bluuebunny/crossref_metadata_2025 huggingface dataset:
Achieving therapeutic clarity in assisted personal body care: professional challenges in interactions with severely ill COPD patients
Authors: Lomborg Kirsten , Kirkevold Marit
Published: February 2007

Aim and objectives.  This paper aims to present a theoretical account of professional nursing challenges involved in providing care to patients suffering from chronic obstructive pulmonary disease. The study objectives are patients’ and nurses’ expectations, goals and approaches to assisted personal body care.

Background.  The provision of help with body care may have therapeutic qualities but there is only limited knowledge about the particularities and variations in specific groups of patients and the nurse–patient interactions required to facilitate patient functioning and well‐being. For patients with severe chronic obstructive pulmonary disease, breathlessness represents a particular challenge in the performance of body care sessions.

Design.  We investigated nurse–patient interactions during assisted personal body care, using grounded theory with a symbolic interaction perspective and a constant comparative method.

Methods.  Twelve cases of nurse–patient interactions were analysed. Data were based on participant observation, individual interviews with patients and nurses and a standardized questionnaire on patients’ breathlessness.

Findings.  Nurses and patients seemed to put effort into the interaction and wanted to find an appropriate way of conducting the body care session according to the patients’ specific needs. Achieving therapeutic clarity in nurse–patient interactions appeared to be an important concern, mainly depending on interactions characterized by: (i) reaching a common understanding of the patient's current conditions and stage of illness trajectory, (ii) negotiating a common scope and structuring body care sessions and (iii) clarifying roles.

Conclusion.  It cannot be taken for granted that therapeutic qualities are achieved when nurses provide assistance with body care. If body care should have healing strength, the actual body care activities and the achievement of therapeutic clarity in nurses’ interaction with patients’ appear to be crucial.

Relevance to clinical practice.  The paper proposes that patients’ integrity and comfort in the body care session should be given first priority and raises attention to details that nurses should take into account when assisting severely ill patients.
The effects of gender and age on health‐related quality of life following kidney transplantation
Authors: Liu Hongxia , Feurer Irene D , Dwyer Kathleen , Speroff Theodore , Shaffer David , Wright Pinson C.
Published: February 2007

Aims and objectives. To evaluate whether gender, age and their interaction affect health‐related quality of life and overall health status following kidney transplantation.

Background. Some investigators have examined the main effects of gender and/or age on health‐related quality of life following kidney transplantation, but the potential interaction effect of these measures on this outcome has not been reported.

Design. This was a cross‐sectional, single‐centre study, based in one US geographic area.

Methods. Self‐report survey data were provided by adult kidney transplant recipients using the SF‐36 Health Survey (SF‐36) and a visual analogue scale of overall health. SF‐36 physical and mental component summary and individual scales and overall health were measured prospectively at one time point post‐transplant. All adult patients were eligible to participate and rolling enrolment was employed. Statistical effects were tested using analysis of covariance (controlling for time post‐transplant).

Results. Subjects (n = 138) included 66 women and 72 men. There were no effects of gender, age group, or their interaction on MCS or overall health scores (allp ≥ 0·12). Physical component summary scale data demonstrated: (i) a significant effect of gender (p = 0·025); (ii) a statistically marginal effect of age group (p = 0·068); and (iii) a statistically marginal gender by age group interaction effect (p = 0·066). Women reported poorer scores on the SF‐36 physical functioning (p = 0·049), role physical (p = 0·014) and bodily pain scales (p = 0·028). There was an effect of age group on physical functioning (p = 0·005), with younger patients reporting higher scores.

Conclusions. Women report lower scores on several physical measures and may experience a greater reduction with age in physical health‐related quality of life than men. Physical functioning declines with age following kidney transplantation.

Relevance to clinical practice. Findings may help healthcare professionals to develop gender‐ and age‐specific interventions to optimize health‐related quality of life of kidney transplant patients.
Prolonged cardiac allograft ischemic time – no impact on long‐term survival but at what cost?
Authors: Marasco Silvana F , Esmore Donald S , Richardson Meroula , Bailey Michael , Negri Justin , Rowland Michael , Kaye David , Bergin Peter J
Published: February 2007

Abstract:  Introduction:  The aim of this paper was to review the outcomes of cardiac transplantation with regards to short‐ and long‐term survival, focusing particularly on patients who receive organs with long ischemic times and the resource utilization necessary to support such patients through their postoperative period.

Methods:  A retrospective review of 420 consecutive cardiac transplants in a single institution was undertaken.

Results:  The five‐ and 10‐yr survival rates for the entire group were 0.76 (95% CI: 0.72–0.80) and 0.60 (0.54–0.66). There was no decrease in mid‐ or long‐term survival in patients who received organs with ischemic times over 300 min. Longer donor organ ischemic time was not associated with increased 30 d mortality but was significantly associated with longer intensive care bed stay, increased incidence of primary graft failure, need for mechanical support, and complications such as acute renal failures.

