bluuebunny/crossref_metadata_2025 huggingface dataset:
The effect of mannitol on renal function after cardiopulmonary bypass in patients with established renal dysfunction*
Authors: Smith M. N. A. , Best D. , Sheppard S. V. , Smith D. C.
Published: June 2008

The usefulness of mannitol in the priming fluid for cardiopulmonary bypass is uncertain in patients with normal renal function, and has not been studied in patients with established renal dysfunction. We studied 50 patients with serum creatinine between 130 and 250 μmol.l−1 having cardiac surgery. Patients were randomised to receive mannitol 0.5 g.kg−1, or an equivalent volume of Hartmann’s solution, in the bypass prime. There were no differences between the groups in plasma creatinine or change in creatinine from baseline, urine output, or fluid balance over the first three postoperative days. We conclude that mannitol has no effect on routine measures of renal function during cardiac surgery in patients with established renal dysfunction.
Predicting adverse outcomes of cardiac surgery with the application of artificial neural networks
Authors: Peng S‐Y , Peng S‐K
Published: June 2008

Risk‐stratification models based on pre‐operative patient and disease characteristics are useful for providing individual patients with an insight into the potential risk of complications and mortality, for aiding the clinical decision for surgery vs non‐surgical therapy, and for comparing the quality of care between different surgeons or hospitals. Our study aimed to apply artificial neural networks (ANN) models to predict mortality and morbidity after cardiac surgery, and also to compare the efficacy of this model to that of the logistic regression model and Parsonnet score. The accuracy of the ANN, logistic regression and Parsonnet score in predicting mortality was 83.8%, 87.9% and 78.4%. The accuracy of the ANN, logistic regression and Parsonnet score in predicting major morbidity was 79.0%, 74.3% and 68.6%. The area under the receiver operating characteristic curves (AUC) of the ANN, logistic regression and Parsonnet score in predicting in‐hospital mortality were 0.873, 0.852 and 0.829. The AUCs of the ANN, logistic regression and Parsonnet score in predicting major morbidity were 0.852, 0.789 and 0.727. The results showed the ANN models have the best discriminating power in predicting in‐hospital mortality and morbidity among these models.
Medication‐related patient safety incidents in critical care: a review of reports to the UK National Patient Safety Agency*
Authors: Thomas A. N. , Panchagnula U.
Published: June 2008

We reviewed all patient safety incidents reported to the UK National Patient Safety Agency between 1st August 2006 and 28th February 2007 from intensive care or high dependency units. Incidents involving medications were then categorised. 12 084 incidents were submitted from 151 organisations (median 40, range 1–634/organisation). 2428 incidents were associated with medication use involving 355 different drugs, most commonly morphine (207 incidents), gentamicin (190 incidents) and noradrenaline (133 incidents). Noradrenaline (55 incidents of harm) and insulin (48 incidents of harm) were most commonly associated with patient harm. Sixty‐one percent of medication incidents were associated with drug administration and 26% with prescription. Two hundred and eighty‐seven medication incidents caused temporary harm and 43 more than temporary harm. Five per cent of medication incidents were associated with staff communication during transfer from theatre or recovery. Categorisation of medication‐associated incidents has allowed us to suggest changes to improve the reporting of incidents and to improve medication safety.
Laryngeal mask airway and tracheal tube cuff pressures in children: are clinical endpoints valuable for guiding inflation?
Authors: Ong M. , Chambers N. A. , Hullet B. , Erb T. O. , Von Ungern‐Sternberg B. S.
Published: June 2008

We prospectively assessed common clinical endpoints for their usefulness in avoiding hyperinflation of the cuffs of laryngeal mask airways (slight outward movement) and tracheal tubes (disappearance of an audible leak around the cuff during manual ventilation < 20 cmH2O) in 640 children. Cuff pressures were measured at induction and immediately before emergence from anaesthesia. With the laryngeal mask airway (sizes 1–4), the median cuff pressures ranged from 90 to > 120 cmH2O at induction and 105 to > 120 cmH2O before emergence. With tracheal tubes (sizes 3–7 mm), median cuff pressures were 40–60 cmH2O at induction and 45–70 cmH2O at emergence. With the use of nitrous oxide a consistent rise in cuff pressure was observed between the first and second readings whereas cuff pressures remained constant when nitrous oxide was not used. The use of clinical endpoints alone was associated with significant hyperinflation of cuffs with both devices in almost all patients, with an exacerbation when nitrous oxide was used. In order to avoid unnecessary cuff hyperinflation in laryngeal mask airways and tracheal tubes, the routine use of cuff manometers is mandatory in children.
The anaesthetic management of children with anterior mediastinal masses
Authors: Hack H. A. , Wright N. B. , Wynn R. F.
Published: June 2008

