bluuebunny/crossref_metadata_2025 huggingface dataset:
Growth hormone effects on hypertrophic scar formation: a randomized controlled trial of 62 burned children
Authors: De Oliveira Gisele V. , Sanford Arthur P. , Murphy Kevin D. , De Oliveira Hermes M. , Wilkins Judy P. , Wu Xiaowu , Hawkins Hal K. , Kitten Gregory , Chinkes David L. , Barrow Robert E. , Herndon David N.
Published: July 2004

The hypercatabolism after massive pediatric burns has been effectively treated with recombinant human growth hormone, an anabolic agent that stimulates protein synthesis and abrogates growth arrest. While experimental studies have shown increased potential for fibrosis induced by growth hormone therapy, adverse effects on human scars have not been investigated. Our aim was to evaluate hypertrophic scar formation in 62 patients randomized to receive injections of 0.05 mg/kg/day of recombinant human growth hormone or placebo, from discharge until 1 year after burn. Scar scales were used to evaluate scar‐severity at discharge, 6, 9, 12, and 18–24 months after burn, by three observers blinded to treatment. Computer‐assisted planimetry allowed quantification of percentage of hypertrophic scar formation. Types I and III collagens were localized and quantified in scars and normal skin of patients from both groups, using immunohistochemistry with confocal laser microscopy analysis. Insulin‐like growth factor‐1 blood levels helped assess compliance. Statistical analysis showed that scar hypertrophy significantly increased from 6 to 12 months after injury in both groups, while decreasing at 18–24 months postburn. Types I and III collagens were statistically increased in the reticular layer of scars from both groups when compared to paired normal skin. Insulin‐like growth factor‐1 was significantly increased in the recombinant human growth factor‐treated group. No differences were seen when recombinant human growth factor and control groups were compared using the scar scales, planimetry, or immunohistochemistry. We concluded that recombinant human growth hormone therapy did not adversely affect scar formation and should not contraindicate the administration of recombinant human growth hormone as a therapeutic approach to severely burned children.
Electroporation enhances transfection efficiency in murine cutaneous wounds
Authors: Byrnes Colman K. , Malone Robert W. , Akhter Nabeel , Nass Petra H. , Wetterwald Antoinette , Cecchini Marco G. , Duncan Mark D. , Harmon John W.
Published: July 2004

Transfection of wounds with DNA‐encoding growth factors has the potential to improve healing, but current means of nonviral gene delivery are inefficient. Repeated high doses of DNA, necessary to achieve reliable gene expression, are detrimental to healing. We assessed the ability of in vivo electroporation to enhance gene expression. Full‐thickness cutaneous excisional wounds were created on the dorsum of female mice. A luciferase‐ encoding plasmid driven by a CMV promoter was injected at the wound border. Following plasmid administration, electroporative pulses were applied to injection sites. Pulse parameters were varied over a range of voltage, duration, and number. Animals were euthanized at intervals after transfection and the luciferase activity measured. Application of electric pulses consistently increased luciferase expression. The electroporative effect was most marked at a plasmid dose of 50 µg, where an approximate tenfold increase was seen. Six 100‐µs‐duration pulses of 1750 V/cm were found to be the most effective in increasing luciferase activity. High numbers of pulses tended to be less effective than smaller numbers. This optimal electroporation regimen had no detrimental effect on wound healing. We conclude that electroporation increases the efficiency of transgene expression and may have a role in gene therapy to enhance wound healing.
Predictive and monitoring value of matrix metalloproteinase‐9 for healing quality after sinus surgery
Authors: Watelet Jean‐Baptiste , Claeys Cindy , Cauwenberge Paul Van , Bachert Claus
Published: July 2004

Functional endoscopic sinus surgery is considered the standard therapeutic procedure for chronic rhinosinusitis and nasal polyposis after failure of medical treatment. We tested the hypothesis that the healing outcome after surgery was correlated to the secretion profile of gelatinase‐B (matrix metalloproteinase‐9 [MMP‐9]) and transforming growth factor‐β1 (TGF‐β1) in nasal fluid. We performed a prospective study in 36 patients bilaterally operated for chronic rhinosinusitits or nasal polyposis and the healing quality was evaluated until 6 months after surgery by standardized nasal endoscopy, using a visual analog scale. Before functional endoscopic sinus surgery and during the postoperative period, TGF‐β1 and MMP‐9 in nasal secretions were measured by enzyme‐linked immunosorbent assay. Both MMP‐9 and TGF‐β1 showed a significant increase initially after surgery. The healing quality after 6 months was significantly and independently correlated to preoperative MMP‐9 concentrations in nasal secretions (p = 0.03), initial disease (p = 0.03), and previous sinus surgery (p = 0.004). Furthermore, concentrations of MMP‐9 were significantly lower in patients with good healing (visual analog scale < 3) from week 3 to month 6 compared to patients with poor healing. MMP‐9 is the first objective factor suitable to predict and monitor the healing quality after sinus surgery, indicating MMP‐9 as a possible therapeutic target.
Pig chondrocyte xenoimplants for human chondral defect repair: an in vitro model
Authors: Fuentes‐Boquete Isaac , López‐Armada María J. , Maneiro Emilia , Fernández‐Sueiro José L. , Caramés Beatriz , Galdo Fausto , De Toro Francisco J. , Blanco Francisco J.
Published: July 2004

