Reports  2013;4(12):2042533313507920.
Objective
Unsuspected idiopathic intracranial hypertension (IIH) is found in a significant minority of patients attending clinics with named headache syndromes, if it is specifically sought out. Chronic fatigue syndrome is frequently associated with headache. Could the same be true of chronic fatigue? Moreover, there are striking similarities between the two conditions. Could they be related? Attempting to answer these questions, we describe the results of a change in clinical practice aimed at capturing patients with chronic fatigue who might have IIH.
Design
Cross-sectional.
Setting
Hospital outpatient and radiology departments.
Participants
Patients attending a specialist clinic with chronic fatigue syndrome and headache who had lumbar puncture to exclude raised intracranial pressure.
Main outcome measures
Intracranial pressure measured at lumbar puncture and the effect on headache of cerebrospinal fluid drainage.
Results
Mean cerebrospinal fluid pressure was 19 cm H2O (range 12–41 cm H2O). Four patients fulfilled the criteria for IIH. Thirteen others did not have pressures high enough to diagnose IIH but still reported an improvement in headache after drainage of cerebrospinal fluid. Some patients also volunteered an improvement in other symptoms, including fatigue. No patient had any clinical signs of raised intracranial pressure.
Conclusions
An unknown, but possibly substantial, minority of patients with chronic fatigue syndrome may actually have IIH. An unknown, but much larger, proportion of patients with chronic fatigue syndrome do not have IIH by current criteria but respond to lumbar puncture in the same way as patients who do. This suggests that the two conditions may be related.
doi:10.1177/2042533313507920
PMCID: PMC3899735  PMID: 24475346
chronic fatigue syndrome; idiopathic intracranial hypertension; headache; lumbar puncture
6.  Examining the practice of generalist expertise: a qualitative study identifying constraints and solutions 
JRSM Short Reports  2013;4(12):2042533313510155.
Objectives
Provision of person-centred generalist care is a core component of quality primary care systems. The World Health Organisation believes that a lack of generalist primary care is contributing to inefficiency, ineffectiveness and inequity in healthcare. In UK primary care, General Practitioners (GPs) are the largest group of practising generalists. Yet GPs fulfil multiple roles and the pressures of delivering these roles along with wider contextual changes create real challenges to generalist practice. Our study aimed to explore GP perceptions of enablers and constraints for expert generalist care, in order to identify what is needed to ensure health systems are designed to support the generalist role.
Design
Qualitative study in General Practice.
Setting
UK primary care.
Main outcome measures
A qualitative study – interviews, surveys and focus groups with GPs and GP trainees. Data collection and analysis was informed by Normalisation Process Theory.
Design and setting
Qualitative study in General Practice. We conducted interviews, surveys and focus groups with GPs and GP trainees based mainly, but not exclusively, in the UK. Data collection and analysis were informed by Normalization Process Theory.
Participants
UK based GPs (interview and surveys); European GP trainees (focus groups).
Results
Our findings highlight key gaps in current training and service design which may limit development and implementation of expert generalist practice (EGP). These include the lack of a consistent and universal understanding of the distinct expertise of EGP, competing priorities inhibiting the delivery of EGP, lack of the consistent development of skills in interpretive practice and a lack of resources for monitoring EGP.
Conclusions
We describe four areas for change: Translating EGP, Priority setting for EGP, Trusting EGP and Identifying the impact of EGP. We outline proposals for work needed in each area to help enhance the expert generalist role.
doi:10.1177/2042533313510155
PMCID: PMC3899736  PMID: 24475347
generalism; generalist practice; normalisation process theory; primary care; generalist expertise
7.  Obesity hypoventilation syndrome in obstructive sleep apnea patients in the United Arab Emirates: a retrospective cross-sectional study 
JRSM Short Reports  2013;4(12):2042533313510156.
Objectives
To estimate the frequency of symptoms of obesity hypoventilation syndrome (OHS) in patients with obstructive sleep apnoea (OSA) and to evaluate comorbidities associated with OHS.
Design
Retrospective study based on patients' medical records and on further sleep tests performed in the study centre during the inclusion visit.
Setting
Respiratory Care Unit and Sleep Disorder Centre of the Zayed Military Hospital United Arab Emirates.
Participants
All patients referred to the study centre for a suspicion of sleep-disordered breathing.
Main outcome measures
Prevalence of OSA and OSA + OHS and comorbidities in patients with OSA and OHS.