Children with anterior mediastinal masses may experience serious complications during general anaesthesia. We retrospectively surveyed the records of children with an anterior mediastinal mass who had been admitted to our hospital over a 7 year period. The presence of pre‐operative symptoms or signs, findings of any special investigations performed and the anaesthetic outcome were noted. All radiological investigations were studied and tracheal compression measured. The majority of patients presented with severe clinical signs. There was a poor relationship between clinical signs and size of tumour or tracheal compression on CT scan. Corticosteroids were used prior to diagnosis in 33% of patients, all of whom were considered high risk. A clear diagnosis was made in 95% of these patients. The overall complication rate was 20% and 5% of patients had a serious complication related to anaesthesia. Stridor was the only sign that predicted an anaesthetic complication. Peri‐operative respiratory complications were confined to patients with an isolated tracheal cross‐sectional area less than 30% normal or less than 70% and associated with bronchial compression.
Morphology and distribution of Oligocene and Miocene pockmarks in the Danish North Sea – implications for bottom current activity and fluid migration
Authors: Andresen K. J. , Huuse M. , Clausen O. R.
Published: June 2008

This study gives the first description of 33 mid‐Oligocene and 646 late Miocene pockmarks mapped in the Danish part of the central North Sea. The pockmarks are all highly elongated, with average long‐ and short axes of 2.5 km and 700 m, and average internal depth of 30 m. The Miocene pockmarks strike 140–160° while the Oligocene pockmarks strike 100–105°; paralleling the strike of the major Miocene and Oligocene clinoforms on which they occur. In cross‐sections, the pockmarks appear as U‐, V‐ and W‐shaped or tabular depressions. Based on their geometry and degree of symmetry, three distinct pockmark groups have been distinguished: (A) 58% of the pockmarks are symmetrical, ellipsoidal depressions; (B) 40% are asymmetrical, lunate depressions; and (C) 2% comprise asymmetrical ring‐shaped depressions. Group A pockmarks are interpreted as representative for the first stage in the pockmark development, only influenced by fluid expulsion and subsequent erosion by bottom currents. Group B pockmarks are influenced by bottom current erosion, current and gas winnowing and possibly authigenic carbonate precipitation. Group C pockmarks represent a further development from Group B pockmarks with further winnowing, carbonate precipitation and removal of seafloor sediment to form the ring‐shape. Current erosion has exerted the major influence on the final geometry of 83% of the pockmarks. The pockmarks occur above gas‐mature Jurassic source rocks, modelled to be in the generative window during the late Miocene, and thermogenic gas is suggested as the main fluid involved in the pockmark formation. The timing of gas expulsion from the Jurassic source rocks in combination with loading imposed to the basin by the progradational Miocene clinoforms are interpreted as the main factors controlling the timing and location of the pockmarks. The pockmarks thus tell a story of thermogenic gas venting to the surface and paleo‐current scour of the seabed in the eastern part of the central North Sea during the mid Oligocene and late Miocene.
Pharmacokinetics and clinical efficacy of midazolam in children with severe malaria and convulsions
Authors: Muchohi Simon N. , Kokwaro Gilbert O. , Ogutu Bernhards R. , Edwards Geoffrey , Ward Steve A. , Newton Charles R. J. C.
Published: June 2008

WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT

• Midazolam (MDZ), a water‐soluble benzodiazepine, can be administered via several routes, including intravenously (IV), intramuscularly (IM) and buccal routes to terminate convulsions. It may be a suitable alternative to diazepam to stop convulsions in children with severe malaria, especially at peripheral healthcare facilities. The pharmacokinetics of MDZ have not been described in African children, in whom factors such as the aetiology and nutritional status may influence the pharmacokinetics.

WHAT THIS STUDY ADDS

• Administration of MDZ (IV, IM, or buccal) at the currently recommended dose (0.3 mg kg−1) resulted in rapid achievement of median maximum plasma concentrations of MDZ within the range 64–616 ng ml−1, with few clinically significant cardio‐respiratory effects. A single dose of MDZ rapidly terminated (within 10 min) seizures in all (100%), 9/12 (75%) and 5/8 (63%) children following IV, IM and buccal administration, respectively. Although IM and buccal MDZ may be the preferred treatment for children in the pre‐hospital settings the efficacy appears to be poorer.