The objective of this study was to evaluate the use of cultured porcine chondrocyte xenotransplantation for the repair of human chondral defects. Two‐millimeter‐diameter defects were drilled into explants of femoral cartilage from healthy adult donors. No cells were implanted in the chondral defects of the control group, while pig chondrocytes from normal femoral cartilage were deposited into the treated chondral defects. Cartilage explants were cultured for 4, 8, and 12 weeks. Tissue sections were processed for standard histologic staining and immunostaining with monoclonal antibodies against types I and II collagen, chondroitin‐4‐sulfate, chondroitin‐6‐sulfate, keratan sulfate, and integrin subunit β1. The porcine origin of chondrocytes was confirmed using a specific pig monoclonal anti‐CD46. Repair was only observed in the cell‐treated defects. Mono‐ or bilayers of cells were detected after 4 culture weeks on the bottom of the defects, while after 8–12 weeks a repair tissue filled near 30–40 percent of the defect. At 8 weeks, the newly synthesized tissue was composed of a fibrous mesh including some cells. However, at 12 weeks it showed a hypercellular hyaline‐like region. This hypercellular region showed excellent bonding with the native cartilage, cells were located in numerous lacunae, and a high content of proteoglycans as indicated by an intense toluidine blue stain was observed. The repaired tissue showed positive immunostaining for both type I and II collagen, as well as chondroitin‐4‐sulfate, chondroitin‐6‐sulfate, keratan sulfate, and integrin subunit β1. Positive staining for porcine anti‐CD46 was localized exclusively in the neo‐synthesized tissue. We conclude that xenotransplantation of pig chondrocytes can repair, in an in vitro model, defects in human articular cartilage.
αv integrins play an important role in myofibroblast differentiation
Authors: Lygoe Kate A , Norman Jill T. , Marshall John F. , Lewis Mark P.
Published: July 2004

Transforming growth factor‐β1 is a potent mediator of the differentiation of fibroblasts into myofibroblasts, which is characterized by the appearance of the cytoskeletal protein α‐smooth muscle actin. The aim of this study was to investigate the role of integrin extracellular matrix receptors in transforming growth factor‐β1–induced myofibroblast differentiation. We show that blockade of the αv and/or β1 integrins prevents the transforming growth factor‐β1–induced myofibroblast differentiation, seen by the increased expression of α‐smooth muscle actin and enhanced collagen gel contraction in three human fibroblast cell lines (from the mouth, skin, and kidney). Further, blockade of αv specific integrins αvβ5 and αvβ3 suppressed myofibroblast differentiation in fibroblasts from the mouth and skin; however, in the kidney cells, the prevention of differentiation was seen only with blockade of αvβ5 integrin but not αvβ3. A possible reason for this result may be different degrees of responsiveness to transforming growth factor‐β1 treatment seen from different anatomical origins of the cell lines. These data indicate a novel role for αv integrins in the differentiation of human fibroblasts from the mouth, skin, and kidney into myofibroblasts and suggest that there is a common differentiation pathway.
Firsthand cigarette smoke alters fibroblast migration and survival: implications for impaired healing
Authors: Wong Lina S. , Martins‐Green Manuela
Published: July 2004

Although it is known that high levels of cigarette smoke lead to cell death, little is known about the effects of low‐to‐moderate levels of smoke components that are found in vivo, such as those experienced by cells in tissues. Clinical studies and experimental data show that smokers heal poorly and are more prone to develop fibrotic diseases. Here we show the effects of first‐hand cigarette smoke on fibroblasts, cells that are critically involved in these processes. Using doses of smoke found in the tissues of smokers and a variety of cell and molecular approaches, we show that these doses of cigarette smoke do not cause cell death but rather stimulate fibroblasts to produce stress response and survival proteins such as interleukin‐8, PKB/Akt, p53, and p21 that in turn contribute to an increase in cell survival. In addition, smoke‐treated cells show a decrease in cell migration, which can be explained by the increased cell adhesion and alterations in cytoskeletal elements. We also show that these levels of smoke cause changes in mitochondrial morphology with a minimum loss of function and these changes are the result of exposure to reactive oxygen species. We conclude that the increase in cell survival may lead to a build‐up of connective tissue in the area of a wound, potentially leading to delayed healing and/or fibrosis and that the alterations in the cytoskeleton and in cell adhesion result in inhibition of cell migration, a process that could lead to nonclosure of the wound for lack of proper fibroblast migration to form the healing tissue.
Quantitative and reproducible murine model of excisional wound healing
Authors: Galiano Robert D. , Michaels, V Joseph , Dobryansky Michael , Levine Jamie P. , Gurtner Geoffrey C.
Published: July 2004

