bluuebunny/crossref_metadata_2025 huggingface dataset:
Dobutamine stress surface mapping of myocardial ischemia in Kawasaki disease
Authors: Takechi Nobuyuki , Seki Takashi , Ohkubo Takashi , Ogawa Shunichi
Published: March 2003

Abstract
 

Background
: To detect and localize myocardial ischemia, a method that does not require physical exertion is sometimes needed in children with Kawasaki disease.

Methods
: Dobutamine stress body surface mapping was performed in 115 children with a history of Kawasaki disease (58 without coronary artery lesions, 40 who had coronary lesions without myocardial ischemia and 17 with myocardial ischemia). The maximum infusion rate of dobutamine was 30 μg/kg per min. Myocardial ischemia was diagnosed by the presence of an area of hypoperfusion on scintigraphy at rest and/or an increase in hypoperfusion during a dobutamine stress test compared with resting scintigraphy. We studied the number of leads that showed significant ST depression on the isopotential map (nST), the number of the row containing the lead with the smallest negative value on the isointegral map (Imin), and the localization of myocardial ischemia on the isointegral map. Based on findings in patients without coronary artery lesions, we defined the criteria for detecting myocardial ischemia as nST ≥ 1 and Imin≤ 4.

Results
: The sensitivity of detecting myocardial ischemia was 94.1% using nST and 41.7% using Imin, while the specificity of these methods was 98.9 and 96.9%, respectively. The localization of myocardial ischemia on stress body surface mapping was 100% concordant with that determined by stress myocardial scintigraphy.

Conclusions
: Dobutamine stress body surface mapping for the detection of myocardial ischemia is a non‐invasive, more convenient and repeatable test compared with exercise myocardial scintigraphy and it is a more objective test compared with exercise echocardiography. Dobutamine stress body surface mapping is useful for the identification and localization of silent myocardial ischemia in pediatric patients with Kawasaki disease, especially those who cannot perform tests involving physical exercise.
Skeletal development of achondroplasia: Analysis of genotyped patients
Authors: Matsui Yoshito , Kawabata Hidehiko , Ozono Keiichi , Yasui Natsuo
Published: March 2003

Abstract

Background
: Achondroplasia is a skeletal dysplasia caused by substitution of arginine for glycine at codon 380 (G380R) mutation of the fibroblast growth factor receptor 3. To date, the developmental course of the phenotype (short stature and skeletal characteristics) has not been clarified in the genotyped population.

Methods
: The relationship between age and clinical data (height, arm span and measurements of skeletal radiographs) were statistically analyzed from 27 achondroplasia patients with the G380R genotype.

Results
: The height standard deviation score had positive correlation and decreased with age, while span‐to‐height ratio did not. Among measurements of skeletal radiographs, the pelvic index, which represents the squared pelvis deformity, were correlated and increased with age. However, interpedicular distance of the first and fourth lumbar vertebrae (L1:L4) ratio as an index for the caudally narrowed pattern of the lumbar spinal canal and fibula‐to‐tibia ratio for the disproportionally long fibulae were not correlated and did not increase with age.

Conclusion
: In making a clinical diagnosis of achondroplasia in early infancy, it should be noted that short stature and squared pelvis deformity are not prominent.
Childhood hypoplastic anemia with sugar chain anomaly of red cell membranes
Authors: Shibuya Atsushi
Published: March 2003

Abstract

Background
: Childhood hypoplastic anemia of unknown etiology had not existed until now. To assess pathophysiological differentiation in childhood hypoplastic anemia, we analyzed red cell membrane components in six children with hypoplastic anemia of unknown etiology.

Methods
: The six children all had chronic moderate anemia and thrombocytopenia. They also showed hypoplastic marrow cellularity with erythroblastopenia, megakaryocytopenia, and mild morphological anomalies (pelger Hëut anomaly of neutrophils and bi‐ or trinuclear erythroblasts), except for one child who had normal platelets and megakaryocytes. Red blood cells of patients and several anemic children, cord blood and healthy controls were analyzed by the peanut lectin agglutination (PNA) test, flow cytometry, sodium dodecyl sulfate_polyacrylamide gel electrophoresis of membrane proteins, high performance liquid chromatography (HPLC) of sugar chains and the colony‐forming assay of bone marrow erythroblasts.

Results
: In the six children, the PNA agglutination test showed a persistent positive reaction not only for peripheral red blood cells but also for bone marrow erythroblasts. This was not observed in other anemic children and healthy controls. With HPLC analysis, the sugar chains of red blood cell membranes showed the loss of sialic acid from O‐linked oligosaccharides.

Conclusions
: Our results suggested that the abnormality of red blood cells from these patients was attributable to abnormal surface sugar chains (loss of sialic acid from O‐glycan), which are already present at the erythroblast stage in the bone marrow and that may be responsible for a group of anemias.
Comparative randomized study: Administration of natural and synthetic surfactant to premature newborns with respiratory distress syndrome
Authors: Giannakopoulou Christina , Hatzidaki Eleftheria , Korakaki Eftychia , Christodoulaki Maria , Margari Kalliope‐Maria , Mamoulakis Dimitris
Published: March 2003

Abstract
Background
: The respiratory distress syndrome (RDS) in premature newborns has been etiologically correlated to immature lungs and specifically with surfactant deficiency. Exogenous administration of surfactant is nowadays considered to be the treatment of choice. In this paper we attempt a comparison of clinical results from the administration of natural Alveofact and synthetic Exosurf surfactants in premature newborns with respiratory distress syndrome.