AIM

To investigate the pharmacokinetics and clinical efficacy of intravenous (IV), intramuscular (IM) and buccal midazolam (MDZ) in children with severe falciparum malaria and convulsions.

METHODS

Thirty‐three children with severe malaria and convulsions lasting ≥5 min were given a single dose of MDZ (0.3 mg kg−1) IV (n = 13), IM (n = 12) or via the buccal route (n = 8). Blood samples were collected over 6 h post‐dose for determination of plasma MDZ and 1′‐hydroxymidazolam concentrations. Plasma concentration–time data were fitted using pharmacokinetic models.

RESULTS

Median (range) MDZ Cmax of 481 (258–616), 253 (96–696) and 186 (64–394) ng ml−1 were attained within a median (range) tmax of 10 (5–15), 15 (5–60) and 10 (5–40) min, following IV, IM and buccal administration, respectively. Mean (95% confidence interval) of the pharmacokinetic parameters were: AUC(0,∞) 596 (327, 865), 608 (353, 864) and 518 (294, 741) ng ml−1 h; Vd 0.85 l kg−1; clearance 14.4 ml min−1 kg−1, elimination half‐life 1.22 (0.65, 1.8) h, respectively. A single dose of MDZ terminated convulsions in all (100%), 9/12 (75%) and 5/8 (63%) children following IV, IM and buccal administration. Four children (one in the IV, one in the IM and two in the buccal groups) had respiratory depression.

CONCLUSIONS

Administration of MDZ at the currently recommended dose resulted in rapid achievement of therapeutic MDZ concentrations. Although IM and buccal administration of MDZ may be more practical in peripheral healthcare facilities, the efficacy appears to be poorer at the dose used, and a different dosage regimen might improve the efficacy.
Bone mineral density and bone turnover in relation to serum leptin, α‐ketoglutarate and sex steroids in overweight and obese postmenopausal women
Authors: Filip Rafal , Raszewski Grzegorz
Published: June 2008

Objective  Recent studies have shown that parallel changes in body weight and bone mass can be partially mediated via circulating leptin. Therefore, among the hormones involved in bone and mineral metabolism, such as oestrogens, testosterone and parathormone, leptin has recently become a subject of considerable interest. The aim of this study was to assess associations between leptin, E2, testosterone, dehydroepiandrosterone sulphate (DHEA‐S), SHBG, α‐ketoglutaric acid (AKG) and bone mineral density (BMD) and bone turnover markers in overweight and obese postmenopausal women.

Design  Eighty healthy, postmenopausal Caucasian women were studied. BMD of the lumbar spine (L2–L4) and femoral neck regions were examined using the dual X‐ray absorptiometry (DXA) method. Associations were evaluated in stepwise multiple regression analysis, including information on the possible confounders and effect modifiers, for example, age, years since menopause, height and weight.

Results  Femoral neck BMD was positively correlated with weight (r = 0·52, P < 0·000001), body mass index (BMI) (r = 0·48, P < 0·000006), hipline (r = 0·48, P < 0·00006), waistline (r = 0·45, P < 0·00002) and DHEA‐S (r = 0·36, P < 0·0008). Correlations of E2, SHBG, testosterone and leptin, as well as biochemical markers of bone turnover with L2–L4 and femoral neck BMD were not found. In the whole study group, significant predictors of L2–L4 BMD were BMI (β = 0·35, P < 0·01) testosterone (β = 0·27, P < 0·05) and osteocalcin (OC) (β = 0·22, P < 0·05) (R2 = 0·23), while predictors of femoral neck BMD were BMI (β = 0·42, P < 0·001), testosterone (β = 0·24, P < 0·05), E2 (β = 0·19, P < 0·05), as well as osteocalcin (β = 0·20, P < 0·05) (R2 = 0·41). In the subgroup with BMI 30–39·9, the significant predictors of both L2–L4 and femoral neck BMD were testosterone (β = 0·32, P < 0·05, R2 = 0·19; β = 0·33, P < 0·05, R2 = 0·29) and osteocalcin (β = 0·34, P < 0·05, R2 = 0·19; β = 0·45, P < 0·01, R2 = 0·29). In the subgroup with waist : hip ratio (WHR ≥ 0·85, the predictor of L2–L4 BMD was E2 (β = 0·38, P < 0·05) (R2 = 0·21), whereas the predictors of femoral neck BMD were BMI (β = 0·29, P < 0·05) and testosterone (β = 0·35, P < 0·01) (R2 = 0·36).

