bluuebunny/crossref_metadata_2025 huggingface dataset:
The clinical characteristics of DSM‐IV bipolar I and II disorders: baseline findings from the Jorvi Bipolar Study (JoBS)
Authors: Mantere Outi , Suominen Kirsi , Leppämäki Sami , Valtonen Hanna , Arvilommi Petri , Isometsä Erkki
Published: September 2004

Objective:  To obtain a comprehensive view of the clinical epidemiology of bipolar I and II disorder in secondary‐level psychiatric settings.

Methods:  In the Jorvi Bipolar Study (JoBS), 1630 non‐schizophrenic psychiatric in‐ and outpatients in three Finnish cities were screened for bipolar I and II disorders with the Mood Disorder Questionnaire. Diagnoses were made using semistructured SCID‐I and ‐II interviews. Information collected included clinical history, current episode, symptom status, and other characteristics.

Results:  A total of 191 patients with bipolar disorder (90 bipolar I and 101 bipolar II) were included in the JoBS. The majority of bipolar II (50.5%) and many bipolar I (25.6%) patients were previously undiagnosed; the remainder had a median 7.8 years delay from first episode to diagnosis. Despite several lifetime episodes, 26 and 58% of bipolar I and II patients, respectively, had never been hospitalized. A polyphasic episode was current in 51.3%, rapid cycling in 32.5%, and psychotic symptoms in 16.2% of patients. Mixed episodes occurred in 16.7% of bipolar I, and depressive mixed states in 25.7% of bipolar II patients.

Conclusion:  Even in psychiatric settings, bipolar disorders usually go undetected, or recognized only after a long delay. A significant proportion of not only bipolar II, but also bipolar I patients are never hospitalized. Polyphasic episodes and rapid cycling are prevalent in both types. Depressive mixed states are at least as common among bipolar II patients as mixed episodes among bipolar I.
Acute treatment of bipolar depression with adjunctive zonisamide: a retrospective chart review
Authors: Baldassano Claudia F , Nassir Ghaemi S , Chang Alice , Lyman Alan , Lipari Melissa
Published: September 2004

Background:  This retrospective chart review evaluated the use of zonisamide as adjunctive treatment in patients with bipolar depression.

Method:  The charts of outpatients with bipolar I or II disorder treated with adjunctive zonisamide were reviewed. The efficacy of zonisamide was assessed via comparison of physician‐rated Global Assessment of Functioning (GAF) and Clinical Global Impression of Severity (CGI‐S) Scale scores at baseline and after 6 weeks of therapy using paired t‐tests. Patients who scored ≤2 on the CGI‐S after 6 weeks of zonisamide therapy were considered good responders to zonisamide.

Results:  Charts for 12 patients (four men and eight women) with a mean (±SD) age of 39.6 (±7.6) years were evaluated. Patients received a mean (±SD) zonisamide dosage of 236 (±68) mg/day. Mean GAF scores significantly improved from 44.0 at baseline to 59.3 at week 6 (P = 0.05). Mean CGI‐S scores improved from 4.54 at baseline to 3.42 at week 6, but the change was not statistically significant. Six patients (50.0%) were considered responders to zonisamide. Four patients discontinued zonisamide therapy, two for an adverse event (sedation) and two for lack of efficacy.

Conclusions:  Zonisamide may be a useful adjunctive treatment for some patients with bipolar depression. Conclusions from this study are limited due to its retrospective design. Further investigation of zonisamide in the treatment of bipolar depression is warranted.
A prospective 4–5 year follow‐up of juvenile onset bipolar disorder
Authors: Jairam Rajeev , Srinath Shoba , Girimaji Satish C , Seshadri Shekhar P
Published: September 2004

Objective:  Data on outcome of juvenile onset bipolar disorder is limited. This study examined the course and outcome of bipolar disorder and assessed the rate and predictors of recovery and relapse in a sample of children and adolescents over a 4–5 year period.

Method:  Twenty‐five consecutively ascertained subjects (9–16 years) with a diagnosis of mania (mean duration at intake of 4.6 ± 3.9 weeks), were comprehensively assessed at baseline and at 6‐month intervals using the Diagnostic Interview for Children and Adolescents (revised) (DICA‐R), the Missouri Assessment for Genetic Interview in Children (MAGIC), the Young's Mania Rating Scale (YMRS) and the Children's Global Assessment (CGAS). The study phenotype required DSM‐IV criteria of mania with elation and/or grandiosity as a criterion to distinguish them from those with attention deficit hyperactivity disorder. Subjects received the standard treatment as prescribed by their primary treating team.

Results:  During the course of the study period, all 25 subjects (100%) recovered from the index episode. The mean time to recovery was 44 ± 46 days. The mean duration of follow‐up was 51.6 ± 4.1 months. Sixteen subjects (64%) relapsed after a mean period of 18 ± 16.4 months. A majority of the relapses (72.4%) were while the subjects were on treatment.