Conclusions:  Although using donor organs with longer ischemic times for cardiac transplantation does not impact on survival, there is a significantly increased utilization of resources to ensure these patients survive the postoperative period.
Non‐myeloablative allogeneic stem cell transplantation for metastatic renal cell carcinoma
Authors: Yun Tak , Lee Keun‐Wook , Song Eun‐Gi , Na Im‐Il , Shin Hyun‐Chun , Yoon Sung‐Soo , Park Seon‐Yang , Kim Byoung‐Kook , Lee Jung‐Hee , Choi Seong‐Jun , Lee Je‐Hwan , Lee Kyoo‐Hyung
Published: February 2007

Abstract:  Between 1999 and 2004, 11 patients with metastatic renal cell carcinoma (RCC) underwent non‐myeloablative stem cell transplantation (NST) with conditioning using fludarabine‐based regimens in two institutions of Korea. Among 11 patients, only one patient showed partial response (response rate: 9%), three showed stable disease, and six progressive disease. Three patients developed acute graft‐versus‐host disease (GVHD), and among them, one developed grade III acute GVHD which caused early death at day 60 after transplantation, and this patient showed partial response at day 30. Six patients developed chronic GVHD, three limited, and three extensive GVHD, respectively. Survival after one yr was 18% in transplanted patients. Median overall survival for entire cohort was 4.3 months. Eight patients died from progressive disease and three (27%) from treatment‐related mortality. Only one patient survived 51.2 months after NST with slowly progressive disease. This patient received donor lymphocyte infusion three times after NST and achieved complete donor chimerism. NST does not lead to durable response and prolonged overall survival in the majority of patients with RCC in our series.
Cure of ventriculitis and central nervous system shunt infection by Staphylococcus epidermidis with vancomycin by intraventricular injection in a liver transplant recipient
Authors: Schwabe M. , Jüttner E. , Blaich A. , Potthoff K. , Pisarski P. , Waller C.F.
Published: February 2007

Abstract: A 19‐year‐old female underwent orthotopic liver transplantation for acute hepatic failure because of fulminant Wilson's disease. Three months post transplantation she developed systemic fungal meningoencephalitis and obstructive hydrocephalus that required cerebrospinal fluid (CSF) shunting by a ventriculo‐atrial shunt. Subsequently, she contracted Staphylococcus epidermidis bacteremia, ventriculitis, and shunt infection. Treatment with vancomycin either by conventional intravenous (i.v.) or continuous i.v. injection proved ineffective because of insufficient drug concentrations in the CSF. Eradication of S. epidermidis from CSF and cure of chronic ventriculitis and shunt infection was readily achieved by delivering vancomycin by intraventricular injection (5 mg/24 h) via an extraventricular drain together with continuous i.v. infusion (4 g/24 h) over a period of 18 days. This treatment was well tolerated and free of untoward side effects despite the patient's chronic immunosuppression subsequent to liver transplantation. Intraventricular injection of vancomycin is an effective and safe procedure to eradicate S. epidermidis from the central nervous system when i.v. vancomycin treatment fails.
Acute esophageal necrosis (black esophagus) in the renal transplant recipient: manifestation of primary cytomegalovirus infection
Authors: Trappe R. , Pohl H. , Forberger A. , Schindler R. , Reinke P.
Published: February 2007

Abstract:We report a severe case of cytomegalovirus (CMV) esophagitis in a renal transplant recipient presenting as acute esophageal necrosis (AEN, ‘black esophagus’). AEN is an uncommon entity that is a result of mucosal necrosis and has been described only a few times previously. To our knowledge, this is the first report of AEN due to a CMV infection. The disease was manifested by abdominal and epigastric pain, thrombocytopenia, leukopenia, and elevated liver enzymes. Upper endoscopy showed acute esophageal necrosis. Ganciclovir therapy was initiated immediately and resulted in a complete remission of symptoms. We conclude that the possibility of CMV infection should be suspected in any patient presenting with cytopenia, elevated liver enzymes, and epithelial gastrointestinal lesions in the first 6 months after transplantation, and that early viral detection and antiviral therapy can be lifesaving.
Leflunomide failure to control recurrent cytomegalovirus infection in the setting of renal failure after allogeneic stem cell transplantation
Authors: Battiwalla M. , Paplham P. , Almyroudis N.G. , McCarthy A. , Abdelhalim A. , Elefante A. , Smith P. , Becker J. , McCarthy P.L. , Segal B.H.
Published: February 2007

Abstract: Cytomegalovirus (CMV) reactivation is common in the allogeneic stem cell transplant setting but the incidence of CMV organ disease and mortality has been dramatically reduced by prophylactic or preemptive antiviral therapy. We report the case of a CMV‐seropositive 46‐year‐old man with non‐Hodgkin's lymphoma who underwent an unrelated allogeneic stem cell transplant from a CMV‐seronegative HLA‐matched unrelated donor. CMV encephalitis and colitis developed that was refractory to single‐agent therapy. The CMV isolate demonstrated genotypic resistance to both ganciclovir and foscarnet. CMV disease was controlled by prolonged combination ganciclovir and cidofovir therapy, but severe renal dysfunction developed. Leflunomide was selected as a last resort to avoid the nephrotoxicity of cidofovir. CMV antigenemia rapidly increased following leflunomide administration, necessitating discontinuing this agent and resuming prior antiviral therapy. The pharmacokinetics of leflunomide in the setting of renal insufficiency is presented. Options for salvage therapy in refractory CMV disease in allogeneic stem cell transplant recipients are briefly reviewed.
Analysis of cytomegalovirus (CMV) viremia using the pp65 antigenemia assay, the amplicor CMV test, and a semi‐quantitative polymerase chain reaction test after allogeneic marrow transplantation
Authors: Ksouri H. , Eljed H. , Greco A. , Lakhal A. , Torjman L. , Abdelkefi A. , Othmen T. Ben , Ladeb S. , Slim A. , Zouari B. , Abdeladhim A. , Hassen A. Ben
Published: February 2007