Methods
: The study subjects were 92 premature newborns who had been hospitalized in the Department of Neonatology, of the University of Crete. A total of 42 subjects received synthetic surfactant and 50 subjects received natural surfactant. The surfactant was administered in one to three doses, depending on respiratory support requirements.

Results
: The time of administration was a little
longer for the natural surfactant group. The duration of mechanical
ventilatory support, requiring oxygen, the duration of hospitalization
and the percentage of increase of arterial alveolar partial pressure
oxygen ratio (a/ΑPO2) were slightly
higher for the synthetic surfactant group. The mortality rate during
the neonatal period (28th day) was higher for the synthetic surfactant
group than for the natural surfactant group (38.1 vs 24%).
A similar tendency was noticed also as regards to complications,
e.g. pneumothorax (11.2 vs 5.2%; relative risk (RR)
0.27) intraventricular hemorrhage (34.6 vs 21.1%;
RR 0.61), septicemia (11.5 vs 5.2%; RR 0.46) and
bronchopulmonary dysplasia (12.5 vs 2.8%; RR 0.22).

Conclusion
: The use of natural surfactant seems to offer more advantages in comparison with its synthetic counterpart.
Developmental changes in cyclo‐oxygenase mRNA induction by hypoxia in rat kidney
Authors: Ogawa Tetsushi , Tomomasa Takeshi , Morikawa Akihiro
Published: March 2003

Background
: Prostaglandins, synthesized by cyclo‐oxygenase (COX), regulate renal hemodynamics and also epithelial water and solute transport. Developmental changes occur in COX‐2 mRNA expression and its response to lipopolysaccharide stimulation in rats. We examined age‐related changes in COX mRNA expression induced by hypoxia in the renal cortex and medulla of developing rats.

Methods
: Total RNA was extracted from 1‐ and 4‐week‐old male Wistar rats exposed to one or 4 h of hypoxia (8% O2). Cyclo‐oxygenase mRNA was quantitatively analyzed using a real‐time polymerase chain reaction with dual‐labeled fluorogenic probes.

Results
: Expression of COX‐1 mRNA did not change in response to hypoxia in the cortex or medulla in either infantile or adult rats. In infantile rats, COX‐2 mRNA expression was not induced by one or 4 h of hypoxia. In adults, 1‐ and 4‐h exposures to hypoxia induced COX‐2 mRNA in the renal cortex, and 1‐h of exposure induced COX‐2 mRNA in the medulla.

Conclusions
: Response of expression of COX‐2 mRNA in rats exposed to acute hypoxia show age‐related variability treated by acute hypoxia. Cyclo‐oxygenase‐2 might not play a major role in the hypoxic infantile rat kidney.
Investigation of risk factors for tonsillopharyngitis with macrolide resistant Streptococcus pyogenes in Turkish children
Authors: Çİftçİ Ergİn , DoĞru Ülker , Gürİz Haluk , Aysev Derya , İnce Erdal
Published: March 2003

Background
: Streptococcus pyogenes is the most important causative agent of tonsillopharyngitis. Although penicillin is the drug of choice in streptococcal tonsillopharyngitis, macrolides are recommended drugs in patients who have an allergy to penicillin. However, resistance to macrolides is an important problem in some regions of the world. Risk factors for resistance development have not been investigated sufficiently.

Objectives
: To investigate the risk factors for the development of tonsillopharyngitis with macrolide resistant S. pyogenes.

Methods
: Three hundred and forty‐five children with tonsillopharyngitis caused by S. pyogenes were investigated for various risk factors. Streptococcus pyogenes isolated from children's throat culture were examined for erythromycin, clarithromycin and azithromycin susceptibility.

Results
: Two hundred and sixty‐three children were found eligible for the analysis of risk factors. Resistances to erythromycin, clarithromycin and azithromycin were detected as 3.8, 4.2 and 4.2%, respectively. Macrolide use of the family members in the last 3 months (odds ratio = 7.04, P = 0.005) has been determined to be a risk factor for the development of tonsillopharyngitis with macrolide resistant S. pyogenes.

Conclusion
: Restriction of macrolide antibiotic use appears to be the most important measure to prevent the development of tonsillopharyngitis with resistant S. pyogenes.
Dual chamber cardiac pacing in children: Single chamber pacing dual chamber sensing cardiac pacemaker or dual chamber pacing and sensing cardiac pacemaker?
Authors: Bostan Özlem M. , Çeliker Alpay , Karagöz Tevfik , Özer Sema , Özme Şencan
Published: March 2003

Background
: Dual chamber pacemakers (single chamber pacing dual chamber sensing cardiac pacemaker (VDD) and dual chamber pacing and sensing cardiac pacemaker (DDD)) are being used frequently in children and adolescents. The aim of this study was to verify the safety and performance of the VDD and DDD pacing systems, and to evaluate the differences between two pacing modes with regard to atrial sensing and tracking functions.

Methods
: In this study, we evaluated 14 patients with VDD pacing and 15 patients with DDD pacing between 1994 and 2000. In the patient group with VDD pacing, all had congenital or acquired atrioventricular (AV) block. In the patient group with DDD pacing, 11 had congenital or acquired AV block, three had sinus node dysfunction with AV conduction disturbance and one had idiopathic hypertrophic subaortic stenosis. Twenty‐eight devices were implanted in the subpectoral area using the transvenous route. After implantation the atrial tracking capabilities of the pacing systems were analyzed by telemetry, Holter monitoring, and treadmill exercise testing.