Conclusion  The main endocrine variable predicting lumbar spine BMD in overweight and obese postmenopausal females was testosterone, while the main determinants of femoral neck BMD were both testosterone and E2. No effect was found of serum leptin on examined indicators of bone status.
Revealing a subclinical salt‐losing phenotype in heterozygous carriers of the novel S562P mutation in the α subunit of the epithelial sodium channel
Authors: Riepe Felix G. , Van Bemmelen Miguel X. P. , Cachat Francois , Plendl Hansjörg , Gautschi Ivan , Krone Nils , Holterhus Paul‐Martin , Theintz Gerald , Schild Laurent
Published: June 2008

Objective  Pseudohypoaldosteronism type I (PHA1) is a rare inborn disease causing severe salt loss. Mutations in the three coding genes of the epithelial sodium channel (ENaC) are responsible for the systemic autosomal recessive form. So far, no phenotype has been reported in heterozygous carriers.

Patients  A consanguineous family from Somalia giving birth to a neonate suffering from PHA1 was studied including clinical and hormonal characteristics of the family, mutational analysis of the SCNN1A, SCNN1B, SCNN1G and CFTR genes and in vitro analysis of the functional consequences of a mutant ENaC channel.

Results  CFTR mutations have been excluded. SCNN1A gene analysis revealed a novel homozygous c.1684T > C mutation resulting in a S562P substitution in the αENaC protein of the patient. Functional analysis showed a significantly reduced S562P channel function compared to ENaC wild type. Protein synthesis and channel subunit assembly were not altered by the S562P mutation. Co‐expression of mutant and wild‐type channels revealed a dominant negative effect. In heterozygote carriers, sweat sodium and chloride concentrations were increased without additional hormonal or clinical phenotypes.

Conclusion  Hence, the novel mutation S562P is causing systemic PHA1 in the homozygous state. A thorough clinical investigation of the heterozygote SCNN1A mutation carriers revealed increased sweat sodium and chloride levels consistent with a dominant effect of the mutant S562P allele. Whether this subclinical phenotype is of any consequence for the otherwise asymptomatic heterozygous carriers has to be elucidated.
Interferon‐λ1 (interleukin‐29) preferentially down‐regulates interleukin‐13 over other T helper type 2 cytokine responses in vitro
Authors: Srinivas Shekar , Dai Jihong , Eskdale Joyce , Gallagher Grant E. , Megjugorac Nicholas J. , Gallagher Grant
Published: June 2008

Interferon (IFN)‐λ1 [interleukin (IL)‐29] is a member of the interferon lambda family (also known as type III interferons), whose members are distantly related to both the type I interferons and members of the IL‐10 family. While IFN‐λ1 has significant antiviral activity, it is also becoming apparent that it has important immunoregulatory properties, especially with regard to the T helper type 2 (Th2) response. Previously, we have shown that IFN‐λ1 is capable of down‐regulating IL‐13 production in an IFN‐γ‐independent manner and that this is mediated in part via monocyte‐derived dendritic cells. Here, we have extended our knowledge of IFN‐λ1 regulation of the human in vitro Th2 response by examining the regulation of three major Th2 cytokines, IL‐4, IL‐5 and IL‐13, by IFN‐λ1. Our results reveal that IFN‐λ1 preferentially inhibits IL‐13 production, compared with IL‐4 or IL‐5. Levels of IL‐13 mRNA, the amount of secreted IL‐13 protein and numbers of IL‐13‐positive CD3+ CD4+ cells were all significantly diminished by IFN‐λ1. IFN‐λ1 significantly decreased some aspects of IL‐4 and IL‐5 production, but its effects were not as consistent as those seen on IL‐13. IFN‐λ1 was also effective at decreasing IL‐13 secretion under conditions designed to support the generation of Th2 cells. Irrespective of whether Concanavalin‐A or T‐cell‐stimulatory microbeads were used, IFN‐λ1 markedly diminished IL‐13 secretion in cultures where IL‐4 had been added. Thus, IFN‐λ1 appears to be an inhibitor of human Th2 responses whose action is primarily directed towards IL‐13 but which may also affect Th2 responses generally and does not invoke a complementary elevation of IFN‐γ secretion.
Protective role of membrane tumour necrosis factor in the host’s resistance to mycobacterial infection
Authors: Allie Nasiema , Alexopoulou Lena , Quesniaux Valerie J. F. , Fick Lizette , Kranidioti Ksanthi , Kollias George , Ryffel Bernhard , Jacobs Muazzam
Published: June 2008

