Description

IJCP publishes high-calibre, timely, clinically focused material for a global general medical audience, including original data from clinical investigations plus educational review and discussion of related and otherwise topical clinical concerns. IJCP supplements focus on advances in clinical medicine, highlighting evidence and delivering practical insight and objective analysis. IJCP and IJCP supplements offer rapid peer review and publication, provide the highest standards of author service, and are widely indexed.

Publisher details

Blackwell Publishing

Publications in this journal

• Differences in Physician Attitudes Towards Patient-Centredness: Across Four Medical Specialties

  Authors: Caryn Chan Mei Hsien, Wan Azman Wan Ahmad

  International Journal of Clinical Practice.

• Epidemiology of chronic Chikungunya rheumatism in south India: a population-based study

  Authors: Mathew AJ, Goyal V, George E, Thekkemuriyil DV, Bhaskaran Nair J, Chopra A

  International Journal of Clinical Practice. 65.

• Response to Teeuwen et al. 'Doppler-guided intra-operative fluid management during major abdominal surgery: a systematic review and meta-analysis'

  Authors: S R Walsh, T Y Tang, S Bass, M E Gaunt

  International journal of clinical practice. 62(4):649-650.

• The relationship between serum copper and ceruloplasmin in routine clinical practice.

  Authors: P J Twomey, T M Reynolds, A S Wierzbicki, A Viljoen

  International journal of clinical practice. 62(3):485-7.

  INTRODUCTION: The biochemical assessment of copper status is not easy when investigating deficient and excess states. Most clinicians request copper and ceruloplasmin and assume that the resultsINTRODUCTION: The biochemical assessment of copper status is not easy when investigating deficient and excess states. Most clinicians request copper and ceruloplasmin and assume that the results provided by their local laboratory are comparable with data in the literature. AIMS AND METHODS: We decided to obtain paired copper and ceruloplasmin values retrospectively from the laboratory information systems from three different hospital laboratories to see how the relationships compared. Descriptive statistics and the relationship between caeruloplasmin and copper were obtained. RESULTS: Our data shows differences in the relationship (slope, intercept and correlation co-efficient) between copper and ceruloplasmin; this is especially the case at the clinical cut-off of a ceruloplasmin concentration of 200 mg/l. CONCLUSION: Differing methods or populations may be contributing to the differences between the data sets. We therefore recommend that local cut-offs are derived for the investigation of copper deficiency and excess states.

• Unravelling the mystery of 'cautious fluids'.

  Authors: Benjamin Reddi

  International journal of clinical practice. 62(3):498-9.

• Pharmacopolitics, statin switching and therapeutic substitution: much ado about something.

  Authors: R Minhas, R G Bogle, K C R Patel, J C Moon

  International journal of clinical practice. 62(3):354-5.

• Fragility fractures in older patients: reducing the risk.

  Authors: Laura Lowe Tosi

  International journal of clinical practice. 62(3):357-8.

• Oversensitive dipsticks? A minimalist take on urinalysis for microscopic haematuria.

  Authors: P A Andrews

  International journal of clinical practice. 62(3):362-3.

• Cardiovascular outcomes among sildenafil users: results of the International Men's Health Study.

  Authors: M A Mittleman, M Maclure, M A Lewis, G C Hall, N Moore, F Giuliano, H Porst, H Hedelin, A Martin-Morales, R E Sobel, R Reynolds, D B Glasser

  International journal of clinical practice. 62(3):367-73.

  AIM: To assess the incidence of serious cardiovascular disease (CVD) events [i.e. myocardial infarction (MI) and stroke] and all-cause mortality in men with erectile dysfunction (ED) who receivedAIM: To assess the incidence of serious cardiovascular disease (CVD) events [i.e. myocardial infarction (MI) and stroke] and all-cause mortality in men with erectile dysfunction (ED) who received prescriptions for sildenafil. METHODS: The International Men's Health Study (IMHS) was a prospective, observational cohort study of patients with ED and a new or existing prescription for sildenafil. Baseline and follow-up questionnaires provided information on demographics, CVD risk factors and ED. Postevent questionnaires were mailed to patients following possible nonfatal CVD events to collect information related to exposure to sildenafil/ED treatments before the event. RESULTS: Thirty-five CVD events were reported in 30 patients in the analysis set (n = 3813). The incidence of all-cause mortality, MI and stroke was 0.4, 0.6 and 0.1 per 100 patient-years of observation respectively. Among the six men who reported using sildenafil in the month before a nonfatal CVD event, two reported use in the 24 h before the event. CONCLUSION: The results of the IMHS support previous reports that ED and CVD are often comorbid and share risk factors.