Results
: The mean age of patients in the VDD pacing group was younger. The percentage of congenital heart disease was higher in the DDD pacing group. There was no significant difference regarding fluoroscopy time during implantation and follow‐up time between the two groups. During implantation, in the VDD pacing group the mean sensed atrial signal was 3.1 ± 1.3 mV and this decreased to 1.37 ± 0.68 mV (P < 0.05) during follow‐up. This pattern was also observed in DDD group (3 ± 2 mV vs 1.9 ± 1.5 mV, P < 0.05). Although the P wave measurement at implantation did not differ between the two groups, it was significantly higher in the DDD pacing group at the last control. Three patients with VDD pacing were reprogrammed to VVI or single chamber pacing and sensing, rate adaptive cardiac pacemaker because of complete loss of AV synchrony. There was no atrial sensing problem in the DDD pacing group. During the follow‐up, one patient with VDD pacing developed diaphragmatic stimulation and required lead revision. In one patient with DDD pacing, venous thrombosis occurred in the right subclavian vein and was treated with thrombolytic therapy. During treadmill exercise testing, in one patient with VDD and one patient with DDD pacing temporary failure of atrial sensing occurred. At 24 h Holter monitoring, intermittent loss of atrial sensing was documented in two patients with VDD pacing.

Conclusions
: Dual chamber pacing in children with DDD or VDD pacemakers is a suitable method for bradycardia treatment. Atrial sensing problems may occur in VDD pacemakers. Therefore, DDD pacing mode should be preferred whenever suitable for the patient to maintain the AV synchrony.
Nitric oxide further attenuates pulmonary hypertension in magnesium‐treated piglets
Authors: Haas Kelly Mullins , Suzuki Satoshi , Yamaguchi Nobuyuki , Kato Ineko , Ban Kyoko , Tanaka Taihei , Fukuda Sumio , Togari Hajime
Published: March 2003

Background
: Persistent pulmonary hypertension of the newborn (PPHN) commonly appears as a complication of several pulmonary and non‐pulmonary diseases. The hypoxia possibly inhibits Ca2+ ± dependent K+ channels, thus resulting in membrane depolarization of pulmonary smooth muscle cells, which leads to the opening of Ca2+ channels and Ca2+ entry, resulting in contraction of the vascular smooth muscle. However, magnesium (Mg2+) is an antagonist of Ca2+. We studied the effect of magnesium sulfate on the treatment of hypoxia‐induced pulmonary hypertension and compared to the site of action of nitric oxide (NO).

Methods
: Zero‐day‐old piglets were used in each experiment. The effects of Mg2+ were tested in each hypoxic, normoxic and hyperoxic states. Once the desired physical state was achieved, Mg2+ was administered at a dose of 100 mg/kg approximately every 10 min. In order to determine the exact mechanism of the Mg2+, Nw‐nitro‐l‐arginine (LNNA), a NO synthase‐inhibitor, was administered simultaneously with Mg2+ in some of the experiments.

Results
: There was a significant correlation between the percent reduction of the pulmonary arterial pressure (PAP) caused by magnesium and the level of oxygen (O2) present in the pulmonary artery. The greatest amount of reduction was seen in the hypoxic condition where the least amount of O2 is found. A further reduction in the PAP was seen when NO was given at the end of the Mg2+ trials. There was no significant reduction seen in the systemic arterial pressure.

Conclusion
: Inhaled NO further reduced the PAP in piglets already treated with Mg2+.
Natural progress of blood glucose in full‐term low‐grade low‐birthweight infants
Authors: Ishikawa Norio
Published: March 2003

Background
: Although various authors have suggested the risk of hypoglycemia in practical medicine for low‐birthweight infants is exaggerated, convincing evidence using recent definitions of hypoglycemia is not documented.

Methods
: To evaluate the risk of hypoglycemia in low grade low‐birthweight infants (LGLBWI) (2100 g < birthweight < 2500 g) whose only abnormality is low‐birthweight, whole blood glucose (BGw) was measured five times (0, 0.5, 1, and 4 h after birth and just before the first bottle feeding) in 49 LGLBWI and 38 normal birthweight infants.

Results
: Whole blood glucose was not lower in LGLBWI with a gestational age of 38−40 weeks (GT38LGLBWI) than in normal birthweight individuals with a gestational age of 38−40 weeks at each of the five measuring times. No case of GT38LGLBWI, not even in small for gestational age infants, required treatment for hypoglycemia. The BGw was significantly lower in 37‐week gestational age LGLBWI than in GT38LGLBWI at 0.5 h and 1 h after birth (P < 0.05). However, in all cases with low BGw value (below 30 mg/dL at 1 h after birth), BGw value increased naturally to the normal level 1.5 h after birth. No symptoms of hypoglycemia were observed.