Abstract: A pp65 antigenemia assay for polymorphonuclear leukocytes (PMNLs) (CINAkit Rapid Antigenemia), and a qualitative polymerase chain reaction (PCR) test for plasma ‘PCR‐P qual’ (Amplicor cytomegalovirus [CMV] test) were performed for 126 samples (blood and plasma) obtained from 18 bone marrow transplant patients, over a 9‐month surveillance period. Among those samples, 92 were assayed with a semi‐quantitative PCR test for PMNLs ‘PCR‐L quant.’ The number of samples with a positive CMV test for antigenemia and PCR‐P qual assays was 20.63% and 12.7%, respectively, whereas the PCR‐L quant assay was positive in 48 of the 92 samples assayed (52.17%). The rates of concordance of the results of PCR‐P qual and antigenemia, PCR‐P qual and PCR‐L quant, antigenemia and PCR‐L quant were 92%, 65.2% and 66.8%, respectively. The analysis of the results for the 92 specimens tested by all 3 methods showed a rate of concordance of 63% among all methods. Good agreement (κ=0.72) was found only between pp65 Ag and PCR‐P qual assays. Clinical disease correlates with an antigenemia high viral load. Three patients had CMV disease despite preemptive therapy, and all of them had graft‐versus‐host‐disease (GVHD). PMNLs‐based assays are more efficient in monitoring CMV reactivation, but for high‐risk patients with GVHD, more sensitive assays (real‐time PCR) must be done.
Legionella pneumophila aortitis in a heart transplant recipient
Authors: Guyot S. , Goy J.J. , Gersbach P. , Jaton K. , Blanc D.S. , Zanetti G.
Published: February 2007

Abstract: We describe the case of a patient with a culture‐proven infection of the ascending aorta caused by Legionella pneumophila 16 months after cardiac transplantation. Serology follow‐up and surveillance culture of the hospital water supply suggested a nosocomial acquisition of the infection during the post‐transplantation period. The diagnosis was made after 5 months of recurrent unexplained febrile episodes. A Teflon ring implanted around the aortic suture line during the intervention may have contributed to the unusual localization of the infection. The patient was successfully treated with antibiotics and aortic reconstruction.
Influenza transmission to recipient through lung transplantation
Authors: Meylan P.R.A. , Aubert J.‐D. , Kaiser L.
Published: February 2007

Abstract: We report a case of transmission of influenza A virus through lung transplantation. Given the prevalence of influenza during the yearly epidemic, the duration of viral excretion, and the risk of respiratory complications, the occurrence of such events needs to be considered during the influenza season.
Multifocal spinal and extra‐spinal Mycobacterium chelonae osteomyelitis in a renal transplant recipient
Authors: Korres D.S. , Papagelopoulos P.J. , Zahos K.A. , Kolia M.D. , Poulakou G.G. , Falagas M.E.
Published: February 2007

Abstract: Only localized cases of Mycobacterium chelonae osteomyelitis have been reported. In this article, a 55‐year‐old immunosuppressed man with M. chelonae osteomyelitis and multiple spinal and extra‐spinal involvement is presented. The patient had nodulo‐pustular skin lesions, spondylodiscitis at multiple levels, and osteolytic lesions at extra‐spinal locations. Biopsy and cultures of the osseous lesions showed M. chelonae osteomyelitis. The patient started antimycobacterial chemotherapy with ciprofloxacin and clarithromycin. Progressive cervical kyphosis associated with anterior wedged deformity of the C5 vertebra and posterior C5–C6 spondylolisthesis resulted in compression of the spinal cord and neurological impairment. The patient underwent anterior decompression and C4–C6 arthrodesis using a titanium mesh cage and cervical plate. About 15 months after the initiation of chemotherapy and 5 months after surgery, the patient was pain free, with significant improvement of his neurological function. In the presence of immunosuppression, the physician should be alert for unusual or opportunistic pathogens of osteomyelitis. Long‐term antimicrobial chemotherapy and surgical intervention is the cornerstone of successful treatment of multifocal bone M. chelonae infection.
Coccidioidomycosis in healthy persons evaluated for liver or kidney donation
Authors: Blair J.E. , Mulligan D.C.
Published: February 2007

Abstract: Coccidioidomycosis is a fungal infection caused by Coccidioides species endemic to the southwestern United States, where it poses unique challenges for transplant recipients. Donor‐derived coccidioidomycosis has been documented, but its risk of transmission is not known. We prospectively screened 568 healthy persons requesting evaluation for possible liver or kidney donation. Twelve (2.1%) of the 568 donor candidates were seropositive (11 initially and 1 with seroconversion and symptomatic illness within 1 week after negative screening). Three of these 12 patients proceeded to kidney donation, and a fourth patient proceeded to liver donation. None of the 4 transplant recipients received special coccidioidal prophylaxis, although all were administered fluconazole according to standard antifungal prophylaxis protocols. At follow‐up (7–54 months), no coccidioidomycosis was identified in any recipient. The prevalence of coccidioidal antibodies was low among potential organ donor candidates, but the risk of donor‐derived coccidioidomycosis remains unknown and further study is warranted.
The resistance to leaf rust and powdery mildew of recombinant lines of barley (Hordeum vulgare L.) derived from H. vulgare × H. bulbosum crosses
Authors: Shtaya M. J. Y. , Sillero J. C. , Flath K. , Pickering R. , Rubiales D.
Published: February 2007