• Comparison of intermittent and continuous intra-abdominal pressure monitoring using an in vitro model.

  Authors: P B McBeth, I Zengerink, D Zygun, K Ranson, I Anderson, R N Lall, A W Kirkpatrick

  International journal of clinical practice. 62(3):400-5.

  INTRODUCTION: Intra-abdominal pressure (IAP) is increasingly being considered as an important physiologic parameter to be measured in critically ill patients. Traditional methods of monitoring IAPINTRODUCTION: Intra-abdominal pressure (IAP) is increasingly being considered as an important physiologic parameter to be measured in critically ill patients. Traditional methods of monitoring IAP rely on intermittent IAP (IIAP) measurements using indwelling bladder catheters. Recently, a method of continuous IAP (CIAP) monitoring has been developed using a three-way bladder catheter. This study evaluates the reliability of IIAP and CIAP measurement techniques using an in vitro model. METHODS: An in vitro model of the abdomen was constructed using a 50 l container with a 100 ml infusion bag at the base to simulate a bladder. A three-way catheter tip was centered within the infusion bag filled with 50 ml saline. To simulate IAP the container was filled with water at 5 cm H(2)O increments from 10 to 25 cm H(2)O. Pressures were recorded by observers from a bedside monitor interfaced with a three-way Foley catheter using alternating intermittent and continuous techniques. Each subject was blinded to the known pressure values. Descriptive statistics and a generalised estimating equation (GEE) was used to describe the relationship of IIAP and CIAP to known pressures. RESULTS: One hundred and thirty-two (132) observations were made by 20 subjects for both IIAP and CIAP estimates. In 45.5% of IIAP measures, the estimate was correct, and it was never more than 1 cm H(2)O different from the actual. Similarly, in 38.6% of CIAP measures, the estimate was correct, and was never more than 2 cm H(2)O from the actual. The GEE regression coefficients comparing known pressures with IIAP and CIAP were 1.007 and 0.976 respectively. The minimum and maximum pressure deviations never exceeded more than 1.3 cm H(2)O from the actual. CONCLUSION: Intermittent IAP and CIAP are both reliable and reproducible methods to measure IAP in an in vitro model. There exists a direct and significant association between both measurements and the actual value. Neither measure was shown to be superior.

• KADIAN (morphine sulfate extended-release) capsules for treatment of chronic, moderate-to-severe, nonmalignant pain.

  Authors: E L Ross, K Hahn

  International journal of clinical practice. 62(3):471-9.

  Chronic pain, one of the most common reasons for which patients seek medical attention, is defined as pain that persists beyond the normal healing time, usually about 3 months. Chronic pain can beChronic pain, one of the most common reasons for which patients seek medical attention, is defined as pain that persists beyond the normal healing time, usually about 3 months. Chronic pain can be malignant or nonmalignant in origin, or can appear in the absence of identifiable pathology. Pharmacological treatment options include non-opioid and opioid analgesics, as well as adjuvant medications. Opioids, the most potent analgesics, are typically reserved for the treatment of chronic, moderate-to-severe pain that has not responded to non-opioid therapy. Morphine remains the gold standard among commonly used opioids. Long-acting opioids are formulated to offer continuous delivery of analgesia around the clock. These agents are formulated to maintain therapeutic blood levels of morphine, with minimal fluctuations. KADIAN Capsules, which contain polymer-coated extended-release morphine sulfate pellets, is one such formulation available for the treatment of moderate-to-severe pain for which an analgesic is indicated for more than a few days. This article reviews KADIAN and identifies unique features from early pharmacokinetic and pharmacodynamic studies, recent data on pharmacokinetic interactions with alcohol and results from recent trials in treating nonmalignant pain.