The goal of animal wound healing models is to replicate human physiology and predict therapeutic outcomes. There is currently no model of wound healing in rodents that closely parallels human wound healing. Rodents are attractive candidates for wound healing studies because of their availability, low cost, and ease of handling. However, rodent models have been criticized because the major mechanism of wound closure is contraction, whereas in humans reepithelialization and granulation tissue formation are the major mechanisms involved. This article describes a novel model of wound healing in mice utilizing wound splinting that is accurate, reproducible, minimizes wound contraction, and allows wound healing to occur through the processes of granulation and reepithelialization. Our results show that splinted wounds have an increased amount of granulation tissue deposition as compared to controls, but the rate of reepithelialization is not affected. Thus, this model eliminates wound contraction and allows rodents' wounds to heal by epithelialization and granulation tissue formation. Given these analogies to human wound healing, we believe that this technique is a useful model for the study of wound healing mechanisms and for the evaluation of new therapeutic modalities.
Human β‐defensin‐2 expression is increased in chronic wounds
Authors: Butmarc Janet , Yufit Tatyana , Carson Polly , Falanga Vincent
Published: July 2004

First identified in psoriatic epidermis and subsequently in other inflammatory cutaneous lesions, human β‐defensin‐2 (hβD‐2) is one of two endogenous antimicrobial peptides related to defensins in plants and animals. Our objective was to determine the expression of hβD‐2 after injury and in chronic wounds. Biopsies of normal ipsilateral thigh skin and wound edges were taken from nine consecutive patients with venous leg ulcers (day 1) and from the same biopsy sites 2 days later (day 3). Sequential samples were also obtained from intact or meshed bilayered bioengineered skin consisting of neonatal human keratinocytes and dermal fibroblasts in a collagen matrix. Specimens were processed and immunostained for hβD‐2 using a polyclonal rabbit antibody. In both human tissues and bioengineered skin, staining for hβD‐2 was confined to the upper epidermal layers, sparing the basal cells. Analysis of 26 tissue samples from patients showed that normal skin had no hβD‐2 expression but that marked up‐regulation occurred after wounding by day 3. Conversely, chronic ulcers showed moderate‐to‐strong immunostaining for hβD‐2 at baseline on day 1, with little or no change in intensity after wounding by day 3. In vitro, bioengineered skin showed increased distribution of cytoplasmic hβD‐2 immunostaining after meshing. We conclude that the expression of hβD‐2 is up‐regulated after injury. Chronic wounds uniformly show a constitutively high baseline expression of hβD‐2, possibly due to ongoing tissue injury and bacterial colonization.
Comparison of oxidative stress biomarker profiles between acute and chronic wound environments
Authors: Moseley Ryan , Hilton Joanna R. , Waddington Rachel J. , Harding Keith G. , Stephens Phil , Thomas David W.
Published: July 2004

Increasing evidence implicates excessive reactive oxygen species (ROS) generation and ROS‐derived degradation products in the pathogenesis of many skin diseases. While numerous attempts have been made to identify prognostic biomarkers of wound healing in skin, these have met with limited success. This study examined the profiles of various oxidative stress biomarkers, namely total protein carbonyl content (from protein oxidation), malondialdehyde content (from lipid peroxidation), and the total antioxidant capacities, in acute wound fluid (n= 10) and chronic wound fluid (n= 12), using a rapid, noninvasive collection technique. Protein carbonyl content was quantified spectrophotometrically and by sodium dodecyl sulfate‐polyacrylamide gel electrophoresis/Western blotting, following 2,4‐dinitrophenylhydrazine derivitization. Malondialdehyde levels were similarly quantified, following N‐methyl‐2‐phenylindole derivitization. Total antioxidant capacity was determined via wound fluid inhibition of cytochrome C reduction by a superoxide radical flux. Acute wound fluid contained higher protein carbonyl content than chronic wound fluid, particularly evident following sodium dodecyl sulfate‐polyacrylamide gel electrophoresis/Western blot analysis under nonreducing and reducing conditions (p < 0.001 and p < 0.02, respectively), related to significantly higher protein levels (p = 0.0005) in acute wound fluid. Human serum albumin (∼66 kDa) was identified as the most prominent protein oxidized in both acute and chronic wound fluid, which may contribute to the reduced albumin and total protein levels in chronic wound fluid. No significant difference (p > 0.1) in malondialdehyde levels or total antioxidant capacities were determined between acute and chronic wound fluids, although chronic wound fluid exhibited significantly higher total antioxidant capacities (p < 0.005), accounting for variations in wound fluid protein content. These findings suggest an adaptation in the antioxidant profiles of chronic wound fluid to counteract the loss of consumed antioxidants in the chronic wound environment. This study highlights the roles of ROS/antioxidants in skin wound healing, their possible involvement in chronic wounds and the potential value of ROS‐induced biomarkers in wound healing prognosis.
Alpha‐smooth muscle actin in pathological human disc nucleus pulposus cells in vivo and in vitro
Authors: Hastreiter Dawn , Chao Jeannie , Wang QI , Ozuna Richard M. , Spector Myron
Published: July 2004