A set of 23 recombinant lines (RLs) of barley (Hordeum vulgare L.) derived from H. vulgare × H. bulbosum L. crosses was inoculated with barley leaf rust (Puccinia hordei) and powdery mildew (Blumeria graminis f.sp. hordei) at the seedling stage to identify their levels and mechanisms of resistance. Eight RLs were studied further in glasshouse and field tests. All three barley parents (‘Emir’, ‘Golden Promise’ and ‘Vada’) were highly susceptible to powdery mildew and leaf rust isolates. Several RLs showed partial resistance expressed as high relative latency periods and low relative infection frequencies against leaf rust. This high level of partial resistance was due to a very high level of early aborting colonies without host cell necrosis. Several RLs showed hypersensitive resistance to some or all isolates. For powdery mildew, one RL was completely resistant to the CC1 isolate and had a hypersensitive resistance to the CO‐02 isolate. Three RLs derived from ‘Emir’ were completely resistant to both powdery mildew isolates, and three more RLs tested in the field had higher levels of partial resistance than their parents. The results indicate that H. bulbosum contains major and minor gene(s) for resistance to leaf rust and powdery mildew that can be transferred to cultivated barley.
EST‐derived microsatellites as a rich source of molecular markers for oats
Authors: Becher R.
Published: February 2007

Polymerase chain reaction‐based microsatellite markers are valuable tools for molecular breeding because of their co‐dominant inheritance and their applicability for high‐throughput analysis. Being still very limited for oats, their number has to be increased significantly to cover the entire genome. For these purposes, a set of 7031 recently published expressed sequence tags (ESTs) was screened for microsatellites with dinucleotide, trinucleotide and tetranucleotide repeat motifs. Subsequent in silico analysis resulted in the development of 216 primer pairs for Avena EST‐derived microsatellite loci (AME). Using a sample set of 12 oat lines, 107 of 195 functional primers could be assayed as polymorphic. The marker variability averaged out at three alleles per locus and a polymorphic information content (PIC) value of 0.42. This variability documents their suitability for molecular oat‐breeding purposes. Finally, 51 of the AME loci could be placed within the known reference map of ‘Kanota’ × ‘Ogle’ that previously contained only 12 microsatellite loci. Thus, a remarkable enhancing of the number of mapped oat microsatellite loci could be achieved.
Meiosis and fertility in interspecific hybrids of Nicotiana tabacum L. ×N. glauca Grah. and their derivatives
Authors: Trojak‐Goluch A. , Berbeć A.
Published: February 2007

Nicotiana glauca is of potential interest to breeders as it carries resistance to black root rot of tobacco. Cytological investigations of sexual interspecific hybrids of N. tabacum T′T′TT (2n = 4x = 48) cv. ‘Wiślica’ × N. glauca GG (2n = 2x = 24) were carried out. The analyses of chromosome association at diakinesis and metaphase I in the PMCs of amphihaploid F1 T′TG (2n = 3x = 36) revealed low variable pairing with 0–5 bivalents. The sterile amphihaploids F1 were converted into partial female fertile amphidiploids T′T′TTGG by chromosome doubling. Among 36 mature plants obtained, 15 were found to have chromosome numbers (2n = 6x = 72) and were verified as amphidiploids, 9 had (2n = 6x = 70 or 71) chromosomes while the remaining 12 were haploid. True amphidiploids, in spite of quite high chromosome pairing during meiosis, were very different in pollen fertility, ranging from 0% to 85%. Male fertility disturbances did not correlate with the degree of female fertility upon pollination with N. tabacum. Sesquidiploids T′TG (2n = 5x = 60) obtained from backcrossing the amphidiploids to parental tobacco showed more than 22 bivalents, 10–12 univalents and occasional multivalents that indicated the possibility of interchange events between N. tabacum and N. glauca genomes.
The EU integration process and the convergence of social protection benefits at national level
Authors: Alsasua Jesús , Bilbao‐Ubillos Javier , Olaskoaga Jon
Published: February 2007

The essential objective of this article is to measure and interpret the degree of convergence of social protection benefits in European Union member states as the process of European integration has progressed. In this sense, the article analyses the potential role of per capita income and of the socio‐demographic characteristics of the population as explanatory variables for the levels of social protection provision in European countries. The empirical study focuses on the period from 1985 to 1999, and investigates whether differences in welfare provision levels decreased as European integration progressed, in line with the convergence in economic and socio‐demographic variables between member states.
Negotiating Acts of Citizenship in an Era of Neoliberal Reform: The Game of School Closures
Authors: BASU RANU
Published: February 2007