Conclusions
: In the care of hypoglycemia in LGLBWI, attention should be paid first to gestational age, namely, tendency to prematurity. In this study, however, no hypoglycemia that required treatment was found among full‐term normal LGLBWI, even those who were small for gestational age. Frequent blood glucose measurement for those infants is therefore unnecessary.
An explanation of the coping strategies used by Community Psychiatric Nurses in Wales
Authors: Coyle Dave , Edwards Deborah , Hannigan Ben , Burnard Phillip , Fothergill Anne
Published: March 2003

Abstract Six hundred and fourteen Community Psychiatric Nurses (CPNs) were surveyed to estimate the extent to which they used various coping strategies in order to reduce occupation‐related stress. A questionnaire booklet, which included a number of validated measures and the Psychnurse methods of coping questionnaire, were used. ‘Having a stable home life that was separate from work’ and ‘knowing that my life outside of work is healthy, enjoyable and worthwhile’ were methods used most in order to cope with work‐based stress. ‘Through having team supervision’ and ‘by having confidential one to one supervision’ were the methods used the least. The mean overall coping scores were significantly higher for females and those who felt that they had job security. Those people who scored higher on the coping test instrument were significantly more likely to be older and have worked within the field of community mental health for longer. The current drive towards clinical supervision promoted through policy initiatives, appears not to be supported by these findings. The implications for CPN services and for further study are highlighted.
Use of nursing homes in Baccalaureate nursing education
Authors: Chen Shu‐Li , Witucki Janet , Melcher Pat , McKibben Mary Angela
Published: March 2003

Abstract Although the use of nursing homes in nursing education has been described in the published research, no current report exists outlining guidelines for faculty if they desire to use nursing homes for their undergraduate nursing courses. Thus, the purpose of this paper is to identify courses that are best taught in nursing homes and the approaches faculty can implement when using nursing homes for student experience. The use of nursing homes for the courses in fundamentals, leadership and management, research and community health is discussed. A step‐by‐step approach for faculty to initiate the use of nursing homes for undergraduate teaching is also provided. The nature of the faculty, the characteristics of nursing home settings and the characteristics within the community will affect students' learning experiences and effectiveness. Thus, it is important to consider nursing homes as appropriate for certain types of learning needs.
Factors influencing job satisfaction and ethical dilemmas in acute psychiatric care
Authors: Severinsson Elisabeth , Hummelvoll Jan K.
Published: March 2003

Abstract This study addressed the factors that nursing staff perceived as creating job satisfaction in their working environment in addition to addressing the ethical dilemmas that staff experienced within an acute psychiatric care setting. It also addressed how clinical supervision contributed to job satisfaction among staff as well as the differences between staff who attended and staff who did not attend to clinical supervision. Data were analyzed using descriptive statistics. Overall, the results of this study showed that the factors influencing nurses are related to areas of dissatisfaction, for example, stress and experiences with shortcomings. Factors that contribute to job satisfaction or dissatisfaction were found to be related to the nurses' value systems. The ethical dilemmas that were specifically addressed involved how to care for patients and handle work in relation to patients' autonomy, how to approach the patient, how to provide care against the will of the patient, and what action was ethically right for each particular patient.
Determinants of nursing service in urban public hospitals: An economic perspective
Authors: Kanda Katsuya , Kodama Shimpei
Published: March 2003

Abstract The purpose of the present study was to analyze the determinants of nurse staffing in urban public hospitals in Japan. The study sample included 51 public hospitals in 23 urban cities in 1996. Structural equation modeling was performed using the following: nurse‐to‐inpatient ratio; medical service and hospitalization fees; approved nurse staffing level; outpatient‐to‐inpatient ratio; subsidy‐to‐hospital‐revenue ratio; and regional variation index of inpatient service expenditures. The nurse‐to‐inpatient ratio was associated with medical service fees reflecting patients’ acuity levels and the subsidy‐to‐hospital‐revenue ratio, but was not associated with the hospital income from hospitalization fees (the largest share of which consists of nursing fees). Public hospitals in areas with limited inpatient care resources had a higher level of approved nurse staffing and a higher subsidy‐to‐hospital‐revenue ratio. A significant determinant of public hospitals’ nurse staffing was local government‐funded subsidization rather than the balance between nursing service fees and costs.
Nurses’ knowledge, attitudes and beliefs regarding substance use: A questionnaire survey
Authors: Happell Brenda , Carta Bill , Pinikahana Jaya
Published: March 2003

Abstract A questionnaire on nurses’ knowledge, attitudes, beliefs and practises regarding substance use was distributed to 302 nurses in Victoria. One hundred and thirty‐four returned the questionnaire, giving an overall response rate of 44.3%. The survey results showed that although knowledge and skill gaps exist in assessment and management of alcohol and drug problems, overall knowledge levels were adequate. Although positive attitudes towards substance use were expressed, specific educational programs to enhance nurses’ skills in assessment and management of substance‐related disorders may be beneficial.
Self‐Image of People in Their Fifties
Authors: Jamjan Laiad , Jerayingmongkol Prapasri
Published: March 2003

People in their fifties experience a transitional phase in aging. The impact of physical and emotional change is considerable due to deteriorated health and economic status. With the onset of aging, self‐image of the pre‐senescent provides an understanding of one's perceptions and thoughts on aging. Therefore, increased awareness of the pre‐senescents’ needs has resulted in further development of the nurse's role in health promotion. The main aim of this study was to gain a better understanding of self‐image, a key factor of health promotion in the pre‐senescent. The study participants consisted of 10 women in their fifties from the Aging Club at 43rd Health Center, Bangkok, Thailand. Focus group interview was used to explore self‐image. The interview focused on the concept of health, aging, retirement, and the impact of change.

Health results:  The majority (80%) of the participants agreed that the definition of health was the equilibrium of basic needs. The definition of good health to them was a delightful mood. They described the concept of good health as either the balance of excretion, sleep and rest, or being free of disease and personal illness. Three participants complained of health problems because they had to take care of their husbands. Deteriorated health was found to be the stimulus to such aging states as blurred vision, hearing loss, menopause, and osteoporosis.