Conclusions:  Acute juvenile onset mania has a high rate of recovery and low chronicity. The relapse rate was high and most of these occurred in the first 3 years despite aggressive prophylactic treatment. The effectiveness of currently used thymoleptics, in particular lithium, in the prophylaxis of juvenile bipolar disorder needs to be evaluated in controlled studies.
Geriatric rehabilitation nursing: Developing a model
Authors: Routasalo Pirkko , Arve Seija , Lauri Sirkka
Published: September 2004

In this paper, we describe a geriatric rehabilitation nursing model developed on the basis of the nursing and rehabilitation literature. That literature comprised some 120 articles addressing the rehabilitation of elderly patients and the work done by nurses in that process, various philosophical questions and the results of geriatric rehabilitation. One‐third of these articles has been evaluated on the strength of the articles’ evidence, and these are discussed in this paper. The findings show that the main factors in geriatric rehabilitation nursing are the patient with health or functional problems and the nurse with professional values, knowledge and skills. The patient is part of a family and the nurse works as part of a multidisciplinary team. In the geriatric rehabilitation process, the patient and the nurse work in close interaction. The aims of rehabilitation depend upon the patient's commitment to the objective and upon the nurse's commitment to help the patient achieve that objective. A health orientation, goal‐oriented work, nursing decision‐making and a rehabilitative approach to work are all central to this effort. Work is organized in multidisciplinary teams where nurses have equal responsibilities with other professional staff. Testing and development of the model is ongoing.
Errors in body temperature assessment related to individual variation, measuring technique and equipment
Authors: Sund‐Levander Märtha , Grodzinsky Ewa , Loyd Dan , Wahren Lis Karin
Published: September 2004

Errors in body temperature measurement might seriously influence the evaluation of an individual's health condition. We studied individual variation, measurement technique and the equipment used when assessing body temperature. In the first part of the study, three volunteers performed repeated measurements for five mornings. In the second part, the morning rectal, oral, ear and axillary temperatures were measured once in 84 men and women (19–59 years). The repeated measurements showed a daily temperature difference of 0.1–0.4°C in rectal and oral temperatures, 0.2°C−1.7°C in the ear and 0.1–0.9°C in the axillary temperatures. In the sample of 84 subjects, men and postmenopausal women had a lower mean body temperature compared to premenopausal women. The mean deviation between rectal temperature, and oral, ear and axillary temperatures, respectively, was > 0.5°C, with a large individual variation. In conclusion, in order to improve the evaluation of body temperature, the assessment should be based on the individual variation, the same site of measurement and no adjustment of oral, ear or axillary temperatures to the rectal site.
Predictors of patients’ experiences of nursing care in medical‐surgical wards
Authors: Ahmad Muayyad M , Alasad Jafar A
Published: September 2004

The purposes of this study were to explore patients’ opinions of nursing care and to identify predictors of patients’ experiences of nursing care in medical‐surgical wards. The sample of the study was 225 adult patients in medical‐surgical wards in a major teaching hospital in Jordan. The experiences of nursing care total score in this study was relatively high. The findings showed that the majority of the participants had positive experiences regarding the time nurses spent with them as well as the respect nurses provided to patients’ relatives and friends. Although the amount of information nurses provided to patients was found to be a significant predictor of patients’ experiences, the provided information was perceived by the majority of the patients as inadequate. Identifying factors that enhance patients’ experiences of nursing care is crucial as it assists nurses to provide better care.
The anesthetic management of an intrabronchial escape of a hydatid's ruptured laminated membrane during rigid bronchoscopy
Authors: Dabir Shideh , Boloursaz Mohammad‐Reza , Javaherzadeh Mojtaba , Radpay Badiozaman , Parsa Tahereh
Published: September 2004

We describe the anesthetic management of a case in whom a previously undiagnosed pulmonary hydatid cyst manifested as a large amount of intrabronchial fragmented pieces of laminated membrane suddenly and unexpectedly during diagnostic rigid bronchoscopy.
Effects of low dose ketamine before induction on propofol anesthesia for pediatric magnetic resonance imaging
Authors: Tomatir Erkan , Atalay Habip , Gurses Ercan , Erbay Hakan , Bozkurt Pervin
Published: September 2004

Background : We aimed to investigate effects of low dose ketamine before induction on propofol anesthesia for children undergoing magnetic resonance imaging (MRI).

Methods : Forty‐three children aged 9 days to 7 years, undergoing elective MRI were randomly assigned to receive intravenously either a 2.5 mg·kg−1 bolus of propofol followed by an infusion of 100 μg·kg−1·min−1 or a 1.5 mg·kg−1 bolus of propofol immediately after a 0.5 mg·kg−1 bolus of ketamine followed by an infusion of 75 μg·kg−1·min−1. If a child moved during the imaging sequence, a 0.5–1 mg·kg−1 bolus of propofol was given. Systolic and diastolic blood pressures, heart rate, peripheral oxygen saturation and respiratory rates were monitored. Apnea, the requirement for airway opening maneuvers, secretions, nausea, vomiting and movement during the imaging sequence were noted. Recovery times were also recorded.

Results : Systolic blood pressure and heart rate decreased significantly in the propofol group, while blood pressure did not change and heart rate decreased less in the propofol‐ketamine group. Apnea associated with desaturation was observed in three patients of the propofol group. The two groups were similar with respect to requirements for airway opening maneuvers, secretions, nausea‐vomiting, movement during the imaging sequence and recovery time.

Conclusions : Intravenous administration of low dose ketamine before induction and maintenance with propofol preserves hemodynamic stability without changing the duration and the quality of recovery compared with propofol alone.
Postoperative behavioral changes following anesthesia with sevoflurane
Authors: Keaney Aideen , Diviney Dara , Harte Sinead , Lyons Barry
Published: September 2004

Background : Behavioral disturbance following hospitalization is a relatively frequent event, some children still having negative behavioral changes (NBC) 1 month following their operation. Sevoflurane has a propensity to induce ‘excitement’ during induction of anaesthesia, and delirium in the immediate postoperative phase. The aim of this study was to evaluate whether this translates into prolonged behavioral change.