In Ontario, the landscape of public education has changed quite rapidly during the past decade. Critics argue that neoliberal policies concerning privatization and marketization in the education system have produced different outcomes for different groups. One of the most sensitive issues during these years has been the closure of schools. Over three years (1999–2002) nearly 200 schools were closed in Ontario. These many changes, however, have not gone uncontested and communities have adapted to these circumstances in different ways. Acts of citizenship range from coping independently to challenging these changes collectively. This article examines the failures and successes of various acts of citizenship in challenging neoliberal governmental rationalities. More specifically, it traces the difficult process of school closure negotiations using examples from Toronto. Based primarily on participant observation carried out over a year, it examines the politics of the community consultation process among a heterogeneous ‘family of schools’ amid mixed incomes and varying capacities and needs. Through these case studies it explores whether these acts are inclusionary or exclusionary, homogenizing or diversifying, positive or negative. The evolution of the planning process is examined at three different periods (1998, 1999, 2000), demonstrating the slow and steady construction, advancement and legitimization of neoliberal policy, and correspondingly the spaces and citizens it makes and unmakes through this process. The article concludes with a framework of collective action highlighting relational aspects of citizenship that lead to positive or negative consequences for civil society.
Artemisinin antimalarials moderately affect cytochrome P450 enzyme activity in healthy subjects
Authors: Asimus Sara , Elsherbiny Doaa , Hai Trinh N. , Jansson Britt , Huong Nguyen V. , Petzold Max G. , Simonsson Ulrika S.H. , Ashton Michael
Published: February 2007

The aim of this study was to investigate which principal human cytochrome P450 (CYP450) enzymes are affected by artemisinin and to what degree the artemisinin derivatives differ with respect to their respective induction and inhibition capacity. Seventy‐five healthy adults were randomized to receive therapeutic oral doses of artemisinin, dihydroartemisinin, arteether, artemether or artesunate for 5 days (days 1–5). A six‐drug cocktail consisting of caffeine, coumarin, mephenytoin, metoprolol, chlorzoxazone and midazolam was administered orally on days −6, 1, 5 and 10 to assess the activities of CYP1A2, CYP2A6, CYP2C19, CYP2D6, CYP2E1 and CYP3A, respectively. Four‐hour plasma concentrations of parent drugs and corresponding metabolites and 7‐hydroxycoumarin urine concentrations were quantified by liquid chromatography‐tandem mass spectrometry. The 1‐hydroxymidazolam/midazolam 4‐h plasma concentration ratio (CYP3A) was increased on day 5 by artemisinin [2.66‐fold (98.75% CI: 2.10–3.36)], artemether [1.54 (1.14–2.09)] and dihydroartemisinin [1.25 (1.06–1.47)] compared with day −6. The S‐4′‐hydroxymephenytoin/S‐mephenytoin ratio (CYP2C19) was increased on day 5 by artemisinin [1.69 (1.47–1.94)] and arteether [1.33 (1.15–1.55)] compared with day −6. The paraxanthine/caffeine ratio (CYP1A2) was decreased on day 1 after administration of artemisinin [0.27 (0.18–0.39)], arteether [0.70 (0.55–0.89)] and dihydroartemisinin [0.73 (0.59–0.90)] compared with day −6. The α‐hydroxymetoprolol/metoprolol ratio (CYP2D6) was lower on day 1 compared with day −6 in the artemisinin [0.82 (0.70–0.96)] and dihydroartemisinin [0.83 (0.71–0.96)] groups, respectively. In the artemisinin‐treated subjects this decrease was followed by a 1.34‐fold (1.14–1.58) increase from day 1 to day 5. These results show that intake of artemisinin antimalarials affect the activities of several principal human drug metabolizing CYP450 enzymes. Even though not significant in all treatment groups, changes in the individual metrics were of the same direction for all the artemisinin drugs, suggesting a class effect that needs to be considered in the development of new artemisinin derivatives and combination treatments of malaria.
The origin of the 1·73‐m2 body surface area normalization: problems and implications
Authors: Heaf James G.
Published: February 2007

A historical review of the origins of body surface area (BSA) determination reveals a number of theoretical and methodological errors, as does the choice of 1·73 m2 as the normal BSA for humans. BSA normalization is justifiable for some physiological variables, e.g. glomerular filtration rate and cardiac output, but not all. However, other normalization indices, in particular extracellular volume, offer theoretical and practical advantages compared with BSA. While the choice of the figure 1·73 m2 is essentially arbitrary, and inapplicable to modern Western populations, its retention as a permanent physiological constant is recommended, in order to permit international and historical comparisons.
Plasticity of Antiepileptic Drug Targets
Authors: Beck Heinz
Published: February 2007

Summary:  The mechanisms underlying the development of drug resistance in epilepsy are complex and, at this time, not fully understood. It is widely accepted that the efficacy of an antiepileptic drug (AED) is determined by its ability to cross the blood–brain barrier (BBB) and bind to intraparenchymal target sites. According to the target hypothesis, pharmacoresistance occurs when target sites are structurally and/or functionally modified in such a way that they become less sensitive to AEDs. A large number of targets for AEDs have been identified in the brain, many of which undergo molecular changes during chronic epilepsy. So far, a reduced sensitivity of drug targets to AEDs in chronic human and experimental epilepsy has been suggested for the voltage‐gated Na+ channel and the GABAA receptor. At the molecular level, altered drug targets may arise due to the transcriptional regulation of ion channel subunit genes. Alternatively, ion channel subunits may be modified by redox modulation or phosphorylation, a set of mechanisms that may be invoked much more rapidly than transcriptional changes. In addition to functional experiments, genetic studies are currently attempting to identify polymorphisms that are specifically associated with the functional phenotypes of drug resistance and drug responsiveness in the epileptic population. It is hoped that our increased understanding of the target mechanisms underlying pharmacoresistance will lead to the development of novel therapeutic strategies that will improve treatment outcomes in individuals with refractory epilepsy.
Case Management and Risk of Nursing Home Admission for Older Adults in Home Care: Results of the AgeD in HOme Care Study
Authors: Onder Graziano , Liperoti Rosa , Soldato Manuel , Carpenter Iain , Steel Knight , Bernabei Roberto , Landi Francesco
Published: February 2007

OBJECTIVES: To explore the relationship between a case management approach and the risk of institutionalization in a large European population of frail, old people in home care.