That a contractile actin isoform has been found in cells of other cartilage tissues in healing and disease states prompted this investigation of the presence of α‐smooth muscle actin (α‐SMA) in pathological human intervertebral disc tissue. The presence of this isoform has been reported in human intervertebral disc specimens obtained at autopsy from subjects for whom there were no reported symptoms. An objective of this study was to evaluate the cell density and percentage of α‐SMA–containing cells in pathological nucleus pulposus tissue obtained from lumbar disc surgery from 17 patients. Additionally, explants of nucleus pulposus material were cultured to determine how α‐SMA expression changed with time in vitro. Seventy‐six 5‐mm diameter explants (approximately 2 mm thick) pooled from six lumbar surgeries were cultured for 1, 2, 4, or 6 weeks. Microtomed sections of paraffin‐embedded specimens were stained with hematoxylin and eosin or a monoclonal antibody to α‐SMA. Histologically, cells were categorized as to α‐SMA phenotype (positive or negative), and the areal cell density was determined. The evaluation of the cultured nucleus pulposus explants also included documentation of the percentage of cells that were round or elongated and the percentage of the cells that were part of a group (group: ≥ 2 cells). Every nucleus pulposus section exhibited the presence of α‐SMA–containing cells, which accounted for approximately 24 percent of the cells in vivo. In vivo, the cell density was significantly higher in older individuals (p = 0.02). The average time for cell outgrowth from the explants was 8.6 days. Approximately 10–15 percent of the cells in the explants stained positive for α‐SMA. The time in culture had no significant effect on any of the outcome measures except the percentage of α‐SMA–containing cells that were round (p = 0.008), with values decreasing through 4 weeks and then slightly rising at 6 weeks. The role of α‐SMA in intervertebral disc pathology warrants further investigation.
Bioelastic membranes for topical application of a thromboxane synthetase inhibitor for protection of skin from pressure injury: a preliminary study
Authors: Kemppainen Barbara W. , Urry Dan W. , Swaim Steven F. , Sartin Eva A. , Gillette Robert L. , Hinkle Sherri H. , Coolman Shindok L. , Luan Chi‐Xiang , Xu Jie
Published: July 2004

A previous study showed that topical exposure to bioelastic‐thromboxane synthetase inhibitor‐matrix resulted in local tissue concentrations of thromboxane synthetase inhibitor sufficient for thromboxane synthetase inhibition. The objective of this research was to use an animal model to determine if a dressing having controlled release of thromboxane synthetase inhibitor (dazmegrel) could be used to prevent tissue breakdown over pressure points, i.e., lesion at the assistive device–skin interface. The animal model studies utilized the greyhound, a dog that has thin skin, angular conformation, limited body fat and is predisposed to pressure ulcers similar to those occurring in humans. The model uses a short‐limb walking cast on one pelvic limb with the severity of the dermal pressure lesions induced over the medial malleolus controlled by the amount of padding in the cast and length of time the cast is in place. The bioelastic matrix loaded with dazmegrel provided protection from shearing and pressure skin injury over the medial malleolus, as evidenced by a decrease in epidermal abrasion/ulceration as measured with planimetry. Histopathologic evaluation of the skin over the medial malleolus indicated a protective function of the bioelastic matrix as measured as lower numbers of neutrophils, lymphocytes, and decreased collagen density compared to such numbers when no bioelastic matrix was present. These studies provided evidence that bioelastic‐thromboxane sythetase inhibitor‐ matrix helps in preventing or reducing the severity of pressure lesions, e.g., assistive device–skin interface wounds.
Effects of pre‐slaughter nutritional condition on intramuscular collagen solubility, pyridinoline cross‐links and meat tenderness in aged goats
Authors: SHIBA Nobuya , MATSUZAKI Masatoshi , TSUNEISHI Eisaku
Published: July 2004

Effects of preslaughter nutritional condition on intramuscular collagen characteristics were studied, in order to clarify the potential of intensive feeding to aged animals in improving meat tenderness. Ten castrated male goats were assigned into one of two groups: one group was allowed ad libitum access to a concentrate diet (total digestible nutrients 70%, crude protein 15%) and Italian ryegrass hay (ADLIB‐group), and the other group was fed a restricted amount of their diet (concentrate diet 0.5% of bodyweight/day; hay 1.5% of bodyweight/day) to maintain their bodyweight (MAIN‐group). After 3 months of the experimental period, goats were slaughtered and meat samples were obtained immediately. Goats in ADLIB‐group had lower total and insoluble collagen concentrations, higher fat concentrations and collagen solubility than those in MAIN‐group, but soluble collagen concentrations of muscles were similar for both groups. Goats in ADLIB‐group had lower pyridinoline concentrations than those in MAIN‐group, in all muscles, but the differences of pyridinoline concentration between the groups were not statistically significant. Warner‐Bratzler shear force values of Longissimus and Biceps femoris muscles were lower in ADLIB‐group than in MAIN‐group. The increase of meat tenderness by preslaughter intensive feeding seemed to be associated with the increase in intramuscular fat deposition and high collagen solubility, and pyridinoline cross‐link appeared to be one of the factors related to collagen solubility.
Clearing the cervical spine after polytrauma: implementing unified management for unconscious victims in the intensive care unit
Authors: Morris C. G. , Mullan B.
Published: July 2004