Methods : A total of 120 children presenting for daycase surgical procedures under anesthesia were included in the study. Children were randomized to induction and maintenance of anesthesia with sevoflurane or halothane. No additional sedative drugs were administered. Postoperative behavioral change was assessed using the Post‐Hospital Behavior Questionnaire (PHBQ) on postoperative days 1, 7 and 30.

Results : The Sevoflurane group (n = 63) were more distressed on emergence of anesthesia than the Halothane group (n = 57) (P < 0.05). About 58.3, 46.8 and 38.3% of all children exhibited NBC on postoperative days 1, 7 and 30, respectively. There was no association between anesthetic agent and behavior. There was a significant relationship between decreasing age and NBC (P < 0.005).

Conclusions : Children anesthetized with sevoflurane exhibit more immediate postoperative distress than those anesthetized with halothane. This difference is not carried over into the longer posthospital period. Negative behavioral changes occur more frequently with decreasing age.
Early intravenous cannulation in children during sevoflurane induction
Authors: Schwartz Donald , Connelly Neil Roy , Gutta Srinivasa , Freeman Katharine , Gibson Charles
Published: September 2004

Background : It has been shown that early placement of an intravenous line in children anesthetized with halothane is equally safe compared with later placement. Whether this is true of sevoflurane is not known.

Methods : Pediatric patients, age 1–18 years, undergoing elective general anesthesia via an inhalation induction were randomized to intravenous placement either 30 or 120 s following loss of lid reflex. Movement on intravenous placement and incidence of laryngospasm were determined. Difficulty with intravenous placement was recorded.

Results : Movement on intravenous placement was more prevalent in the early group than in the late group (P < 0.0001). There was no laryngospasm in the late group and eight cases in the early group (P < 0.004). Children who had laryngospasm were older (P < 0.02) and weighed more (P < 0.04). Older children in the early group were more likely to have significant movement.

Conclusion : Following an inhalation induction with sevoflurane in children, movement with intravenous placement was greater, and the incidence of laryngospasm was higher, when the intravenous access was attempted 30 s rather than 120 s following loss of lid reflex. We recommend waiting two min following the loss of lid reflex before attempting intravenous placement in children receiving an inhalation induction with sevoflurane.
Droperidol for perioperative sedation causes a transient prolongation of the QTc time in children under volatile anesthesia1
Authors: Stuth Eckehard A.E. , Stucke Astrid G. , Cava Joseph R. , Hoffman George M. , Berens Richard J.
Published: September 2004

Background : Droperidol is useful for postoperative sedation in infants and children after cardiac surgery because it provides sedation and akinesia with minimal respiratory depression. However, droperidol has been associated with QT prolongation and ventricular arrhythmias. We investigated, if neuroleptanalgesic doses of droperidol led to QT prolongation and cardiac arrhythmias in children undergoing cardiac surgery.

Methods : We retrospectively analysed electrocardiogram rhythm strips that were obtained before and in time increments after a 100 μg·kg−1 intravenous bolus of droperidol in 20 children undergoing cardiac surgery. The longest QT interval was determined in each ECG and corrected for heart rate (QTc). All arrhythmias were recorded.

Results : Droperidol led to a significant increase in QTc time that was still present at 15 min but had resolved within 30 min after the bolus. No associated arrhythmias were observed.

Conclusions : The statistically significant prolongation of QTc time after a sedative dose of droperidol is of concern because it may increase the risk for malignant cardiac arrhythmias. A large, prospective study is necessary to identify the true risk for arrhythmias after droperidol in this patient population, but our study suggests that any arrhythmogenic risk, if present, will be very transient, since the increase in QTc time was limited to a period of less than 30 min after the bolus.
Health‐related quality of life in the first year following diagnosis of Type 2 diabetes: newly diagnosed patients in general practice compared with screening‐detected patients. The Hoorn Screening Study
Authors: Adriaanse M. C. , Dekker J. M. , Spijkerman A. M. W. , Twisk J. W. R. , Nijpels G. , Van Der Ploeg H. M. , Heine R. J. , Snoek F. J.
Published: September 2004

Aims  To determine health‐related quality of life (HRQoL) in the first year following diagnosis of Type 2 diabetes among newly diagnosed patients in general practice compared with patients detected by targeted population screening.

Methods  The study population consisted of 49 newly diagnosed patients in general practice and 116 screening‐detected patients. HRQoL was operationalized as symptom distress, perceived health status and emotional well‐being, that were assessed prospectively ∼2 weeks, 6 months and 12 months after the diagnosis of Type 2 diabetes, with the Type 2 Diabetes Symptom Checklist (DSC‐type 2), the Short Form 36 (SF‐36) and the Well‐Being Questionnaire (W‐BQ12), respectively.