• Successful thrombolysis of a symptomatic neonatal aortic thrombosis associated with hypernatraemic dehydration--case report and literature review.

  Authors: J P Morales, T Sabharwal, S M Tibby, K G Burnand

  International journal of clinical practice. 62(3):502-5.

• How do patients with urinary incontinence perceive care given by their general practitioner? A cross-sectional study.

  Authors: P Albers-Heitner, B Berghmans, F Nieman, T Lagro-Janssen, R Winkens

  International journal of clinical practice. 62(3):508-15.

  BACKGROUND: Urinary incontinence (UI) is a widespread problem, affecting quality of life and leading to high costs, mainly caused by incontinence pads. It seems that, despite guidelines, many UIBACKGROUND: Urinary incontinence (UI) is a widespread problem, affecting quality of life and leading to high costs, mainly caused by incontinence pads. It seems that, despite guidelines, many UI patients get pads from their general practitioner (GP) without adequate diagnostics or treatment. OBJECTIVES: To assess what further treatment UI patients receive from their GP next to pads and to measure patient satisfaction with care. METHODS: A postal survey among UI patients who started pad use in the past 12 months. MAIN OUTCOME: Satisfaction with UI care. Results: We analysed 208 questionnaires. 29.3% of pad users had no direct contact with their GP for a pad prescription. Of 147 UI patients who visited their GP 50.3% only got pads. 25% of patients was not satisfied with the information on UI received from their GP, especially younger patients, women, less healthy patients and patients with urgency UI. CONCLUSIONS: Dutch UI patients using pads experience suboptimal GP care and management. Factors identified through patient feedback should be used to improve quality of care for UI in primary care.

• New insights into the link between cardiovascular disease and depression.

  Authors: S A Mosovich, R T Boone, A Reichenberg, S Bansilal, J Shaffer, K Dahlman, P D Harvey, M E Farkouh

  International journal of clinical practice. 62(3):423-32.

  INTRODUCTION: Although the association between depression and cardiovascular disease (CVD) is well documented, the underlying mechanisms for this relationship remain unclear. In this paper, weINTRODUCTION: Although the association between depression and cardiovascular disease (CVD) is well documented, the underlying mechanisms for this relationship remain unclear. In this paper, we present three possible models which account for the comorbidity between depression and cardiovascular disease. MODELS: The first model outlines depression as a risk factor for CVD and the second model presents CVD as a risk factor for depression. The third model proposes a common underlying pathway related to the effects of chronic stress on the body in manifesting as depression or cardiovascular disease. CONCLUSIONS: If the proposed model holds true, it may be possible that an intervention initiated before overt manifestations of CVD or depression become apparent, may delay or prevent the onset of these serious clinical entities.

• NSAIDs and breast cancer: a possible prevention and treatment strategy.

  Authors: A Agrawal, I S Fentiman

  International journal of clinical practice. 62(3):444-9.

  CONTEXT: Non-steroidal anti-inflammatory drugs (NSAIDs) inhibit cyclooxygenase (COX) and thereby reduce prostaglandin synthesis. Abnormally upregulated COX and prostaglandins are features of breastCONTEXT: Non-steroidal anti-inflammatory drugs (NSAIDs) inhibit cyclooxygenase (COX) and thereby reduce prostaglandin synthesis. Abnormally upregulated COX and prostaglandins are features of breast cancer so NSAIDs might have a role in treatment and prevention of the disease. OBJECTIVE: To review the available epidemiological data on the relation between NSAIDs and risk of breast cancer together with interventional studies in established disease. RESULTS: Both case-control and cohort studies indicate a moderate reduction in risk of breast cancer among women taking NSAID particularly aspirin. There may be a reduction in oestrogen receptor positive tumours in aspirin users but results are heterogeneous. It is not possible to estimate the dose-response effect for duration of use. In patients with breast cancer, aspirin increased levels of serum nitric oxide (NO) and maspin both of which inhibit growth of breast cancer cells in vitro. Furthermore, a reduced breast cancer and all-cause mortality has been reported in those taking NSAIDs after diagnosis. The cyclooxygenase 2 (COX-2) inhibitor celecoxib showed promising preliminary efficacy and acceptability in combination with exemestane in advanced breast cancer although cardiotoxicity led to discontinuation of celecoxib in a prevention trial for individuals with colonic polyps. CONCLUSIONS: NSAIDs may reduce breast cancer risk by 20% but the optimal type, dose and duration is still undetermined together with the feasibility of such an intervention in an at risk population. There may be a role for NSAIDs in combination with endocrine therapies as either an adjuvant or palliative treatment for women with established breast cancer.