Determining the best method for excluding cervical spine injury while a polytrauma victim is unconscious remains a controversial topic despite a number of published guidelines. A structured questionnaire demonstrated major differences between intensivists, neurosurgeons, orthopaedic surgeons and spinal surgeons with regard to the imaging modalities requested, the perception of their performance, the relative risks of missed injuries and the complications of immobilisation. Unconscious victims of polytrauma often come under the care of several subspecialties, with the direct consequence that management can be contradictory and lack standardisation. Advanced Trauma Life Support and Eastern Association for the Surgery of Trauma guidelines can reinforce and even contribute to non‐standardised care. Having performed this clinician survey, we have now developed a multidisciplinary management protocol appropriate for Northern Ireland.
An audit of peribulbar blockade using 15 mm, 25 mm and 37.5 mm needles, and sub‐Tenon's injection*
Authors: Van Den Berg A. A.
Published: July 2004

The efficacy of peribulbar anaesthesia performed with short, medium and long needles, with sub‐Tenon's injection as a control, was audited. Two hundred patients undergoing cataract surgery underwent peribulbar injection using 25G needles of the following lengths: 15 mm, 25 mm or 37.5 mm. Sub‐Tenon's injections were performed with a curved 25‐mm sub‐Tenon anaesthesia cannula. The injection technique, ocular akinesia and analgesia scoring system, and supplementary injection protocols were standardised. After initial injections of local anaesthetic via the sub‐Tenon's cannula or with 37.5 mm, 25 mm and 15 mm needles, supplementation was required in one (2%), 13 (26%), 22 (44%) and 32 (64%) of patients, respectively; the total number of supplementary injections required were 1, 16, 35 and 47, respectively. It is concluded that the efficacy of peribulbar anaesthesia depends upon the proximity of the deposition of local anaesthetic solution either to the globe or orbital apex. These data justify the classification of peribulbar anaesthesia into: circum‐ocular (sub‐Tenon's, episcleral), peri‐ocular (anterior, superficial); peri‐conal (posterior, deep) and apical (ultra‐deep) for teaching purposes.
Integrated approaches to academic anaesthesia – the Cambridge experience
Authors: Menon D. K. , Wheeler D. W. , Wilkins I. A. , Phillips P. D. , Fletcher S. J. , Penfold N. W. , Smith H. L. , Gupta A. K. , Matta B. F.
Published: July 2004

There is mounting concern about the pressures experienced by University Departments of Anaesthesia, which, if lost, could threaten undergraduate peri‐operative medicine teaching, development of critical appraisal skills among anaesthetists, and the future of coherent research programs. We have addressed these problems by establishing a foundation course in scientific methods and research techniques (the Cambridge SMART Course), complemented by competitive, fully funded, 12‐month academic trainee attachments. Research conducted during academic attachments has been published and used to underpin substantive grant applications allowing work towards higher degrees. Following the attachment, a flexible scheme ensures safe reintroduction to clinical training. Research at consultant level is facilitated by encouraging applications for Clinician Scientist Fellowships, and by ensuring that the University Department champions, legitimises and validates the allocation of research time within the new consultant contract. We believe that these are important steps in safeguarding research and teaching in anaesthesia, critical care and peri‐operative medicine.
An American tale – professional conflicts in anaesthesia in the United States: implications for the United Kingdom
Authors: Kane M. , Smith A. F.
Published: July 2004

Professional conflict between nurse anaesthetists and anaesthesiologists in the United States of America is well known in the UK but has not been explored and documented in detail. We present an account, based on critical analysis of published literature and other documentary evidence, of the historical, professional and financial factors which have led to this. In the USA, anaesthesia developed as a nursing specialty until physicians began to take on this work after the Second World War. Payment arrangements between the 1960s and the 1990s made anaesthesiology a lucrative career choice for medical graduates and this led both to considerable growth in the number of anaesthesiologists and to a strengthening of the resolve of nurse anaesthetists to retain their scope of work and preserve their professional status. Changes in payment regulations in the 1980s and 1990s threatened anaesthesiologists' income and led to re‐appraisal of evidence over relative cost‐effectiveness and safety of different provider models. More recently, the terms of engagement have shifted from disputes over evidence to political lobbying to promote the professional capabilities and status of each of the anaesthesia providers. Factors of relevance to possible changes in the provision of anaesthesia in the United Kingdom are highlighted.
Effects of the European Working Time Directive on anaesthetic training in the United Kingdom
Authors: Sim D. J. , Wrigley S. R. , Harris S.
Published: July 2004

Decreases in the hours worked by trainee anaesthetists are being brought about by both the New Deal for Trainees and the European Working Time Directive. Anticipated improvements in health and safety achieved by a decrease in hours will be at the expense of training time if the amount of night‐time work remains constant. This audit examined the effects of a change from a partial to a full shift system on a cohort of trainee anaesthetists working in a large district general hospital in the South‐west of England. Logbook and list analyses were performed for two 10‐week periods: one before and one after the decrease in hours. An 18% decrease in the number of cases done and an 11% decrease in the number of weekly training lists were found for specialist registrars. A 22% decrease in the number of cases done and a 14% decrease in the number of weekly training lists were found for senior house officers. Furthermore, a decrease of one service list per specialist registrar per week was seen, which will have implications for consultant manpower requirements.
Evaluation of Frova, single‐use intubation introducer, in a manikin. Comparison with Eschmann multiple‐use introducer and Portex single‐use introducer*
Authors: Hodzovic I. , Latto I. P. , Wilkes A. R. , Hall J. E. , Mapleson W. W.
Published: July 2004