Results  The DSC‐type 2 total score (range 0–4) improved significantly within newly diagnosed patients in general practice (median at ∼2 weeks, 6 months and 12 months; 0.56, 0.21, 0.26; P = 0.000) and not within screening‐detected patients (0.24, 0.24, 0.29; P = 0.093). Descriptives showed that newly diagnosed patients in general practice compared with screening‐detected patients had consistently worse mean scores on all SF‐36 mental health subscales Social Functioning, Role Emotional, Mental Health, Vitality, and all W‐BQ12 scales at each time point. The differences were statistically significant for Role Emotional, Mental Health, Vitality (SF‐36), and General well‐being (W‐BQ12). The SF‐36 General Health (F = 3.7, P = 0.028) and Vitality (F = 4.5, P = 0.012) scores of newly diagnosed patients in general practice improved significantly over time, compared with screening‐detected patients.

Conclusions  Newly diagnosed patients in general practice compared with screening‐detected patients reported more diabetes‐related symptom distress shortly after the diagnosis, and a consistently worse mental health status at each time point. Improved Vitality scores in newly diagnosed patients in general practice in the first year following diagnosis of Type 2 diabetes suggest a positive effect of diabetes treatment on HRQoL.
The combination oral and nutritional treatment of late‐onset diabetes mellitus (CONTROL DM) trial results
Authors: Reboussin D. M. , Goff D. C. , Lipkin E. W. , Herrington D. M. , Summerson J. , Steffes M. , Crouse R. J. , Jovanovic L. , Feinglos M. N. , Probstfield J. L. , Banerji M. A. , Pettitt D. J. , Williamson J.
Published: September 2004

Objective  To examine the effect of short‐term improvements in glycaemic control on brachial artery endothelial function as a marker of cardiovascular health.

Methods  Persons with Type 2 diabetes who were poorly controlled on oral therapy were randomly assigned to monotherapy with repaglinide or combination therapy with repaglinide plus metformin. Brachial artery flow‐mediated vasodilation was assessed by ultrasonography at randomization and following 16 weeks of therapy. The primary outcome was change in brachial artery endothelial function from baseline. Comparison of randomized groups was a secondary aim.

Results  Eighty‐six participants were randomized, and 83 were followed to study completion. Post occlusion brachial artery vasodilation was 3.74% at baseline and 3.82% following 16 weeks of therapy (P = 0.77). The treatment effect was 0.08% (95% CI: −0.48%, 0.64%). No difference was seen between treatment groups (P = 0.69). Overall, A1C was reduced from 8.3% to 7.0%, with a greater reduction in the combination therapy group (from 8.4% to 6.7%) than in the monotherapy group (from 8.3% to 7.3%, p for difference between groups = 0.01). Statistically significant reductions were observed in fasting glucose, and plasminogen activator inhibitor‐1. Statistically significant increases were observed for fasting insulin, uric acid, weight and BMI.

Conclusions  Brachial artery endothelial function was not influenced by short‐term improvements in glycaemic control. The CONTROL DM group was successful in lowering A1C. Future research should explore more intensive and longer‐lasting improvements in glycaemic control on endothelial function. Some data previously published in abstract form (Diabetes 2001; 50 (Suppl. 2): A217).
Risk factors for development of impaired renal function in Type 2 diabetes mellitus patients in primary care
Authors: Naushahi M. J. , De Grauw W. J. C. , Avery A. J. , Van Gerwen W. H. E. M. , Van De Lisdonk E. H. , Van Weel C.
Published: September 2004

Aims  To evaluate risk factors for the development of an impaired renal function, defined as a glomerular filtration rate (GFR) by Cockcroft‐Gault formula < 50.5 ml/min, in primary care patients with Type 2 diabetes mellitus.

Methods  A case–control study of Type 2 diabetes mellitus patients with impaired renal function and age, sex and practice matched controls with Type 2 diabetes mellitus without impaired renal function in 10 Dutch family practices performing the Nijmegen Monitoring Project. Main outcome measure was the independent risk factors of impaired renal function.

Results  Eighty‐seven individuals with impaired renal function were identified. The point prevalence of impaired renal function in the sample population on 31 March 2001 was 87/873 (10.0%; 95% confidence interval 7.0–15.1%). Of 87 cases, 23 (26.5%; 17.3–30.9%) were found to have impaired renal function at diagnosis. Conditional multiple logistic regression analysis revealed the following independent risk factors for the development of impaired renal function: duration of diabetes ≥ 8 years (adjusted odds ratio 5.6 (2.5–12.5); P < 0.001), glomerular filtration rate by Cockcroft‐Gault formula 50.5–80.5 ml/min at diagnosis [3.5 (1.5–8.1); P < 0.01] and existing macrovascular complications at diagnosis [2.6 (1.1–6.3); P < 0.01].

Conclusion  Duration of diabetes ≥ 8 years, mild renal impairment at the time of diagnosis and existing macrovascular complications at the time of diagnosis are independent risk factors for the development of impaired renal function in white patients with Type 2 diabetes mellitus.
The effects of high glucose and atorvastatin on endothelial cell matrix production
Authors: McGinn S. , Poronnik P. , Gallery E. D. M. , Pollock C. A.
Published: September 2004

Background  Statins are known to enhance atherosclerotic plaque stability through influences on extracellular matrix homeostasis. Net matrix production reflects the relative balance of matrix production and degradation through enzymes such as matrix metalloproteinases (MMPs) and their inhibitors, tissue inhibitor of MMP (TIMPs). The effects of statins on endothelial cell production of these parameters following co‐exposure with a proatherogenic stimulus such as high glucose are not known.