• Secondary prevention of fragility fractures by orthopaedic teams in the UK: a national survey.

  Authors: J Chakravarthy, A Ali, S Iyengar, K Porter

  International journal of clinical practice. 62(3):382-7.

  OBJECTIVE: To assess secondary prevention of fragility fractures by orthopaedic surgeons in the UK and study the effect of multidisciplinary approach in providing secondary prevention. METHODS: AOBJECTIVE: To assess secondary prevention of fragility fractures by orthopaedic surgeons in the UK and study the effect of multidisciplinary approach in providing secondary prevention. METHODS: A survey was conducted consisting of a postal questionnaire sent to 1000 UK orthopaedic surgeons. 750 valid responses were received. RESULTS: The survey revealed poor compliance with existing guidelines. In the 60- to 80-year age group, the presence of a fracture liaison nurse made a significant difference in the prescription of vitamin D and calcium, providing weight bearing advice, fall risk assessment and dual energy x-ray absorptiometry (DEXA) scan requests. Orthogeriatric service made a significant difference in providing weight bearing advice and DEXA scan requests. In the above 80-year age group, fracture liaison nurses made a significant difference in provision of fall risk assessment and weight bearing advice. Orthogeriatric services made a significant difference in prescribing vitamin D and calcium, providing weight bearing advice and for DEXA scan requests. CONCLUSION: The study re-emphasises the inadequate initiation of secondary preventive measures by orthopaedic units. It also highlights the importance of orthogeriatric and fracture liaison nurse services in improving compliance with existing guidelines.

• Refeeding syndrome in cancer patients.

  Authors: M A Marinella

  International journal of clinical practice. 62(3):460-5.

  BACKGROUND: Refeeding syndrome (RFS) is a common, yet underappreciated, constellation of electrolyte derangements that typically occurs in acutely ill, malnourished hospitalised patients who areBACKGROUND: Refeeding syndrome (RFS) is a common, yet underappreciated, constellation of electrolyte derangements that typically occurs in acutely ill, malnourished hospitalised patients who are administered glucose solutions or other forms of intravenous or enteral nutrition. DISCUSSION: The hallmark of RFS is hypophosphataemia, but hypokalaemia and hypomagnesaemia are also common. Patients with various types of malignancies are at-risk for RFS, but very little exists in the oncologic literature about this disorder. CONCLUSIONS: As RFS can have many adverse metabolic, cardiovascular, haematologic and neurologic complications, practicing oncologist needs to be aware of the pathophysiology, risk factors and clinical manifestations to promptly recognise this important, and potentially fatal, metabolic disorder.

• Chronic stable angina--revised guidelines from the American College of Cardiology and American Heart Association.

  Authors: G Jackson

  International journal of clinical practice. 62(3):353.

• Cardiovascular disease and depression: the PUFA connection.

  Authors: B K Puri

  International journal of clinical practice. 62(3):355-7.

• Continuous intra-abdominal pressure monitoring: this is the way to go!

  Authors: M L N G Malbrain, I De laet, J J De Waele

  International journal of clinical practice. 62(3):359-62.

• Creating a more productive, clutter-free, paperless office: a primer on scanning, storage and searching of PDF documents on personal computers.

  Authors: L Citrome

  International journal of clinical practice. 62(3):363-6.