In a randomised cross‐over study, 48 anaesthetists attempted to place a Frova single‐use introducer, an Eschmann multiple‐use introducer and a Portex single‐use introducer in the trachea of a manikin set up to simulate a grade 3 laryngoscopic view. The anaesthetists were blinded to success (tracheal placement) or failure (oesophageal placement). Successful placement (proportion, 95% confidence interval) of either the Frova introducer (65%, 50–77%) or the Eschmann introducer (60%, 46–73%) was significantly more likely than with the Portex introducer (8%, 3–20%). There were no significant differences between the success rates for the Frova and the Eschmann introducers. A separate experiment revealed that the peak force exerted by the Frova and Portex introducers was two to three times greater than that which could be exerted by the Eschmann introducer, p < 0.0001, indicating that the single‐use introducers are more likely to cause tissue trauma during placement.
Plasma volume changes associated with two hydroxyethyl starch colloids following acute hypovolaemia in volunteers
Authors: James M. F. M. , Latoo M. Y. , Mythen Michael G. , Mutch M. , Michaelis Christian , Roche A. M. , Burdett Edward
Published: July 2004

This randomised double blind prospective study compared the effective intravascular volume expansion and maintenance, with two types of starches following induced haemorrhagic hypovolaemia. Twenty healthy male volunteers aged between 18 and 65 year were bled 10% of their total blood volume in fully monitored conditions and under the supervision of a trained specialist doctor and research nurse. The lost blood volume was replaced using one of the starch solutions. Effective intravascular volume expansion was monitored hourly using the 51Cr radio‐labelled red blood cell dilution technique, we compared the effects of two hydroxyethyl starch colloid preparations, one a high molecular weight and the other a low molecular weight preparation, on the plasma volume changes over time. The large molecular weight starch (Hextend) provided a less well‐sustained volume expansion effect than the smaller one (Voluven)
Impact of spinal anaesthesia and obesity on maternal respiratory function during elective Caesarean section*
Authors: Von Ungern‐Sternberg B. S. , Regli A. , Bucher E. , Reber A. , Schneider M. C.
Published: July 2004

Spinal anaesthesia for Caesarean section has gained widespread acceptance. We assessed the impact of spinal anaesthesia and body mass index (BMI) on spirometric performance. In this prospective study, we consecutively assessed 71 consenting parturients receiving spinal anaesthesia with hyperbaric bupivacaine and fentanyl for elective Caesarean section. We performed spirometry during the antepartum visit (baseline), immediately after spinal anaesthesia, 10–20 min, 1 h, 2 h after the operation, and after mobilisation (3 h). Baseline values were within normal ranges. There was a significant decrease in all spirometric parameters after effective spinal anaesthesia that persisted throughout the study period. The decrease in respiratory function was significantly greater in obese (BMI > 30 kg.m−2) than in normal‐weight parturients (BMI < 25 kg.m−2), e.g. median (IQR) vital capacity directly after spinal anaesthesia; −24 (−16 to −31)% vs. −11 (−6 to −16)%, p < 0.001 and recovery was significantly slower. We conclude that both spinal anaesthesia and obesity significantly impair respiratory function in parturients.
Retracted: Reversal of vecuronium with neostigmine in patients with diabetes mellitus
Authors: Saitoh Y. , Hattori H. , Sanbe N. , Nakajima H. , Akatu M. , Murakawa M.
Published: July 2004

Reversal of vecuronium‐induced neuromuscular blockade with neostigmine was compared in two groups of 16 subjects: patients with Type 2 diabetes mellitus and normal controls. When the first twitch of the train‐of‐four had returned to 25% of the control value, neostigmine 40 μg.kg−1 and atropine 20 μg.kg−1 were given to reverse the neuromuscular blockade. The train‐of‐four ratio was lower at 3 min, 6 min, 9 min, 12 min and 15 min after reversal in the diabetic group than in the control group but the differences did not reach statistical significance. Fifteen minutes after reversal, the number of patients in whom recovery from neuromuscular blockade was judged insufficient to guarantee good respiratory function (train‐of‐four ratio < 0.74) did not differ between the groups. However, 15 min after reversal, the number of patients with a train‐of‐four ratio < 0.9 was significantly higher in the Diabetic Group than in the Control Group (15 vs. 10, p = 0.033).
Variation in the transcription of laboratory data in an intensive care unit
Authors: Black R. , Woolman P. , Kinsella J.
Published: July 2004

Manual transcription of numerical data is prone to error. We quantified the transcription error rate for blood results recorded in a critical care setting by comparing the handwritten and printed laboratory results in 100 consecutive patients in the intensive care unit, Glasgow Royal Infirmary. Nine hundred and fifty‐four sets of results with 4664 individual values were analysed. There was complete and accurate transcription in 67.6% (n = 645) of cases, a failure to transcribe in 23.6% (n = 225) and inaccurate transcription in 8.8% (n = 84). Transcription was significantly more accurate in the morning (p = 0.02). This study highlights that our current system of recording blood results is unreliable. These results strengthen the case for computerisation of the patient record in terms of data retrieval and transcription accuracy.
The effect of critical care outreach on postoperative serious adverse events
Authors: Story D. A. , Shelton A. C. , Poustie S. J. , Colin‐Thome N. J. , McNicol P. L.
Published: July 2004