Methods  Human endothelial cells were exposed for 72 h to 5 mm (control) or 25 mm (high) glucose ± atorvastatin (1 µmol/l). Extracellular matrix homeostasis was assessed by measuring matrix metalloproteinase (MMP)‐2 secretion, tissue inhibitor of MMP (TIMP)‐1 and ‐2 secretion and net collagen IV production. Results were expressed as percentage ± sem of control values.

Results  Exposure to high glucose increased cellular collagen IV expression to 190.1 ± 11.7% (P < 0.0001) of control levels. No change in MMP‐2 secretion (111.6 ± 5.2%; P > 0.05) was observed but both TIMP‐1 and TIMP‐2 expression were increased to 136.3 ± 6.4% and 144.0 ± 27.5%, respectively (both P < 0.05). The presence of atorvastatin in high glucose conditions reduced collagen IV expression to 136.1 ± 20.6%. This was paralleled by increased secretion of MMP‐2 to 145.8 ± 7.8% (P < 0.01), increased TIMP‐2 expression to 208.0 ± 21.3% (P < 0.005 compared with high glucose) but no change in TIMP‐1 expression (155.1 ± 14.6%) compared with high glucose alone. The presence of atorvastatin in control conditions did not affect levels of collagen IV expression (114.5 ± 13.2%).

Conclusions  Endothelial cell exposure to high glucose was associated with a MMP/TIMP profile that increased extracellular matrix production which was attenuated by concurrent exposure to atorvastatin. Consequently, a mechanism by which the atherosclerotic plaque regression that is observed in patients taking these drugs has been demonstrated.
Presentation and course of Type 2 diabetes in youth in a large multi‐ethnic city
Authors: Zdravkovic V. , Daneman D. , Hamilton J.
Published: September 2004

Aim  To review the clinical experience of children and teens diagnosed with Type 2 diabetes (T2DM) at a paediatric hospital serving a large urban multi‐ethnic population.

Methods  Retrospective chart review of patients with T2DM followed in the diabetes clinic at the Hospital for Sick Children (HSC) over an 8‐year period. Patients who were included were younger than 18, referred at the onset of diabetes, and where presentation and/or clinical course was ‘typical’ of T2DM.

Results  Of 1020 children with diabetes followed at HSC, 4% were identified as having T2DM in 2002. There was a sixfold increase in new cases from 1994 to 2002. The mean age at diagnosis was 13.5 ± 2.2 years (range 8.8–17.5) with a female‐to‐male ratio of 1.7. Most had a first‐ or second‐degree relative with T2DM. There was an overrepresentation of children with T2DM from Asian and African Canadian ethnic groups relative to the regional population. The majority of teens were asymptomatic at presentation, with a smaller number in diabetic ketoacidosis (DKA) at diagnosis. Mean HbA1c at diagnosis was 10 ± 3.4%. Approximately one half of patients were initially treated by diet and exercise with many requiring intensification of therapy over a short period of time.

Conclusions  We report a similar increase in T2DM incidence and clinical presentation at HSC to other clinic reports in large North American urban centres. Of note is the high prevalence of children of South/South‐East Asian descent.
IRIS II study: the IRIS II score—assessment of a new clinical algorithm for the classification of insulin resistance in patients with Type 2 diabetes
Authors: Forst T. , Standl E. , Hohberg C. , Konrad T. , Schulze J. , Strotmann H. J. , Lübben G. , Pahler S. , Bachinger A. , Langenfeld M. , Pfützner A.
Published: September 2004

Aims  With the increasing availability of new drugs for the treatment of insulin resistance in patients with Type 2 diabetes, simple methods for their identification is an important challenge. The aim of our study was to compute a new algorithm for estimating insulin resistance in a routine clinical setting.

Methods  Clinical data and blood samples were collected from 4265 Type 2 diabetic patients from 149 clinical sites. A clinical algorithm to estimate insulin resistance was developed by stepwise multiple regression analysis. The new generated score was compared with the HOMAIR‐score, calculated from fasting insulin and glucose levels measured in a central laboratory. In a subgroup of 48 patients, the score was verified against a frequently sampled intravenous glucose tolerance test with subsequent modified minimal model analysis according to Bergman.

Results  Multiple regression analysis revealed fasting blood glucose, BMI, triglycerides and HDL as the most powerful predictors of insulin resistance which were used for further computation of the IRIS II score. A significant overall correlation was found between the HOMAIR‐score and the new clinical IRIS II score (r = 0.42; P < 0.0001). Compared with HOMAIR, the new score revealed a specificity of 0.95, a sensitivity of 0.34 and a positive predictive value of 0.95. This was in good agreement with the subset analysis of the intravenous glucose tolerance test, where a sensitivity of 0.37 and a specificity of 0.85 of the IRIS II score was calculated. Patients with insulin resistance according to the IRIS II score revealed an increased odds ratio for overall vascular complications (1.28; 1.11–1.46; P < 0.001).

Conclusions  The new IRIS II score can identify insulin resistance in Type 2 diabetic patients with high predictive value and high specificity.
Treatment gap in the use of lipid‐lowering drug therapy in diabetes: a population‐based study
Authors: James P. , Tan H. H. , MacAlpine R. , Brennan G. , Emslie‐Smith A. , Morris A. D.
Published: September 2004

Background  Lowering cholesterol is highly effective in reducing morbidity and mortality in high‐risk people with prevalent cardiovascular disease.