Results
A total of 212 adult patients participated in the study. Of these, 107 patients (50.5% [43.8–57.1% CI 95%]) fulfilled diagnostic criteria for OSA, and the majority were men (79.4%). Among patients with OSA, 18 patients (16.8% [10.8–25.1% CI 95%]) fulfilled diagnostic criteria for OHS. In this group, women were more frequently affected than men (31.8% [7/22] vs. 12.9% [11/85], respectively; p = 0.03) and tended to be older than affected men, with a mean age of 55 ± 10.6 years versus 46 ± 13 for men. After adjustment for gender, OHS was significantly associated with hypertension (OR = 3.5; p = 0.03), diabetes mellitus (OR = 4.6; p = 0.02), ischaemic heart disease (OR = 5.1; p = 0.04) and pulmonary hypertension (OR = 16.1; p = 0.001).
Conclusion
OHS is a common condition in obese patients in the UAE and is associated with an increased risk of cardiovascular comorbidities and diabetes.
doi:10.1177/2042533313510156
PMCID: PMC3899737  PMID: 24475348
obesity; Pickwickian syndrome; obstructive sleep apnoea; hyperpnoea syndrome; pulmonary hypertension; obstructive lung disease; restrictive lung disease
8.  Electromagnetic hypersensitivity (EHS) in the media – a qualitative content analysis of Norwegian newspapers 
JRSM Short Reports  2013;4(11):2042533313487332.
Objectives
Electromagnetic hypersensitivity (EHS) is a condition characterized by experiencing symptoms after perceived exposure to weak electromagnetic fields (EMFs). There is substantial debate concerning the aetiology of EHS, but experimental data indicate no association between EHS and actual presence of EMFs. Newspapers play a key role in shaping peoples’ understanding of health-related issues. The aim of this study was to describe the content of newspaper articles concerning aetiology and treatment of EHS.
Design
Qualitative content analysis of newspaper articles.
Setting
Norwegian newspaper articles were identified using a comprehensive electronic media archive.
Participants
Norwegian newspaper articles published between 1 February 2006 and 11 August 2010.
Main outcome measures
Statements coded according to source of information, whether it was pro or con scientific evidence on EHS aetiology, and type of intervention presented as treatment option for EHS.
Results
Of the statements concerning EHS aetiology (n = 196), 35% (n = 69) were categorized as pro evidence, 65% (n = 127) as con evidence. Of the statements about EHS interventions assessed, 78% (n = 99) were categorized as ‘radiance reduction’, 4% (n = 5) as ‘complementary medicine’, and 18% (n = 23) as ‘other’. Cognitive behavioural therapy (CBT) and psychotropic drugs were never presented as possible treatment options for EHS.
Conclusions
The newspaper media discourse of EHS aetiology and recommended treatment interventions is much in conflict with the current evidence in the field. The majority of statements concerning aetiology convey that EHS is related to the presence of weak EMFs, and radiance reduction as the most frequently conveyed measure to reduce EHS-related symptoms.
doi:10.1177/2042533313487332
PMCID: PMC3831852  PMID: 24319582
electromagnetic hypersensitivity; EHS; media; newspapers; qualitative content analysis
9.  Increasing patients’ ability to identify their physicians with a photo album: a prospective study 
JRSM Short Reports  2013;4(11):2042533313493270.
Objectives
Patients in teaching hospitals often encounter difficulty in correctly identifying their physicians. We hypothesized that a photo album of physicians might increase the ability of patients to correctly identify their physicians and hence conducted this study to test the hypothesis.
Design
A prospective study was conducted.
Setting
Department of Surgery, The Third XiangYa Hospital.
Participants
The patients were divided into two groups on admission: group A as intervention group (n = 75) and group B as control group (n = 94). All the patients were verbally informed of their medical team but only the patients in group A (the intervention group) were also shown the photos of their medical team.
Main outcome measures
One day before being discharged, the patients in group A (the intervention group) were asked to return the photo albums, and all the patients from both groups were asked to give the names of their caring physicians prior to departure from the hospital.
Results
Only 53% of the patients (50 out of 94) in group B (the control group) could give at least one of their physicians’ name, while 85% of the patients (64 out of 75) in group A (the intervention group) could tell at least one of their physicians’ name; there is a significant difference (p < 0.005, 95% CI, 17.4–44.7%).