• Osteosclerotic secondaries from oesophageal carcinoma mimicking a primary bone tumour: a case report and literature review.

  Authors: S R Annapureddy, A Smith, W Martin, G J Charnley

  International journal of clinical practice. 62(3):500-2.

• Implantable cardioverter defibrillator shocks induced by showering.

  Authors: P Spurrell, N Patel, N Sulke

  International journal of clinical practice. 62(3):505-7.

• Faecal screening of colorectal cancer.

  Authors: A Loganayagam

  International journal of clinical practice. 62(3):454-9.

  AIMS: Screening and prevention of colorectal cancer (CRC) is a public health priority. Recent progress in understanding the biology of CRC has lead to possible new approaches to screening. InAIMS: Screening and prevention of colorectal cancer (CRC) is a public health priority. Recent progress in understanding the biology of CRC has lead to possible new approaches to screening. In particular, assay of faecal molecular markers represents a promising non-invasive approach to screening, with improved safety, accuracy and patient compliance. METHODS: MEDLINE/PubMed searches were used to identify key articles relating to faecal-based screening with secondary review of cited publications. RESULTS: Faecal markers of CRC can be broadly divided into DNA based and non-DNA based. CONCLUSIONS: Faecal occult blood testing for CRC screening has been advocated for decades for its non-invasiveness and low cost. It has exhibited a 15-33% decrease in mortality, despite drawbacks with sensitivity and compliance. Other non-DNA markers have the adequate sensitivity for inflammatory lesions but do not have the required specificity for screening average-risk populations. Faecal DNA testing has the potential to enhance the performance characteristics of stool testing. Because of molecular heterogeneity of cancer, no single DNA marker has yielded adequate sensitivity. Analysis of several combinations of markers in studies have produced high detection rates of both CRC and advanced adenomas in selected patient groups. However, the currently available markers, both non-DNA and DNA, have not yet been validated in large-scale studies screening average -risk population nor have they so far shown the necessary sensitivity and specificity required for large-scale screening programmes. Another major drawback with the DNA-based markers is the cost-effectiveness. Issues regarding implementation and compliance remain unanswered. These critical problems have to be rectified before these techniques can be recommended for large-scale CRC screening.

• Effectiveness of oral and intravenous iron therapy in haemodialysis patients.

  Authors: C-C Jenq, Y-C Tian, H-H Wu, P-Y Hsu, J Y Huang, Y C Chen, J T Fang, C W Yang

  International journal of clinical practice. 62(3):416-22.

  Anaemia is a common and serious complication in patients with end-stage renal disease. Iron therapy is crucial in managing anaemia and maintenance of haemodialysis (HD) patients. This studyAnaemia is a common and serious complication in patients with end-stage renal disease. Iron therapy is crucial in managing anaemia and maintenance of haemodialysis (HD) patients. This study investigated the efficacy of both oral and intravenous (i.v.) therapies, and the possible factors deleteriously affecting patient response to iron therapy. Forty patients on maintenance HD from a single institution were enrolled in this 6-month retrospective study. Group I (n = 20) received i.v. two ampoules of atofen (ferric chloride hexahydrate 193.6 mg) per week for a total of 6 weeks (total dosage, 960 mg). Group II (n = 20) received oral ferrous sulphate S.C. Tab (ferrous sulphate 324 mg) one pill three times daily (total dosage, 63,000 mg). Patients whose haematocrit (Hct) level increased at minimum 3% within the period were classified as responders. Iron i.v. ferric chloride (960 mg) was more effective than oral ferrous sulphate (63,000 mg) in correcting anaemia in HD patients with iron deficiency. In group I, serum triglyceride (TG) levels were significantly lower in patients responding to i.v. iron therapy than in patients with no response. In group II, serum high-sensitive C-reactive protein (hs-CRP) level was significantly lower in patients responding to oral iron therapy than patients with no response. The i.v. ferric chloride is more effective than oral ferrous sulphate in treating anaemia in HD patients with iron deficiency. Serum hs-CRP and TG levels may be parameters for predicting hyporesponsiveness to oral and i.v. iron therapies, respectively.

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