Aims  To investigate lipid‐lowering therapy use for secondary prevention of coronary heart disease in all diabetic patients in Tayside, Scotland

Methods  Among the 385 500 Tayside residents on 31 March 2001, the DARTS database identified all people with Types 1 and 2 diabetes with prevalent macrovascular disease, defined as a history of angina or coronary heart disease. The uptake of lipid‐lowering drug was ascertained from MEMO's database of prescriptions dispensed at Tayside pharmacies.

Results  Among the 1128 Type 1 patients, 11.3% had prevalent macrovascular disease and 7.9% used lipid‐lowering therapy with 42.2% for patients with macrovascular disease. Current/former smokers (OR 2.40, 95% CI: 1.15–5.03) and those with a history of coronary heart disease (OR 2.26, 95% CI: 1.04–4.90) were more likely to use lipid‐lowering therapy. Among the 8686 Type 2 patients, 38.8% had prevalent macrovascular disease and 18.3% used lipid‐lowering therapy, with 26.7% for patients with macrovascular disease. Current/former smokers (OR 1.37; 95% CI 1.17–1.61) and those with a history of coronary heart disease (OR 2.07, 95% CI 1.66–2.59) or angina (OR 1.30, CI 1.03–1.63) were more likely to use lipid‐lowering therapy. A duration of 4 years or less from the first macrovascular event was associated with increased use (OR 1.27; 95% CI 1.05–1.54). Age > 70 years reduced the likelihood (OR 0.51, CI 0.44–0.60).

Conclusion  A clear gap exists between those requiring lipid‐lowering drug therapy and those who are actually receiving it in Tayside.
Polymorphisms in the 5′‐upstream region of the PKCβ gene in Japanese patients with Type 2 diabetes
Authors: Ikeda Y. , Suehiro T. , Osaki F. , Tsuzura S. , Kumon Y. , Hashimoto K.
Published: September 2004

Aims  Protein kinase C (PKC), a serine/threonine kinase, is known to be activated in various tissues under hyperglycaemic conditions. Notably, PKCβ, a member of the conventional PKC group, is the predominant isoform detected in vascular tissues and could be involved in the development of diabetic vascular complications. In the present study, we investigated genetic variations in the 5′‐upstream region of the PKCβ gene to assess their possible relation to vascular complications in diabetic patients.

Methods  Variations upstream from the PKCβ gene (−1066/+256) were examined in 60 Type 2 diabetic patients using a cycle sequencing method. Screening of detected variations was performed in 204 Type 2 diabetic patients and 160 healthy controls.

Results  Five single nucleotide polymorphisms; C(−238)G, C(−287)T, A(−348)G, C(−546)G, and C(−853)T, were identified in the upstream region. The C(−287)T and A(−348)G polymorphisms were in perfect linkage disequilibrium. There were no significant differences in genotype or allele frequencies of the five polymorphisms among the diabetic patients and healthy subjects. However, both −238GG and −287CC (−348GG) homozygotes showed significantly higher frequencies of macrovascular disease compared with patients with other genotypes. Further, an electrophoretic mobility shift assay revealed that the −238G fragment had a five‐fold higher affinity for transcription factor Sp1 when compared with −238C.

Conclusions  The C(−238)G and C(−287)T‐A(−348)G polymorphisms in the 5′‐upstream region of the PKCβ gene may have an effect on the susceptibility of diabetic vascular complications through an alteration of tissue PKCβ density or function.
Feasibility of using the TOSCA telescreening procedures for diabetic retinopathy
Authors: Luzio S. , Hatcher S. , Zahlmann G. , Mazik L. , Morgan M. , Liesenfeld B. , Bek T. , Schuell H. , Schneider S. , Owens D. R. , Kohner E.
Published: September 2004

Aims  The TOSCA project was set up to establish a tele‐ophthalmology service to screen for diabetic retinopathy (DR) in Europe. The aim of this study was to determine the feasibility of establishing telemedicine‐based digital screening for detecting DR and to evaluate the satisfaction of both patients and healthcare professionals with the screening procedures used within the TOSCA project.

Methods  The study was a non‐randomized, multicentre study carried out in four different countries over a period of 3 months.

Patients  (n = 390) with diabetes aged > 12 years were included. Two digital retinal images per eye (macular and nasal) were taken and exported to a central server. Patients were asked to complete a questionnaire to assess satisfaction. Accredited graders carried out grading remotely and the results were reported back to the referring centre. Previously graded patient data chosen randomly to represent examples of both DR and no DR were also sent anonymously to the grading centre at a frequency of approximately every 10 patients.

Results  Most (99%) of the images were assessable enabling a retinopathy grade to be assigned to the patient. Patients found the retinal photography procedures acceptable; only 6% in one centre would not recommend the procedure. Healthcare professionals (photographers and graders) were also satisfied with the overall procedures. The average time taken to grade each patient was approximately 5 min.

Conclusions  This study demonstrated that it is feasible to electronically transmit and grade retinal images remotely using the TOSCA process. Built‐in quality assurance procedures proved acceptable.
The association of coronary calcium score and conventional cardiovascular risk factors in Type 2 diabetic subjects asymptomatic for coronary heart disease (The PREDICT Study)
Authors: Elkeles R. S. , Feher M. D. , Flather M. D. , Godsland I. F. , Nugara F. , Richmond W. , Rubens M. B. , Wang D.
Published: September 2004

Aim To determine the association between coronary calcification score (CACS) obtained by electron beam computed tomography (EBCT) and cardiovascular risk factors in Type 2 diabetic subjects entered into a prospective cohort study.