Aging:  The participants accepted that aging was a naturally occurring phenomenon. ‘Age is only a number’, ‘If our minds are still young, our bodies will be youthful.’ They did not want to be called ‘old’.

Retirement:  Represents a time when they will be lonely and lack financial support. This also was described as the autumn of life. It was seen as the time to enjoy the golden years of life.

The impact of changes:  The participants experienced emotional changes such as increased sensitivity of feelings and needed family support. They also complained of physical changes (i.e. loss of appetite, teeth and agility). Only one participant, who had improved her emotional maturity, was proud of aging.

Conclusion:  For the pre‐senescent, the aging transition begins with the changes in one's physical and mental condition. An optimistic attitude towards this process enables the pre‐senescent to approach and better accept the process of aging. Nurses therefore need to continue to develop holistic approaches in caring for the aging.
Association of Activities of Daily Living and Indices of Mental Status with Subsequent 20‐year All‐Cause Mortality in an Elderly Japanese Population
Authors: Kushiro Wakako , Yokoyama Tetsuji , Date Chigusa , Yoshiike Nobuo , Tanaka Heizo
Published: March 2003

Purpose:  To examine the associations of activities of daily living (ADL) and indices of mental status with the risk of subsequent mortality in an elderly Japanese population.

Design:  Prospective cohort study.

Participants:  725 men and 984 women aged 65 years or older at time of baseline examination in 1976–1977.

Measurements:  Demographic data, levels of disability in ADL, and indices of mental status including self‐rated health (SRH), dementia, and depression.

Main outcome measures:  The subsequent 20‐year all‐cause mortality.

Results:  (1) Disability in ADL and several indices of mental status (i.e. bad SRH, high dementia score, decreased pleasure, low morale, and prone to tears) were significantly associated with an increased risk of subsequent 20‐year all‐cause mortality. (2) The risk of all‐cause mortality among people who had no disability in ADL with either of bad SRH, decreased pleasure, high dementia score, or low morale was similar to that among people who had some disability in ADL with either good SRH, increased pleasure, low dementia score, or high morale, respectively.

Conclusion:  There were strong associations among the levels of disability in ADL and several indices of mental status with subsequent mortality. It was concluded that good mental status may improve longevity even when elderly people have some disability in ADL.
Self‐Image of Aging: A Method for Health Promotion
Authors: Jamjan Laiad , Maliwan Vanda , Pasunant Nitaya , Sirapo‐ngam Yupapin , Porthiban Linchong
Published: March 2003

In 2020, 15.25% of the Thai population will be over 60. The elderly are those who are considered to be retired and unemployed. Their physical and mental conditions are rapidly changing. They experience many health problems as the result of deteriorating health. Consequently, the health‐care team needs to focus on the elderly's perception of health, self‐image, and health care provided. Understanding the nature of aging will enhance the elderly's health, such that they will perform self‐care and live a more enjoyable life. The aim of this study was to investigate the health perceptions, self‐image and methods of health promotion provided to the elderly. Focus discussion groups consisting of participants over 60 years of age, were formed. One hundred and eight participants from four Aging Clubs of large cities were invited to participate. The participants came from Chiang Mai (n = 30), Phitsanulok (n = 21), Siriraj (n = 20), and the 43rd Health Center Aging Club (n = 37), a suburb near Bangkok.

Results:  The majority of participants perceived that ‘Health is composed of a good physical and mental condition’ and ‘physical strength and happy mind’. All participants identified three things that made them healthy: exercise, good food, and having hobbies. The participants practised what they believed. Exercise was seen as excellent medicine, and lack of disease was seen as good fortune. Several participants emphasized that having regular check‐ups, avoiding smoking, and avoiding drinking alcohol, as being healthy. Few of the elderly, in a group of > 70‐year‐olds, from the 43rd Health Center and the Phitsanulok group, mentioned traditional treatment as promoting health. Several participants from Chiang Mai saw fresh air and good ventilation as facilitating health. All participants preferred to meet each other and join in recreational activities at the club for the elderly. Interestingly, the 60–70‐year‐old age group from the Siriraj Aging Club believed life planning and a good sexual relationship were essential for good health. All participants revealed good relationships in their families. They used religious principles to keep their equilibrium and to help maintain their spiritual well‐being. Four major factors were identified as contributing to making the participants feel old: physical changes, declined functions, declined health, and emotional instability. Several participants said they felt old when they were told they were old. Other participants complained of feeling old when they were dependent. They said it caused them to lose their self‐respect.

Conclusion:  The study revealed that the different groups of elderly participants had a mutual concept of health. The life experiences of the elderly were based on their beliefs of helpful heath‐care practises. Thus, caregivers need to develop and apply effective and humanistic methods of health promotion for the elderly.
Family Decision Making for Elderly Patients in the Intensive Care Unit
Authors: Oh Heeyoung Lee , Lee Taewha
Published: March 2003

Advances in health care and high technology have increased the survival rate of patients with critical health problems. When one's elder is admitted to an intensive care unit (ICU), the family members often face the challenge of having to make treatment decisions for an elderly patient who is incapable of decision‐making. Making health‐care decisions can be more complex when the patient is in a critical condition and decisions have to be made within a given time. Families experience conflict when they make choices among alternatives that are equally unacceptable. Assisting the family of an elderly patient in reaching the best decision is an integral part of the role of the nurses and other health‐care professionals. In order to enhance the family's decision‐making regarding their elder in the ICU, it is necessary to understand the family's perspective on making the required decision.