DESIGN: Retrospective cohort study.

SETTING: Eleven European countries.

PARTICIPANTS: Three thousand two hundred ninety‐two older adults receiving home care (mean age 82.3±7.3).

MEASUREMENTS: Data on nursing home admission were collected every 6 months for 1 year.

RESULTS: One thousand one hundred eighty‐four (36%) persons received a home care program based on case management, and 2,108 (64%) received a traditional care approach (no case manager). During the 1‐year follow‐up, 81 of 1,184 clients (6.8%) in the case management group and 274 of 2,108 (13%) in the traditional care group were admitted to a nursing home (P<.001). After adjusting for potential confounders, the risk of nursing home admission was significantly lower for participants in the case management group than for those in a traditional care model (adjusted odds ratio=0.56, 95% confidence interval=0.43–0.63).

CONCLUSION: Home care services based on a case management approach reduce risk of institutionalization and likely lower costs.
Risk Factors Associated with the Occurrence of Fractures in U.S. Nursing Homes: Resident and Facility Characteristics and Prescription Medications
Authors: Spector William , Shaffer Thomas , Potter D. E. B. , Correa‐de‐Araujo Rosaly , Rhona Limcangco M.
Published: February 2007

OBJECTIVES: To determine whether resident and facility characteristics and prescription medications influence the occurrence of fractures in nursing homes (NHs).

DESIGN: Panel study with 1‐year follow‐up.

SETTING: A nationally representative sample of NHs from the Medical Expenditure Panel Survey (MEPS).

PARTICIPANTS: Residents aged 65 and older who were in sample NHs on January 1, 1996.

MEASUREMENTS: Health status measures were collected from facility records and abstracted using a computer‐assisted personal interview instrument. Fracture and drug data were updated every 4 months to provide a full year of information. Drug data were obtained from monthly medication administration records. The occurrences of fractures were obtained from medical records. Administered medications were classified using the Department of Veterans Affairs medication classification system. Facility characteristics were based on MEPS survey data collected from NH sources.

RESULTS: In 1996, 6% of residents in a NH at the beginning of the year experienced a fracture during their NH stay(s). Resident risk factors included aged 85 and older, admitted from the community, exhibited agitated behaviors, and used both wheelchair and cane or walker. Use of anticonvulsants, antidepressants, opioid analgesics, iron supplements, bisphosphonates, thiazides, and laxatives were associated with fractures. A high certified nurse aide ratio was negatively associated with fractures.

CONCLUSION: The findings indicate that fractures are associated with resident and facility characteristics and prescribing practices. It reaffirms the importance of medication review with special attention on opioid analgesics, antidepressants, and anticonvulsants to reduce the risk of fractures.
Vasodilators and Nootropics as Predictors of Dementia and Mortality in the PAQUID Cohort
Authors: Dartigues Jean‐François , Carcaillon Laure , Helmer Catherine , Lechevallier Nathalie , Lafuma Antoine , Khoshnood Babak
Published: February 2007

OBJECTIVES:To assess the effects of treatment for memory impairment and the Ginkgo biloba extract (EGb 761) on dementia, mortality, and survival without dementia.

DESIGN:Prospective community‐based cohort study.

SETTING:France.

PARTICIPANTS:Three thousand five hundred thirty‐four subjects aged 65 and older.

MEASUREMENTS:Information on drug consumption was obtained by interview and visual assessment of patients' medicine chests. Active screening of dementia was performed every 2 years over a 13‐year period. The independent effects of treatment for memory impairment and the Ginkgo biloba extract on the risks of dementia and death were estimated using Cox proportional hazards models, adjusted for potentially confounding factors (including comorbidities).

RESULTS:The initial consumption of Ginkgo biloba did not modify the risk of dementia (relative risk (RR)=1.16, 95% confidence interval (CI)=0.84–1.60), whereas the consumption of other treatments for memory impairment was associated with a higher risk of dementia (RR=1.35, 95% CI=1.11–1.63). Subjects who took Ginkgo biloba had a significantly lower risk of mortality in the long term (RR=0.76, 95% CI=0.62–0.93), even after adjustment for potentially confounding factors. The initial consumption of treatment for memory impairment other than Ginkgo biloba did not modify the risk of mortality.

CONCLUSION:These results suggest that treatment with EGb 761 may increase the probability of survival in the elderly population. These findings need to be corroborated and further assessed using randomized, controlled trials.
The Effect of 3‐Year Treatment with 0.25 mg/day of Micronized 17β‐Estradiol on Cognitive Function in Older Postmenopausal Women
Authors: Pefanco Mary Ann , Kenny Anne M. , Kaplan Richard F. , Kuchel George , Walsh Stephen , Kleppinger Alison , Prestwood Karen
Published: February 2007

OBJECTIVES: To evaluate the effect of ultra‐low‐dose (0.25 mg/d) micronized 17β‐estradiol on cognitive function in older postmenopausal women.