Tumour necrosis factor‐α (TNF‐α) plays a critical role in the recruitment and activation of mononuclear cells in mycobacterial infection. The role of membrane TNF, in host resistance against Mycobacterium bovis bacille Calmette–Guérin (BCG), was tested in knock‐in mice in which the endogenous TNF was replaced by a non‐cleavable and regulated allele (Δ1–12, TNFtm/tm). While 100% of mice with complete TNF deficiency (TNF−/−) succumbed to infection, 50% of TNFtm/tm mice were able to control M. bovis BCG infection and survived the experimental period. Membrane expressed TNF allowed a substantial recruitment of activated T cells and macrophages with granuloma formation and expression of bactericidal inducible nitric oxide synthase (iNOS). Using virulent Mycobacterium tuberculosis infection we confirm that membrane TNF conferred partial protection. Infection in TNFtm/tm double transgenic mice with TNF‐R1 or TNF‐R2 suggest protection is mediated through TNF‐R2 signalling. Therefore, the data suggest that membrane‐expressed TNF plays a critical role in host defence to mycobacterial infection and may partially substitute for soluble TNF.
Autonomy through identification: a qualitative study of the process of identification used by people with type 2 diabetes
Authors: Moser Albine , Van Der Bruggen Harry , Spreeuwenberg Cor , Widdershoven Guy
Published: June 2008

Aims and objectives.  The aim of this study is to clarify the process of identification with diabetes as a dimension of autonomy as described by people with type 2 diabetes.

Background.  People with type 2 diabetes view autonomy as competency in shaping one's life. This concept of autonomy has seven dimensions, which emerged as categories in prior research. Dynamic processes shape these dimensions of autonomy. One of the dimensions of autonomy is identification.

Method.  This study has a qualitative descriptive and exploratory design and an inductive approach as described in grounded theory. Data were collected by means of in‐depth interviews. The sample consisted of 15 people with type 2 diabetes mellitus in a nurse‐led, shared‐care setting in the Netherlands.

Results.  The phases of identification are comprehending, struggling, evaluating and mastering. Each phase has its own characteristics. Identifying with the diabetes is a non‐linear, cyclical and continuous process because people with diabetes have to deal with changing conditions.

Conclusion.  The dynamics of identification is directed to a process of identifying with diabetes and its care requirement. Recognizing identification as an element of autonomy enables nurses to adopt a more patient‐oriented view of autonomy.

Relevance to clinical practice.  Nursing that fosters the process of identification promotes autonomy. This implies that a person with diabetes should be able to identify with the nurse's interventions. Hence it is vital that nurses build supportive partnerships when providing care for such a patient.
Heart transplantation experiences: a phenomenological approach
Authors: Sadala Maria Lúcia Araújo , Stolf Noedir Antônio Groppo
Published: June 2008

Aim.  The aim of this study was to understand the heart transplantation experience based on patients’ descriptions.

Background.  To patients with heart failure, heart transplantation represents a possibility to survive and improve their quality of life. Studies have shown that more quality of life is related to patients’ increasing awareness and participation in the work of the healthcare team in the post‐transplantation period. Deficient relationships between patients and healthcare providers result in lower compliance with the postoperative regimen.

Method.  A phenomenological approach was used to interview 26 patients who were heart transplant recipients. Patients were interviewed individually and asked this single question: What does the experience of being heart transplanted mean? Participants’ descriptions were analysed using phenomenological reduction, analysis and interpretation.

Results.  Three categories emerged from data analysis: (i) the time lived by the heart recipient; (ii) donors, family and caregivers and (iii) reflections on the experience lived. Living after heart transplant means living in a complex situation: recipients are confronted with lifelong immunosuppressive therapy associated with many side‐effects. Some felt healthy whereas others reported persistence of complications as well as the onset of other pathologies. However, all participants celebrated an improvement in quality of life. Health caregivers, their social and family support had been essential for their struggle. Participants realised that life after heart transplantation was a continuing process demanding support and structured follow‐up for the rest of their lives.