The purpose of this study was to understand: (i) under what circumstances does a family, having to make a decision, perceive decision‐making to be most difficult? and (ii) what are the beliefs or preferences that influence family decision‐making? An exploratory, descriptive, qualitative study design was employed. Data were collected from 15 family members of 12 elderly patients in ICU at two urban university hospitals in South Korea. Subject selection was determined by collaborating with the head nurses of the three ICU to determine which subjects had ability to articulate their perspectives on decision‐making. Forty–fifty‐min, face‐to‐face, semistructured in‐depth interviews were conducted using an interview guide consisting of 11 open‐ended questions. All interviews were tape recorded and transcribed. Data were read line by line and content analysis was performed.
Continence Care for Older People
Authors: Nishimura Kaoru
Published: March 2003

Surveys of incontinence among the elderly in Japan have shown that about 10% of Japanese men and 40–50% of Japanese women have some degree of incontinence. Unfortunately many of those with incontinence seem to think that there is nothing that can be done about it. They give up because they think incontinence is a part of aging. Incontinence is not simply a part of aging, continence can be regained. However, an assessment to find the causes of an individual's incontinence and his/her possibility of improvement must first be accomplished. Causes of incontinence include bladder functional disorder, intelligence disorder, mobility and dexterity problems, and environment problems. Incontinence is categorized into several types, based upon the particular cause of the incontinence. Bladder functional disorder has been identified as the cause of three types of incontinence: urge incontinence, stress incontinence, and overflow incontinence. Urge incontinence is recognized as the involuntary loss of urine associated with an abrupt and strong desire to void. Urge incontinence often is associated with urinary frequency and is a symptom of bladder muscle irritability. Both urge incontinence and urinary frequency can be controlled by medication that relaxes the bladder muscle. Stress incontinence has been defined as the involuntary loss of urine secondary to increased abdominal pressure. The most common cause of stress incontinence is a weak pelvic floor muscle. Therefore, pelvic floor muscle exercises are useful for the prevention and improvement of stress incontinence. Overflow incontinence has been recognized as the involuntary loss of urine due to over‐distension of the bladder. In order to control overflow incontinence, it is necessary to determine whether the bladder distention is due to enlargement of the prostate gland or is a side‐effect of medication. Functional incontinence has been shown often to be secondary to an intelligence disorder, or to mobility and/or dexterity problems. Regardless of the cause of the incontinence, an appropriate environment is needed in which to treat the incontinence. Treatment and care for the incontinent individual needs to be done by a multidisciplinary team in accordance with the type of incontinence being experienced.
Helping Each Other: Social Engagement of Elderly Participants in Qualitative Research
Authors: Duggleby Wendy
Published: March 2003

The predominant research focus in aging research has been improved outcomes for the frail elderly. This research focus has made a significant impact on care delivery. Unfortunately, it has also resulted in a negative view of aging focusing on losses and problems. A neglected area of research is with the well elderly. The purpose of this presentation is to discuss issues regarding research with well older adults and examine challenges of conducting research in this population. The context of this discussion is the qualitative research study entitled ‘The Aging Experience of Well Elderly Women’. Elderly women in the United States deal with changes in aging by ‘helping others’. During data collection using focus groups, the social engagement that occurred included ‘helping each other’. This social engagement has implications for future directions of research with the well elderly including data collection, analysis and development of effective interventions for health promotion and disease prevention.
Lessons learned as a research assistant studying ambulatory blood pressure in elderly Japanese stroke patients
Authors: Nishimura Chie , Takahashi Ryutaro , Miyamoto Shigeko , Saito Takako , Kanemaru Akiko , Liehr Patricia R.
Published: March 2003

Abstract The research assistant plays a critical part in research projects, yet there is little structured information about the role. The present paper describes the research assistant"s role and provides an example of the research assistant"s activities in nursing research. In this pilot study, 24 h ambulatory blood pressure monitoring was conducted on 15 elderly Japanese stroke patients in a hospital rehabilitation unit. The research assistant's involvement is described along the course of the study: pre‐data collection; data collection and data processing. A research assistant needs to have good communication skills, a detail‐oriented focus and an inquisitive nature.
Electrical activity of the corpus cavernosum in denervated rats
Authors: Başar M , Yildiz Müslüm , Başar Halil , Ak Fikri , Akan Hakan , Atan Ali
Published: March 2003

Background: We evaluated the electrical activity of the corpus cavernosum after intracavernous papaverine injection in rats that had been denervated experimentally.

Methods: Twenty‐four male adult Sprague Dawley rats were divided into three groups: (i) controls (n = 8); (ii) unilateral cavernous nerve resection on the right side (n = 8); and (iii) bilateral cavernous nerve resection (n = 8). Through a suprapubic incision, the urinary bladder was retracted laterally to locate the major pelvic plexus on the lateral surface of the prostate. The major branch of the cavernous nerve, running caudally from the pelvic plexus, was isolated and excised using an operating microscope. Three weeks later, recording of the electrical activity of the corpus cavernosum (EACC) was performed by using a Neuropack‐2 EMG unit (Nihon Kohden, Tokyo, Japan) and coencentric needle electrode. Changes in amplitude were evaluated before and after intracavernosal papaverine injection. The results in the flaccid state and after papaverine injection were compared by using the Mann–Whitney U‐test in all three groups and paired t‐test between groups.