Conclusion
Patients’ ability to identify their physicians can be significantly increased with a photo album.
doi:10.1177/2042533313493270
PMCID: PMC3831853  PMID: 24319583
quality improvement; medical management
10.  Beyond a prolonged QT interval 
JRSM Short Reports  2013;4(11):2042533313494376.
doi:10.1177/2042533313494376
PMCID: PMC3831854  PMID: 24319584
12.  Atypical anaphylaxis using ‘dual technique’ during sentinel lymph node biopsy 
JRSM Short Reports  2013;4(11):2042533313497710.
doi:10.1177/2042533313497710
PMCID: PMC3831856  PMID: 24319586
13.  Bilateral patellar tendon rupture 
JRSM Short Reports  2013;4(11):2042533313499557.
doi:10.1177/2042533313499557
PMCID: PMC3831857  PMID: 24319587
14.  Retropharyngeal abscess in a six-week-old child: an approach to management 
JRSM Short Reports  2013;4(11):2042533313499558.
doi:10.1177/2042533313499558
PMCID: PMC3831858  PMID: 24319588
15.  In vitro neuraotropic growth of cholangiocarcinoma: an experimental study 
JRSM Short Reports  2013;4(10):2042533313476690.
Summary
Objective
Perineural invasion of cholangiocarcinoma happens in the early stage of the disease but is often not recognized until its later stages. Research about the behaviour and mechanism of perineural invasion by cholangiocarcinoma is urgently needed for a useful new model. The aim of this work is to establish a novel model to address the problem.
Design
Neural cells and cholangiocarcinoma cells were co-cultured to mimic the neurotropic invasion of cholangiocarcinoma.
Setting
Human embryonic stem cells were induced to form neural cells by glial cell-derived neurotropic factor and retinoic acid; neural cells and cholangiocarcinoma cells were co-cultured in Transwell chamber.
Participants
Human embryonic stem cells and cholangiocarcinoma cells were applied.
Main outcome measures
Paired t-test was used to compare the counts of penetrating cholangiocarcinoma cells in co-culture and control group.
Results
Formation of neurospheres and neural-like cells were observed following induction at 24 and 48 h, respectively; synapses were viewed to protrude from neural-like cell bodies after incubation for 96 h. Forty-eight hours after incubation, immunocytochemical staining of the cells showed that synaptophysin and glial fibrillary acidic protein were expressed in the neuron-like cells and gliocytes-like cells, respectively. The cholangiocarcinoma cells that had penetrated through the Matrigel/polyethylene terephthalate membrane from the upper chamber to the lower chamber of the Transwell in the co-culture group were significantly more numerous than those in the control group (68 ± 8.3/field versus 46 ± 5.7/field, P < 0.05).
Conclusion
The novel model is a valuable tool to study the perineural invasion of cholangiocarcinoma.
doi:10.1177/2042533313476690
PMCID: PMC3831859  PMID: 24319575
16.  Right lower lobectomy following inhalation of a toy traffic cone 
JRSM Short Reports  2013;4(10):2042533313476699.
doi:10.1177/2042533313476699
PMCID: PMC3831860  PMID: 24319576
17.  Histological evaluation of retrieved Copeland re-surfacing shoulder arthroplasties 
JRSM Short Reports  2013;4(10):2042533313478003.
doi:10.1177/2042533313478003
PMCID: PMC3831861  PMID: 24319577
18.  Distribution of breast cancer subtypes among Jordanian women and correlation with histopathological grade: molecular subclassification study 
JRSM Short Reports  2013;4(10):2042533313490516.
Objective
To evaluate the hormone receptor status and human epidermal growth factor receptor 2 (HER2)/neu gene expression among Jordanian women with breast cancer. To classify our patients into molecular subtypes and to correlate the results with age of the patients and tumour grade.
Design
Evaluation of estrogen receptor (ER), PR and HER2/neu was done by standard immunohistochemical technique and subclassification into molecular subtypes.
Setting
Jordan University Hospital, Amman, Jordan.
Participants
One hundred and ninety-three cases of breast cancer diagnosed at Jordan University Hospital.
Main outcome measures
Molecular subtypes of breast cancer, age and tumour grade.
Results
All the cases were divided into two groups: the young age group less or equal 50 years of age and the older age group more than 50 years of age. The cases were subclassified into luminal A, luminal B, basal cell like (BCL) and Her2/neu+. In older age group, the most common subtype was luminal A (72%). In this age group, most of the cases (48%) were of grade II. In younger age group, 47% of the cases were of luminal A subclass. In this age group, 42% were of grade I.