Conclusion.  The findings suggest that each individual has unique experiences of the heart transplantation process. To go on living participants had to accept changes and adapt: to the organ change, to complications resulting from rejection of the organ, to lots of pills and food restrictions.

Relevance to clinical practice.  Stimulating a heart transplant patients spontaneous expression about what they are experiencing and granting them the actual status of the main character in their own story is important to their care.
Positive health practices and temporal perspective in low‐income adults
Authors: Thompson Cheryl W , Fitzpatrick Joyce J
Published: June 2008

Aims.  The purpose of this study was to describe health‐promoting behaviours and temporal perspective in low‐income adults.

Background.  Positive health practices represent a broad range of health‐promoting behaviours. The ability to adopt positive health practices may be influenced by many factors, one of which is temporal perspective, the perceived relationship between past, present and future times.

Methods.  This exploratory study was conducted in a south central Pennsylvania community with a convenience sample of individuals who were eligible for a subsidised low‐income housing programme. Positive health practices were measured using the Personal Lifestyle Questionnaire. Temporal perspective was measured with the Circles Test.

Results.  The sample consisted of 75 subjects, 61 women (81%) and 14 men (19%). Positive health practices were relatively high (mean = 70 out of a possible score of 96). Forty three per cent of the subjects expressed future temporal dominance and 80% of the subjects in this study expressed non‐continuous temporal relatedness.

Conclusions.  Health‐promoting behaviours in this low‐income sample were similar to those reported in other samples in middle‐class adult samples. The percentage of subjects who expressed future dominance was similar to findings in other samples. The percentage of subjects who expressed non‐continuous temporal relatedness was different from findings reported in other samples, suggesting that perception of the relationship of past, present and future times is different in this low‐income sample compared with other samples.

Relevance to clinical practice.  The temporal relatedness findings suggest that low‐income individuals may not believe that adopting positive health practices will influence future health.
Community nursing services for postdischarge chronically ill patients
Authors: Chow Susan KY , Wong Frances KY , Chan Tony MF , Chung Loretta YF , Chang Katherine KP , Lee Rance PL
Published: June 2008

Objective.  To examine community nursing services for patients with cardiovascular diseases, chronic respiratory diseases and other general medical conditions, making the transition from hospital to home.

Design.  The original study design was a randomised controlled trial. This study is a secondary analysis of the hospital records documented by community nurses for the study‐group patients.

Sample.  The sample consisted of 46 subjects, randomly drawn from the main study group of the study.

Measurements.  The community nursing records were analysed using the Omaha System. Self‐reported health status and readmission data were retrieved from the data base of the original study.

Results.  The three groups of patients experienced problems across the four domains in the Omaha System. Community nursing interventions did not differ greatly by disease groups. The primary purpose of home visits was observation, followed by treatment and procedures and health teaching. The community nurses in the study spent more effort providing health teaching to the respiratory group than to their counterparts. The outcome measures are self‐reported health status and hospital readmission rates. For self‐reported health status, significant differences were observed in the respiratory and cardiovascular group before and after community nursing services. For hospital readmission rate, no significant difference was found.

Conclusions.  To improve the well being of chronically ill patients, a comprehensive home intervention programme, emphasising continuous needs of monitoring and case management, is fundamental to producing desired, measurable effects.

Relevance to clinical practice.  This paper adds the understanding of home‐care services provided by community nurses to chronically ill patients. The scope of nursing services emphasises the significance of a positive, patient‐centred, caring and appropriate client–practitioner relationship to improve the self‐reported health of patients.
The pain experience and future expectations of chronic low back pain patients following spinal fusion
Authors: Bentsen Signe Berit , Rustøen Tone , Wahl Astrid Klopstad , Miaskowski Christine
Published: June 2008

Aim.  In a sample of patients who underwent instrumented spinal fusions for chronic low back pain (CLBP), the purposes of this study were: to determine the amount of pain patients experienced and to determine the impact of length of time since surgery, use of pain medication and their outlook on the future on these pain intensity scores.

Background.  An increasing number of people report CLBP and one of the treatments is instrumented fusion.

Method.  The study used a cross‐sectional design. Visual analogue scales were used to measure pain intensity in different locations and a single item measured patients’ view of the future. Data were collected in November 2001.