Results: In the flaccid penis, the mean (± SD) amplitude of electrical activity of the corpus cavernosum was 17.42 ± 2.05, 12.42 ± 1.88, 9.71 ± 1.59 and 5.85 ± 0.96 μV in control rats, in unilaterally denervated rats (in which the cavernous nerve was intact on the left side), in unilaterally denervated rats in which the cavernous nerve was resected on the right side and in bilaterally denervated rats, respectively. In the flaccid state, EACC is lower in the bilaterally denervated group than in the control and unilaterally nerve‐resected groups (P≤ 0.05). The recording of electrical activity of the corpus cavernosum was continued for 20 min after papaverine injection. In the control group and in both groups of unilaterally denervated rats, we observed a significant decrease in the electrical activity of the corpus cavernosum in the first 5 min after papaverine injection (P≤ 0.05). However, no difference was observed in bilaterally denervated rats after injection (P ≥ 0.05).

Conclusions: We conclude that electrical activity of the corpus cavernosum continues after unilateral nerve injury in rats. Cross‐innervation may play a role in penile innervation and corpus cavernosum electromyography shows electrical activity in denervated rats.
The significance of resections for residual masses after chemotherapy in metastatic testicular tumors
Authors: Suzuki Ken‐ichi , Orikasa Seiichi , Hoshi Senji , Yoshikawa Kazuyuki , Saito Seiichi , Ohyama Chikara , Sato Makoto , Kawamura Sadahumi , Numahata Kenji , Ito Akihiro , Tokuyama Satoru
Published: March 2003

Background: After chemotherapy for metastatic testicular tumors, masses may remain, often in the metastatic sites. This study analyses the role of resections for the residual masses.

Methods: Seventy‐seven patients with advanced (stage II, III) testicular tumors were treated. Of these, 38 patients, including eight with seminoma and 30 patients with non‐seminomatous germ cell tumors, underwent resection of residual masses after chemotherapy and have been followed for a median of 41.5 months (range 2–138) after the resection.

Results: Residual masses were necrosis/fibrosis in 19 patients, mature teratoma in 11 and cancer in eight. The ratio of cancer in stage III (41.2%) was significantly higher than that in stage II (4.8%). Ten of 38 (26.3%) patients experienced recurrences in sites other than the resected sites, and five of 10 patients have died of cancer. Most recurrences (80%) occurred within two years. Recurrences after resection were detected in 4.8% of stage II patients, 52.9% of stage III, 16.7% of necrosis/fibrosis and mature teratoma, and 62.5% of cancer. The survival rate of patients with cancer was significantly lower in spite of adjuvant chemotherapy after surgery.

Conclusions: Resection for residual masses after chemotherapy in metastatic testicular tumors was useful in confirming the tissue and in controlling the metastatic sites. Recurrences were often found in patients with cancer in the residual mass and the prognosis of patients with cancer was poor, therefore the development of more effective therapy for patients with cancer is required to improve the prognosis.
Characterization of ureteral lesions associated with impacted stones
Authors: Yamaguchi Kenya , Minei Sadatsugu , Yamazaki Toshihiko , Kaya Hitoshi , Okada Kiyoki
Published: March 2003

Background: Few studies have addressed the various types of ureteral lesions apparent in patients treated for ureteral stones, especially in those with impacted stones. Macroscopic and microscopic analyses of ureteral lesions associated with impacted stones were therefore undertaken.

Methods: From May 1994 to October 1996, 36 patients with ureteral stones, 21 of whom showed stone impaction, were treated with transurethral ureterolithotripsy. After ureteroscopic examination, biopsied specimens were obtained from six patients with impacted stones and were examined microscopically by conventional hematoxylin and eosin staining.

Results: Ureteroscopy revealed two types of mucosal lesions in the patients with impacted stones: Type 1 lesions were defined as edematous or cystic hemispheric lesions and occurred in 18 patients, whereas type 2 lesions had a villous appearance and were present in three patients. Microscopically, type 1 lesions appeared as submucosal edema without specific findings, whereas type 2 lesions appeared as columnar mesenchymal tissue coated with several layers of transitional epithelium. With regard to factors that might contribute to lesion formation, duration of stone presence was significantly greater for patients with impacted stones than for those with‐non‐impacted stones. However, no differences in such parameters were apparent between patients with type 1 lesions and those with type 2 lesions.

Conclusions: Two types of ureteral lesions associated with impacted stones were confirmed microscopically. The duration of stone presence is a potential contributing factor in the development of ureteral lesions, but factors that determine the type of ureteral lesion remain unclear.
Quality of life in patients having an ileal conduit, continent reservoir or orthotopic neobladder after cystectomy for bladder carcinoma
Authors: Kitamura Hiroshi , Miyao Noriomi , Yanase Masahiro , Masumori Naoya , Matsukawa Masanori , Takahashi Atsushi , Itoh Naoki , Tsukamoto Taiji
Published: March 2003

Background
: To compare the QOL in patients with ileal or colon conduits (IC), continent urinary reservoir (CR) and ileal neobladder (NB), a retrospective study was conducted using a questionnaire sent by mail.