Methods Type 2 diabetic subjects attending routine hospital diabetic clinics without known coronary heart disease (CHD) underwent EBCT to measure CACS. Demographic data were obtained and conventional cardiovascular risk factors were measured at baseline.

Results Four hundred and ninety‐five subjects were assessed of whom 67.7% were male. They had a mean (sd) age of 62.9 (7.1) years, with median (inter‐quartile range) duration of diabetes of 8 (4–13) years. None had a history of coronary artery disease. Forty‐five per cent were receiving lipid‐lowering agents (including 36% statins). In a univariate analysis, there were significant associations between increased CACS and age, duration of diabetes, male gender, waist–hip ratio (WHR), systolic blood pressure, and the use of statins. In a multivariate model adjusting for the possible interaction of these and other factors, the significant association between CACS and WHR, systolic blood pressure, male gender and statin use remained.

Conclusions The close association between CACS and WHR and the association with systolic blood pressure suggest that coronary calcification may be particularly linked to the metabolic syndrome in Type 2 diabetes.
Beyond caring: the moral and ethical bases of responsive nurse–patient relationships
Authors: Tarlier Denise S.
Published: September 2004

Abstract Although we theorize that nurses ‘make a difference’ to patient outcomes and speculate that this happens because nurses ‘care’, there is so far little evidence to support this nebulous claim. Efforts to promote care as the defining characteristic of nursing, and an ‘ethic of care’ as the ethical basis of nursing, have sparked debate within the discipline. This debate has resulted in a polarization that has effectively stalled productive discourse on the issues. Moreover, the focus on care has been at the expense of understanding the true nature of the relationship between caring and the broader base of ethical knowledge that underpins nursing and that must underpin nursing if it is a viable practice profession. This paper used the framework of philosophical argument to explore the moral and ethical foundations of nursing from the perspective of personal and public morals, and responsive nurse–patient relationships as the reflection of ethical nursing knowledge. The foundation of ethical nursing knowledge is the personal moral sense that resides within the individual and that nurses hold in common with others. Personal moral knowledge is transformed into disciplinary ethical knowledge specific to nursing through disciplinary consensus. Responsive relationships are conceptualized in the nursing literature as founded on three essential elements: respect, trust, and mutuality. These three elements are grounded in ethical nursing knowledge; therefore responsive nurse–patient relationships reflect both personal moral knowledge and disciplinary ethical knowledge. By facilitating the articulation of ethical nursing knowledge in practice, responsive relationships connect theory, ethical knowledge, and clinical outcomes.
‘There but for the grace of God’: moral responsibility and mental illness
Authors: Bjorklund Pamela
Published: September 2004

Abstract  Setting the terms of praise‐ and blameworthiness has long dominated philosophers’ discussions of responsibility. Analytic philosophy has most often looked to reason and the abstract relations between individual rational judgements and actions to advance the discourse on moral responsibility. Those whose capacity for reasoned judgement is impaired are deeply problematic. Is it proper to morally appraise ‘the mentally ill’? The philosopher T.M. Scanlon discusses moral responsibility as a precondition of moral appraisal and contends that it is not appropriate to appraise a person as (morally) praise‐ or blameworthy if that person cannot be held responsible for the action(s) for which he is being praised or blamed. What are the conditions, then, under which one can properly be said to be responsible for one's actions? Can one hold ‘the mentally ill’ responsible for their actions? If not, can it in any way be reasonable to expect them to ‘take responsibility’ for their actions and/or characters? The expectation that ‘the mentally ill’ will attempt to control, i.e. take responsibility for their behaviour despite the fact of their mental illness is a pervasive feature of psychiatric approaches to the care and treatment of ‘the mentally ill’. It would seem that such treatment approaches are coherent only to the degree ‘the mentally ill’ can be considered responsible moral agents. This paper explores these issues with regard to that form of mental illness categorized as the personality disorders. It describes the morally and clinically relevant features of personality disorder, explains how they do not fit traditional analytic paradigms of ‘mental illness’ and elaborates the argument that persons with this category of mental illness are fully moral persons who are rightly subject to praise and blame.
The problematic allure of the binary in nursing theoretical discourse1
Authors: Thorne Sally E. , Henderson Angela D. , McPherson Gladys I. , Pesut Barbara K.
Published: September 2004

Abstract  Recent ideological positioning on the world stage has born a startling resemblance to a form of positioning within nursing theory – that of taking complex ideas, reducing them to a simplistic binary form, and uncritically adopting one half of that form. In some cases, this adoption of a binary position has led to a passionately held form of ‘othering’ that prohibits a healthy and critical engagement with ideas. As alluring as settling for the binary form may be – we argue for holding binaries in tension as a catalyst for stimulating dialogue – reasoning and exploration of new ways of wrestling with the social and moral complexity of nursing.
Nursing theories as nursing ontologies
Authors: Flaming Don
Published: September 2004

Abstract  By understanding the constructions of knowledge we currently label nursing theories as nursing ontologies, nurses can perceive these conceptualizations differently. Paul Ricoeur and Stephen White offer a conceptualization of ontology that differs from traditional, realist perspectives because they assume that a person's experience of a phenomenon (e.g., nursing) will change, but also maintain some stability. Discussing nursing ontologies, rather than nursing theories, might increase philosophy's status in nursing and may also more accurately reflect the experience of being a nurse.
Signalling power of special dividends in an imputation environment
Authors: Balachandran Balasingham , Nguyen Tuan Anh
Published: September 2004