We proposed that critical care outreach would decrease the incidence of postoperative serious adverse events and so conducted a sequential cohort study with a surveillance‐only phase (baseline) followed by an intervention phase. We studied high‐risk patients in a large Australian hospital. A critical care qualified nurse reviewed patients for the first three days after return to the general wards. During the intervention phase the nurse intervened in patient care where appropriate. We examined the incidence of 11 categories of serious adverse events per 100 patients during the first three days on the general wards during the surveillance and intervention phases. The surveillance phase had 319 patients and the intervention phase 345 patients. In a subgroup analysis, there were four myocardial infarctions per 100 patients in the surveillance phase and seven per 100 patients during the intervention phase (95% confidence interval: 1–7 infarctions per 100 patients increase). For the other 10 serious adverse events there were 19 per 100 patients in the surveillance phase and 11 per 100 patients in the intervention phase (95% confidence interval: 4–11 serious adverse events per 100 patients decrease). Outreach may have led to greater detection of myocardial infarctions while reducing the incidence of other serious adverse events.
Provision of long‐term venous access procedures by UK anaesthetists: A postal survey
Authors: Johnson D. , Bodenham A.
Published: July 2004

Long‐term venous access is widely used in hospital and in the community for cancer chemotherapy, total parenteral nutrition and long‐term administration of antibiotics. There is a large variety of catheters, ports and other devices designed to facilitate these treatments. A postal survey of anaesthetic departments in England, Wales, Scotland and Northern Ireland was undertaken to assess the role of anaesthetists in this area of clinical practice. Two hundred and fifteen out of 276 (78%) anaesthetic departments responded. Forty‐three percent of departments (92 out of 215) provided some form of long‐term vascular access service. Twenty‐two percent of departments which provided this service (20 out of 92) had anaesthetists with sessional allocation for such procedures. Such work represents a significant workload for anaesthetic departments which is likely to increase over time.
Ximelagatran, a new oral direct thrombin inhibitor, for the prevention of venous thromboembolic events in major elective orthopaedic surgery. Efficacy, safety and anaesthetic considerations
Authors: Rosencher N.
Published: July 2004

The oral direct thrombin inhibitor ximelagatran shows great promise for prevention of venous thromboembolic events following major elective orthopaedic surgery. Its consistent and predictable pharmacokinetics and pharmacodynamics across a wide range of patient populations allow administration with fixed dosing and with no coagulation monitoring. In orthopaedic surgery clinical trials, ximelagatran was effective and well tolerated compared with standard therapy, with dose and timing relative to surgery important factors in determining its optimal profile. In European trials, an initial 3‐mg postoperative dose of subcutaneous melagatran, the active form of ximelagatran, followed by oral ximelagatran 24 mg twice daily achieved similar efficacy and safety to enoxaparin. Although the risk of spinal haematoma following neuraxial anaesthesia is rare, it is increased by the concomitant use of anticoagulants. In orthopaedic surgery trials with ximelagatran to date, complications such as spinal haematoma have not been reported. The pharmacokinetic profile of ximelagatran suggests that concurrent use with neuraxial anaesthesia should require no further precautions than those currently necessary with low‐molecular‐weight heparin.
The air elimination capabilities of pressure infusion devices and fluid‐warmers
Authors: Schnoor J. , Macko S. , Weber I. , Rossaint R.
Published: July 2004

Pressurised infusion devices may have only limited capability to detect and remove air during pressurised infusions. In order to assess pressure infusion systems with regard to their actual air elimination capabilities four disposable pressure infusion systems and fluid warmers were investigated: The Level 1® (L‐1), Ranger ® (RA), Gymar® (GY), and the Warmflo® (WF). Different volumes of air were injected proximal to the heat exchanger and the remaining amount of air that was delivered at the end of the tubing was measured during pressurised infusions. Elimination of the injected air (100–200 ml) was superior by the RA system when compared to L‐1 (p < 0.01). The GY and WF systems failed to eliminate the injected air. In conclusion, air elimination was best performed by the RA system. In terms of the risk of air embolism during pressurised infusions, improvements in air elimination of the investigated devices are still necessary.
Analysis of the moral habitability of the nursing work environment
Authors: Peter Elizabeth H. , Macfarlane Amy V. , O'Brien‐Pallas Linda L.
Published: July 2004

Background.  Following health reform, nurses have experienced the tremendous stress of heavy workloads, long hours and difficult professional responsibilities. In recognition of these problems, a study was conducted that examined the impact of the working environment on the health of nurses. After conducting focus groups across Canada with nurses and others well acquainted with nursing issues, it became clear that the difficult work environments described had significant ethical implications.

Aim.  The aim of this paper is to report the findings of research that examined the moral habitability of the nursing working environment.

Methods.  A secondary analysis was conducted using the theoretical work of Margaret Urban Walker. Moral practices and responsibilities from Walker's perspective cannot be extricated from other social roles, practices and divisions of labour. Moral‐social orders, such as work environments in this research, must be made transparent to examine their moral habitability. Morally habitable environments are those in which differently situated people experience their responsibilities as intelligible and coherent. They also foster recognition, cooperation and shared benefits.