DESIGN: Randomized, placebo‐controlled trial conducted for 3 years.

SETTING: Academic health center in greater Hartford, Connecticut.

PARTICIPANTS: Fifty‐seven healthy, community‐dwelling, older postmenopausal women.

INTERVENTION: Women received 0.25 mg/d of micronized 17β‐estradiol (estrogen therapy (ET), n=32) or placebo (n=25); all women who had not had a hysterectomy received 100 mg/d of oral micronized progesterone for 2‐week periods every 6 months.

MEASUREMENTS: Neuropsychological measures of memory, language, mood, and executive function were collected at baseline, 3 months, and 36 months. Measures of executive function included the Controlled Oral Word Association Test, the Trail Making Test, and the Wisconsin Card Sorting Test. The Boston Naming Test was used to measure language skills. The Symbol Digit Modalities Test was used as a measure of sustained attention. Measures of memory included the Complex Figure Test, Fuld Object Memory Test, and a selected subtest from the Wechsler Memory Scale. Scores from the Geriatric Depression Scale and the Beck Anxiety Inventory were used to assess symptoms of depression.

RESULTS: No differences were found between ET and placebo on any of the neurocognitive measures or depression instruments, nor were there any differences when the groups were stratified according to age.

CONCLUSION: This small study, which had adequate power to detect change in some but not all domains of cognition tested, revealed that low‐dose estrogen neither benefits nor harms cognitive function in older women after 3 years of treatment, but confirmation is needed from larger trials.
Bouncing Back: Patterns and Predictors of Complicated Transitions 30 Days After Hospitalization for Acute Ischemic Stroke
Authors: Kind Amy J. H. , Smith Maureen A. , Frytak Jennifer R. , Finch Michael D.
Published: February 2007

OBJECTIVES: To identify predictors of complicated transitions within 30 days after discharge from hospitalization for acute stroke.

DESIGN: Retrospective analysis of administrative data.

SETTING: Four hundred twenty‐two hospitals in the southern and eastern United States.

PARTICIPANTS: Thirty‐nine thousand three hundred eighty‐four Medicare beneficiaries aged 65 and older discharged after acute ischemic stroke from 1998 to 2000.

MEASUREMENTS: Complicated transition, defined as movement from less‐ to more‐intensive care setting after hospital discharge, with hospital being most intensive and home without home health care being least intensive.

RESULTS: Twenty percent of patients experienced at least one complicated transition; 16% of those experienced more than one complicated transition. After adjustment using logistic regression, factors predicting any complicated transition included older age, African‐American race, Medicaid enrollment, prior hospitalization, gastrostomy tube, chronic disease, length of stay, and discharge site. Patients with multiple complicated transitions were more likely to be African American (odds ratio (OR)=1.38, 95% confidence interval (CI)=1.13–1.68), be male (OR=1.21, 95% CI=1.04–1.40), have a prior diagnosis of fluid and electrolyte disorder (e.g., dehydration) (OR=1.23, 95% CI=1.07–1.43), have a prior hospitalization (OR=1.18, 95% CI=1.01–1.36), and be initially discharged to a skilled‐nursing facility or long‐term care (OR=1.22, 95% CI=1.04–1.44) than patients with only one complicated transition. They were less likely to be initially discharged to a rehabilitation center (OR=0.71, 95% CI=0.57–0.89).

CONCLUSION: Significant numbers of stroke patients experience complicated transitions soon after hospital discharge. Sociodemographic factors and initial discharge site distinguish patients with multiple complicated transitions. These factors may enable prospective identification and targeting of stroke patients at risk for “bouncing back.”
Tako‐tsubo Cardiomyopathy Complicating Left Atrial Radiofrequency Ablation
Authors: DERNTL MICHAEL , WOO GREGORY W. , GWECHENBERGER MARIANNE , MUNDIGLER GERALD , MARX MANFRED , RICHTER BERNHARD , GÖSSINGER HEINZ D. , GONZALEZ MARIO D.
Published: February 2007

Two female patients undergoing left atrial radiofrequency catheter ablation developed Tako‐tsubo cardiomyopathy. This reversible form of left ventricular dysfunction is known to occur under conditions associated with marked sympathetic nervous activation. Radiofrequency catheter ablation in the left atrium can damage autonomic ganglionated plexi, leading to vagal withdrawal, thus resulting in enhanced sympathetic tone. Tako‐tsubo cardiomyopathy has not been previously described following radiofrequency catheter ablation.
Pulmonary Vein Conduction Is the Major Finding in Patients with Atrial Tachyarrhythmias after Intraoperative Maze Ablation
Authors: CHUN K.R. JULIAN , BANSCH DIETMAR , ERNST SABINE , UJEYL AMAAR , HUANG HE , CHU HUIMIN , SATOMI KAZUHIRO , SCHMIDT BORIS , ANTZ MATTHIAS , KUCK KARL‐HEINZ , OUYANG FEIFAN
Published: February 2007

Introduction: Electrophysiological (EP) data from patients with recurrent atrial tachyarrhythmias (ATa) after intraoperative maze ablation are limited. Furthermore, the clinical course after accomplishing pulmonary vein (PV) isolation using the double lasso technique (DLT) is unknown.