The present study examines the impact of the announcement of special dividends for a sample of Australian companies over the period July 1989 to June 2002. The risk‐adjusted price reaction to special dividend announcements from the day before the announcement to the day after the announcement (day −1 to day 1) is positive and statistically significant, averaging 3.67 per cent. Initial special dividend announcements (4.68 per cent) led to stronger price reaction than special dividend announcements that follow an earlier special dividend (1.51 per cent) in the previous year. The magnitude of price reactions to special dividend announcements is statistically related to the size of the special dividend, the existence of prior special dividend announcements, abnormal cash flow for the year ended after the special dividend announcement, the existence of dividend reinvestment plans (DRP) versus non‐DRP, and a preannouncement effect. Finally, we found strong support for the information content/signalling hypothesis for special dividend announcements that do not participate in DRP and limited support for those associated with DRP.
Corporate governance, insider ownership and operating performance of Australian initial public offerings
Authors: Balatbat Maria C. A. , Taylor Stephen L. , Walter Terry S.
Published: September 2004

We examine ownership structures and corporate governance attributes of 313 Australian initial public offerings (IPOs) between 1976 and 1993 and their relation with up to 5 years of post‐listing operating performance, adjusted for similar (non‐IPO) firms. Consistent with prior share price‐based evidence, we find that the operating performance of Australian IPOs typically deteriorates over the first 4 post‐listing years. Any evidence of a positive association between insider ownership and firm performance is confined to the fourth and fifth years after the IPO. Evidence of a positive relation between institutional ownership and performance is restricted to the latter part of our 5‐year post‐listing window. Board composition (i.e. outsider versus insider control) is not associated with operating performance, although there is some evidence that independent board leadership is associated with better operating performance.
Impact of the timing of receipt of an inherited explanation on auditors’ analytical procedures judgements
Authors: Green Wendy
Published: September 2004

The present study extends prior research relating to auditors’ analytical procedures (AP) processes in two ways. First, it examines whether the timing of receipt of an inherited explanation (before or after self‐generating explanations) affects auditors’ hypothesis generation. Second, responding to calls to address how the auditors’ performance of the earlier stages of the AP process affects their performance in later stages of that process (Koonce, 1993; Cohen, Krishnamoorthy and Wright, 2000) the present study concurrently addresses the hypothesis generation, information search, hypothesis evaluation and final judgement stages of the AP process. Consistent with a facilitation effect, more non‐error explanations were generated by auditors initially inheriting a non‐error explanation. Further, consistent with a recency effect, the initial likelihood assessed for the inherited explanation was higher when it was received after self‐generation of alternatives. Despite these initial differences, the timing of the inherited explanation did not significantly affect the auditors’ information search, evaluation processes or outcome performance (in terms of cause selection). Results relating to the receipt of an inherited explanation were similar, except that significantly fewer subjects not inheriting an explanation selected a cause the same as the inherited explanation. These results suggest that although inheriting an explanation from management does affect the outcome of the AP process, it does not lead to fewer correct outcomes, and highlight the importance of examining the AP process in its entirety rather than in a piecemeal manner.
R&D investment and systematic risk
Authors: Ho Yew Kee , Xu Zhenyu , Yap Chee Meng
Published: September 2004

The present study investigates the relationship between a firm's R&D intensity and the risk of its common stock, by analysing a sample of firms which are more profitable, larger in market capitalization and more R&D intensive than the universe of US‐listed firms. The results from the portfolio analysis, Monte Carlos simulations and correlation analysis of our sample show that: (i) R&D intensity is positively related to systematic risk in the stock market; (ii) the greater systematic risk is largely attributable to the greater intrinsic business risk and the greater operating risk of R&D‐intensive firms; (iii) R&D‐intensive firms carry marginally less financial leverage but they do not differ from other firms in terms of operating leverage; and (iv) our results are particularly strong in the manufacturing sector. For the non‐manufacturing sector, the results are not robust for different study periods.
Commonality in liquidity: Evidence from the Australian Stock Exchange
Authors: Fabre Joel , Frino Alex
Published: September 2004

Several studies have reported strong evidence of commonality in liquidity in US markets. The present study uses the research design of Chordia et al. (2000) to examine commonality in liquidity for a broad sample of stocks listed on the Australian Stock Exchange (ASX). In contrast to previous research, there is some evidence of market‐wide commonality in liquidity for ASX stocks, but it is less significant and less pervasive than that observed in other markets. These results are consistent with explanations based on differences in market structure between the USA and Australia.
Technological and organizational influences on the adoption of activity‐based costing in Australia
Authors: Brown David A. , Booth Peter , Giacobbe Francesco
Published: September 2004

The present paper examines one set of potential reasons for the paradox as to why so few firms have adopted activity‐based costing (ABC) despite the demonstrated benefits of this costing system. A cross‐sectional survey of Australian firms is used to examine the influence of seven technological and organizational factors on firms’ initial interest in ABC and their decision to adopt it or not. The organizational factors of top management support, the support of an internal champion, and organizational size were shown to be associated with initial interest in ABC. The decision to adopt or reject ABC had one organizational factor associated with it, the support of an internal champion.