Findings.  Four overarching categories were developed through the analysis of the data: (1) oppressive work environments; (2) incoherent moral understandings; (3) moral suffering and (4) moral influence and resistance. The findings clearly indicate that participants perceived the work environment to be morally uninhabitable. The social and spatial positioning of nurses left them vulnerable to being overburdened by and unsure of their responsibilities. Nevertheless, nurses found meaningful ways to resist and to influence the moral environment.

Conclusions.  We recommend that nurses develop strong moral identities, make visible the inseparability of their proximity to patients and moral accountability, and further identify what forms of collective action are most effective in improving the moral habitability of their work environments.
Implementing local pay systems in nursing and midwifery
Authors: Meerabeau Elizabeth , Corby Susan , Druker Janet , White Geoffrey
Published: July 2004

Background.  The paper is based on a case study, which was part of a Department of Health commissioned research study covering 10 National Health Service (NHS) trusts in England that had adopted a range of approaches to the employment terms and conditions of nurses, midwives, and other non‐medical staff, as the precursor to evaluating Agenda for Change, the modernized pay system for the NHS.

Aim.  The aim of this paper is to discuss a case study of the effects of changing nurses’ pay progression.

Methods.  Fieldwork took place in 2000, and included interviews with managers, union representatives and other staff, and analysis of internal documents.

Findings.  Findings discussed include the constraints on managers when devising a new pay system, the time and detailed work needed and the challenges of assessing their effects (particularly in relation to patient care). Although the latter are difficult to assess, staff involved in the scheme reported benefits from the closer focus on competences which resulted from the scheme.

Conclusions.  The effects of changes to pay schemes are difficult to assess, and the evaluation of the proposed national scheme (Agenda for Change) will be challenging.
School nurses: policies, working practices, roles and value perceptions
Authors: Croghan Emma , Johnson Carol , Aveyard Paul
Published: July 2004

Background.  In the UK, school nursing has recently been at the forefront of policy change, with school nurses being considered pivotal to child‐centred public health practice. There is very little literature on this topic and, in particular, little that is written from a practitioner perspective.

Aim.  This paper reports a survey that examines the work of school nurses compared with the expectations of their first line managers and policy‐makers in government, in order to discover any potential practical or ideological areas of conflict.

Methods.  We first applied a theoretical framework of sensitizing concepts to the historical, political, cultural and contextual background of school nursing. Following this, 46 school nurses in the West Midlands region of the UK were randomly selected and asked to complete a questionnaire about their personal characteristics, experience, training and working practices. The 38 nurses who completed this were then interviewed. Job descriptions for school nurses and governmental job expectations were obtained from various official sources and compared with the self‐reported practices of school nurses.

Findings.  All the nurses met the work criteria of their local employers, except in respect of health needs assessment activities, which two nurses had not yet attempted. All 38 also carried out a range of additional work activities, including providing sexual health services and parental support clinics. They also had a diverse range of skills and qualifications relevant to supporting the needs of their local communities. Qualitative data from interviews provided a useful insight into nurses’ feelings of being valued by their clients and by local and national employers, and feelings of professional undervaluing by their peers. They felt positive about role changes in the last few years, and that they supported the child‐centred public health role advocated by public policy.

Conclusions.  The practice of the school nurses in this study covered what employers and policy‐makers required, with the notable exception of health needs assessment, which nurses were uncomfortable and unconfident about. The theoretical framework used provides a useful starting point for examining how school nursing has developed into its current role.
Nurses’ attitudes towards lesbians and gay men
Authors: Röndahl Gerd , Innala Sune , Carlsson Marianne
Published: July 2004

Background.  During the last decade, official policy and Swedish legislation have strengthened the legal rights of homosexuals and demanded tolerance for this group. There is evidence in the literature that homosexual patients have experienced negative attitudes and poor quality care from nurses, and may be unwilling to disclose their sexuality because of fears of discriminatory treatment.

Aims.  The aim of this paper is to report a study that investigated the attitudes of nurses towards lesbians and gay men and nurses beliefs about the causes of homosexuality.

Method.  The study had a descriptive, comparative design. The Attitudes Toward Homosexuality Scale was used, along with Causes of Homosexuality Questionnaire. The participants were Registered Nurses and Assistant Nurses from one infectious disease clinic in central Sweden (response rate 67%, n = 57), and students enrolled in a university nursing programme and in upper secondary assistant nurses’ training (response rate 62%, n = 165).

Results.  In general, participants expressed positive attitudes (62%). Nurses expressed the most positive attitudes, whereas the assistant nursing students expressed the least positive attitudes. A minority of the sample (30%) expressed neither positive nor negative attitudes. The most common belief about the cause of homosexuality was that it was congenital. Those who held this belief expressed more positive attitudes towards homosexuality than those who believed that homosexuality was acquired. Limitations of the study were that the sample was relatively small and not randomly selected.

Conclusion.  This study demonstrated that attitudes have improved towards homosexuals compared with earlier international studies, although more needs to be done to increase the positive attitudes among the nursing staff and students with neutral attitudes (neither positive nor negative attitudes) to enhance the wellbeing of homosexual persons. General education about homosexuality is a necessary beginning to make homosexual patients visible, which is an important aspect of practical nursing ethics.