Conclusions
Molecular subtyping of breast cancer is an essential predicting factor of tumour response to hormonal therapy. This fact puts increased stress on the urgent need for the development of reliable and reproducible classification systems.
doi:10.1177/2042533313490516
PMCID: PMC3831862  PMID: 24319578
19.  The challenges of obtaining ethics approval for a randomized, double-blind, placebo-controlled research study in Jersey 
JRSM Short Reports  2013;4(10):2042533313492513.
Background and objective
A PhD project involving designing and implementing a small-scale clinical trial at Jersey General Hospital encountered a variety of difficulties in obtaining ethics approval due to Jersey’s unique legal and constitutional position. Clarification of the necessary route of application took some 28 months. It was established that only local ethics approval is required for clinical trials taking place in the Channel Islands and that there is no need for Medicines and Healthcare products Regulatory Agency (MHRA) approval in the form of Clinical Trials Authorization (CTA), because Jersey falls outside the existing legal and regulatory framework. The experiences and findings gained from this project would prove of use to other researchers planning to conduct clinical trials in the Channel Islands.
doi:10.1177/2042533313492513
PMCID: PMC3831863  PMID: 24319579
20.  Relative age effect on Nobel laureates in the UK 
JRSM Short Reports  2013;4(10):2042533313492514.
doi:10.1177/2042533313492514
PMCID: PMC3831864  PMID: 24319580
21.  How distressing is it to participate in medical research? A calibration study using an everyday events questionnaire 
JRSM Short Reports  2013;4(10):2042533313493271.
Objectives
To investigate how distressing participating in medical research is perceived to be, compared to everyday events.
Design
Anonymous questionnaire.
Setting
Scotland and New Zealand.
Participants
One hundred members of the Scottish general public, 94 University of Auckland students, 22 New Zealand Ministry of Health ethics committee members.
Main outcome measures
Distress ratings made on a 0–10 scale for everyday events and common medical research procedures.
Results
Both general population and student samples generally rated the distress caused by participating in various medical research procedures as low or very low. Most research procedures were rated less than the distress caused by not being able to find a car park at a supermarket. In contrast, the ethics committee members rated the distress caused by most of the medical research procedures at a significantly higher level than the ratings of the student and general population samples. Ethics committee members overestimated the distress caused by interview or questionnaire assessments (M = 203.31%, SE = 11.42, 95% CI [179.79, 226.83]) more than medical testing for research (M = 158.06%, SE = 12.33, 95% CI [132.66, 183.46], p = 0.04) and everyday events (M = 133.10%, SE = 7.80, 95% CI [117.03, 149.16], p < 0.001).
Conclusions
Common medical research procedures are not rated as particularly distressing by the general public, and ethics committees may be adopting an over-protective role when evaluating research applications that involve the use of questionnaire or survey methodology.
doi:10.1177/2042533313493271
PMCID: PMC3831865  PMID: 24319581
23.  Avastin and Lucentis: what do patients know? A prospective questionnaire survey 
JRSM Short Reports  2013;4(9):2042533313484146.
Objectives
To assess patients’ knowledge of their drug therapy for neovascular macular degeneration and to identify which aspects of the drug they considered most important if given the option of switching to an alternative drug.
Design
Prospective questionnaire survey.
Setting
Wolverhampton, England.
Participants
A total of 126 patients attending our hospital service for intravitreal ranibizumab therapy for neovascular macular degeneration.
Main outcome measures
Using a questionnaire, patients were asked questions pertaining to aspects of drug therapy in neovascular macular degeneration. Fields covered included drug names, knowledge of alternative drugs, cost of drugs and their views on switching to another drug.
Results
Eighty (63.5%) had heard of Lucentis (ranibizumab) and 31 (24.6%) were aware of Avastin (bevacizumab). Of the latter 31 patients, 20 did not have a preference between Avastin and Lucentis. These patients felt that the factors they would consider important for them to consider switching were effectiveness (10, 50%), specialist recommendation (8, 40%), safety (2, 10%) and cost (0).
Conclusions
Introducing a cheaper, off-label alternative in the therapy of macular degeneration in the presence of a licensed option has been extensively debated. Many patients have no knowledge of this controversial issue but it is likely that efficacy and recommendation by clinicians are more important than cost to patients who may consider switching to the off-label Avastin.
doi:10.1177/2042533313484146
PMCID: PMC3767069  PMID: 24040500
24.  An important diagnosis to consider in recurrent meningitis 
JRSM Short Reports  2013;4(9):2042533313486640.
doi:10.1177/2042533313486640
PMCID: PMC3767070  PMID: 24040501

Results 1-25 (331)