Methods
: Seventy‐nine patients with a mean age of 60 years were included in this study. A total of 36, 22 and 21 underwent IC, CR and NB, respectively and were alive at the time of this study. A structured questionnaire consisting of 97 questions that covered general condition and physical condition, reconstruction‐related symptoms, psychological status, sexual life, social status and satisfaction with the treatment was employed.

Results
: The IC group frequently complained of changes in bathing habits and loss of using public baths in comparison with the CR and the NB groups. High scores for loss of sexual desire were obtained in the IC, the CR and the NB groups, in this order. Because of the nearly physiological voiding, the NB group desired a voiding condition like pre‐operative status as compared with the IC and the CR groups. However, for most of the questionnaire items no difference was seen among the IC, CR and NB groups concerning general condition, reconstruction‐related symptoms, psychological status, sexual life, social status, satisfaction with the treatment and global satisfaction with life and health.

Conclusions
: There was little difference in the QOL score of the questionnaire and satisfaction among the IC, CR and NB groups. It was suggested that almost every patient accepted and adapted to the present status of general quality of life in each group.
Prostate‐specific antigen adjusted for the transition zone volume versus free‐to‐total prostate‐specific antigen ratio in predicting prostate cancer
Authors: Moon Du Geon , Cheon Jun , Kim Je Jong , Yoon Duck Ki , Koh Sung Kun
Published: March 2003

Background
: We performed this study to assess the efficacy of prostate‐specific antigen adjusted for the transition zone volume (PSATZ) and free‐to‐total prostate‐specific antigen (PSA) ratio (F/T ratio) in predicting prostate cancer in men with intermediate PSA levels of 4.1–10.0 ng/mL. Methods: Between March 1997 and September 1998, PSATZ was obtained from 67 patients who underwent ultrasonography guided systemic sextant biopsies and had a PSA of 4.1–10.0 ng/mL. PSATZ was compared with F/T ratio via receiver operating characteristic (ROC) curves.

Results
: Of 67 patients, 22 (32.8%) had prostate cancer and 45 (67.2%) had benign prostatic hyperplasia (BPH) on pathologic examination. Mean PSA, PSA density, F/T ratio and PSATZ were 7.96 ± 2.01 ng/mL, 0.28 ± 0.14 ng/mL/cc, 0.10 ± 0.06 and 0.70 ± 0.28 ng/mL/cc in patients with prostate cancer and 6.39 ± 1.68 ng/mL, 0.16 ± 0.06 ng/mL/cc, 0.15 ± 0.05 and 0.29 ± 0.10 ng/mL/cc in patients with BPH, respectively. The ROC curve analysis demonstrated that PSATZ predicted the biopsy outcome significantly better than F/T ratio in all 67 patients (P < 0.01) and in a subset of 53 men with normal digital rectal examination (P < 0.01). With a cut‐off value of 0.35 ng/mL/cc, PSATZ had a sensitivity of 86% and a specificity of 89% for predicting prostate cancer.

Conclusions
: These results suggest that PSATZ and F/T ratio may be useful in diagnosing prostate cancer with intermediate levels of PSA. Prostate‐specific antigen adjusted for the transition zone volume is more accurate than F/T ratio in distinguishing benign prostatic disease from prostate cancer. But large prospective studies are required to assess the precise role of PSATZ and F/T ratio in early prostate cancer detection.
Ratio of gamma‐seminoprotein to prostate‐specific antigen for the detection of prostate cancer: Its discrimination power could be influenced by the assay methods of PSA and/or gamma‐seminoprotein
Authors: Akino Hironobu , Suzuki Yuji , Oyama Nobuyuki , Kanamaru Hiroshi , Okada Kenichiro
Published: March 2003

Background
: The ratio of gamma‐seminoprotein (γ‐Sm) and prostate‐specific antigen (PSA) has been regarded as being superior over PSA alone as a discriminator between prostate cancer and benign prostatic diseases. In previous studies, PSA and γ‐Sm were measured by the Eiken kit and the old‐version or revised Chugai kit, respectively. We compared the power of γ‐Sm ratio with that of PSA alone when using Markit‐M PSA assay and the revised Chugai γ‐Sm assay.

Methods
: Fifty‐three patients with prostate cancer having no metastasis and 116 with benign prostatic diseases were enrolled in this study. Prostate‐specific antigen was measured by Markit‐M kit and γ‐Sm was measured by the revised Chugai kit. The discrimination power of γ‐Sm ratio and PSA alone was evaluated with receiver operating characteristic (ROC) curves. Comparisons between prostate cancer and benign diseases were performed with Mann–Whitney U‐test and Fisher’s exact test.

Results
: The optimal cut‐off value was set at 3.1 ng/mL for PSA and 0.935 for γ‐Sm ratio. Sensitivity, specificity and positive predictive value of PSA alone were 81.1, 81.0 and 66.2%, respectively, while those of γ‐Sm ratio were 73.6, 90.5 and 78.0%, respectively. There was no statistical significance in each value between PSA and γ‐Sm ratio. Areas under the ROC curves of PSA and γ‐Sm ratio were 0.881 and 0.866, respectively (P > 0.05).

Conclusion
: Contrary to the previous reports, γ‐Sm ratio and PSA were not different in the discrimination between prostate cancer and benign prostatic diseases, which suggested that the discrimination power of γ‐Sm ratio, and presumably that of the free PSA to total PSA ratio as well, could be considerably influenced by the assay kits for serum PSA and/or γ‐Sm (free PSA) used. Therefore, the clinical significance of γ‐Sm ratio should be evaluated for each PSA assay kit.