Methods and Results: EP study and catheter ablation (CA) was guided by a three‐dimensional electroanatomic mapping system (3‐D EA, CARTO, Biosense‐Webster) combined with simultaneous ipsilateral PV mapping using the DLT. Defined endpoints were: (1) identification of conduction gaps within the ipsilateral PVs, (2) elimination of all PV spikes, and (3) ablation of clinical ATas.

CA was performed in eight patients (four females, 62 ± 5 years, LA: 50 ± 6 mm) with drug refractory ATa (9.1 ± 6.3 years) despite non‐“cut and sew” maze operation. Electrical PV conduction was demonstrated in the majority of patients (7/8). All endpoints were achieved. Repeat ablations were required in three patients. Second ablation was due to typical atrial flutter (n = 1) and atrial fibrillation (n = 2). One patient required three ablations due to a left atrial macroreentrant tachycardia. During a mean follow‐up of 15.5 ± 4.8 months, 7/8 patients were free of ATa recurrences.

Conclusion: Incomplete lesions after non‐“cut and sew” maze operation are associated with PV conduction and recurrence of ATas. Electrical isolation of ipsilateral PVs and completion of linear lesions guided by 3‐D EA mapping is feasible and successful in maintaining sinus rhythm during mid term follow‐up. Completeness of linear lesions using EP endpoints should be confirmed during the initial surgical procedure to minimize ATa recurrences.
Postmortem Interrogation and Retrieval of Implantable Pacemakers and Defibrillators: A Survey of Morticians and Patients
Authors: KIRKPATRICK JAMES N. , GHANI SYED N. , BURKE MARTIN C. , KNIGHT BRADLEY P.
Published: February 2007

Introduction: Recent recalls of pacemakers and defibrillators cast a spotlight on product reliability. Universal postmortem device analysis could yield valuable information, but little data exist on the rate and feasibility of device examinations following death. This study investigated how morticians manage pacemakers and defibrillators and surveyed morticians and device patients regarding routine postmortem device interrogation and explantation.

Methods and Results: Seventy‐one morticians were surveyed on device interrogation and explantation practices. One hundred fifty patients presenting for routine device interrogation were interviewed regarding preferences for what should be done with devices postmortem and willingness to execute “device advance directives” authorizing analysis and retrieval. The average number of devices annually explanted per mortician was 7 ± 10 (range = 1 to 50). The most common methods of disposal were placement in medical waste (44%) and donation for human reimplantation in developing nations (18%). Only 4% of morticians reported ever returning devices to manufacturers, but 87% agreed that routine explantation and return of devices to manufacturers would be feasible. Eighty‐seven percent of device patients had no understanding of how their device would be handled after death. However, a majority (82%) indicated a willingness to have their device interrogated after death, and most (79%) were willing to have it returned to manufacturers. Willingness was not associated with age, sex, time since device implantation, or device type.

Conclusions: Implantable pacemakers and defibrillators are rarely analyzed after patients die. Systematic postmortem device retrieval appears feasible and acceptable to morticians and patients. Further efforts are needed to implement universal postmortem device evaluation.
Personality Impact on Experiences of Strain Among Staff Exposed to Violence in Care of People With Intellectual Disabilities
Authors: Lundström Mats , Graneheim Ulla H. , Eisemann Martin , Richter Jörg , Åström Sture
Published: February 2007

Abstract Explored are the relationships among personality and emotional reactions, work‐related strain, and experiences of burnout among staff exposed vs. not exposed to violence when caring for people with intellectual disabilities (ID). Questionnaires measuring personality, emotional reactions, strain and burnout, and exposure to violence were distributed to staff (n = 112) working in 22 group homes for people with ID aged 18 years and older in a community in northern Sweden. The results did not show evidence of a direct influence of personality variables on exposure to violence when working with people with ID and no direct relationships were found between exposure to violence and the staff members’ personality traits as measured with the Temperament and Character Inventory and Rosenberg’s Self‐Esteem Scale. Although the influence of personality traits on how the staff members experienced violence could not be clearly determined, the authors found an association between personality and strain and the risk of burnout in that certain staff exposed to violence felt more emotionally exhausted than did staff who were not exposed. The knowledge of the relationships among violence, personality, and risk of burnout may be important for the understanding which staff need special supports when working with people with ID.
Mental Health Assessment and Intervention for People With Complex Communication Needs Associated With Developmental Disabilities
Authors: Di Marco Mark , Iacono Teresa
Published: February 2007

Abstract  This paper addresses the issues of assessment and psychological interventions of mental health in people with complex communication needs of people with intellectual disability and/or cerebral palsy. The literature indicates that research data have been lacking in this area, with a dearth of appropriate assessment tools and information on how to adapt evidence‐based psychological interventions for this group. Existing psychological intervention research has been characterized by case studies and quasi‐experimental designs with adults with mild intellectual disability who possess relatively good communication skills. In addition, there have been a few experimental studies with a focus on anger management with this group. In light of the lack of an empiric base, clinical practice for people with complex communication needs must draw on the evidence base for the general population, and adaptations of key elements of psychological therapies. Given the paucity of research addressing the mental health issues of people with complex communication needs, there is a need for the development of mental health assessment tools that enable clinicians to directly obtain information from the individual and for building the evidence base for counseling people with complex communication needs.