Results.  The sample consisted of 101 patients (71% women) aged 26–59 years treated with instrumented fusion 1–8 years ago. As many as 87% reported pain 1–8 years after the surgery. Most patients reported pain of low‐to‐moderate intensity in the neck and shoulders, back and hips, feet and legs and in total pain. As many as 45% of the patients did not take pain medication and patients using more analgesics reported more pain than those using fewer analgesics (p < 0·05). Patients with a more positive outlook on the future reported significantly less pain in all of the locations that were evaluated (p < 0·01).

Conclusion.  A high percentage of patients with CLBP continue to experience pain 1–8 years after spinal fusion. A positive outlook towards the future seems to be associated with less pain in these patients.

Relevance to clinical practice.  Patients who continue to experience pain and have a more negative outlook on the future may benefit from psychoeducational interventions that teach them how to better cope with their pain.
Exploring supportive care for individuals affected by Huntington disease and their family caregivers in a community setting
Authors: Soltysiak Beverley , Gardiner Penny , Skirton Heather
Published: June 2008

Aim.  The aim of this research was to identify the needs and coping strategies of individuals with Huntington disease and their family members/carers and to ascertain the extent to which they were supported by the type of specialised service provided in this unit.

Background.  The duration of the illness may be up to 30 years and there are far reaching implications for the affected person, family members and carers. Services for families need to provide expert psychological and practical support, whilst remaining planned and flexible. The aim of this research was to identify needs and coping strategies of individuals with Huntington disease and their carers and ascertain the extent to which they were supported by a specialised community service.

Methods.  Five focus groups and three individual interviews were used to gather data from affected individuals, family, carers and staff of the unit (n = 33). A semi‐structured discussion guide was used in every case. Data were analysed using an inductive coding technique.

Results.  Three main themes emerged; (i) Transitions and the journey, (ii) Challenges in finding and providing support and (iii) The role of the unit in providing supportive care. While the service was seen as supportive, the need for flexibility was emphasised to facilitate the transition from unaffected to affected status. Affected individuals felt it was important to be known as the person they had been, despite the changes due to the disease.

Conclusions.  Provision of service in a dedicated unit is an appropriate way to support affected patients and their carers. Enhancing understanding of the disease and allowing the individual to make choices can assist coping with this challenging disease.

Relevance to clinical practice.  It is helpful to allow patients control over timing and frequency of contact with professionals. Improving understanding of the condition in the public and health professionals may enable patients to access a greater range of social activities.
The impact of type 1 diabetes and eating disorders: the perspective of individuals
Authors: Hillege Sharon , Beale Barbara , McMaster Rose
Published: June 2008

Aim. To describe the perspective of individuals living with the chronic conditions of both type 1 diabetes (T1D) and eating disorders.

Background. The TID and eating disorders are major concerns in Western society with the consequence of more prevalent and severe health complications. This paper arose from research on the impact of T1D on the self of adolescents and young adults.

Design. In a larger longitudinal study (doctoral) of 27 participants (both male and females), data were collected from 1994 from 2001 using in‐depth semi‐structured interviews and a grounded theory approach; four female participants reported that they were experiencing T1D and an eating disorder. This subset of four participants from the original study was case analysed and the issues that arose for the participants are described using secondary analysis.

Conclusions. Issues uncovered included the complexity of managing the interactions of the physical, emotional and social dimensions as well as personal relationships for the participants. These interrelated issues interfere with all‐round management of T1D and eating disorders. Recognition and management of the comorbidity that exits in substantial numbers are of paramount importance in clinical practice. It is also necessary to incorporate the support of significant others in the health care partnership.

Relevance to clinical practice. Health professionals who treat individuals with T1D need to be aware of the incidence of eating disorders among people with TID. Unhealthy weight control practices are of particular concern because they lead to poorer metabolic control which has a flow on effect causing micro vascular complications.
Factorial structure of the Chinese version of the State Anxiety Scale for Children (short form)
Authors: Li Ho Cheung William , Wong Mi Ling Eliza , Lopez Violeta
Published: June 2008

Aim. The present study aimed at examining the factorial structure of the Chinese version of the State Anxiety Scale (Short form), using exploratory and confirmatory analyses.

Background. The factorial structure of the short form of the Chinese version of the State Anxiety Scale for Children has neither been examined by using exploratory factor analysis nor been examined by confirmatory factor analysis. Consequently, whether the factor structure of the short form is congruent with the hypothesised configuration of the factor structure of the full form cannot be confirmed.

Design. Survey.

Method. A test–retest, within‐subjects design was employed. Two hundred children (7–12 years of age) admitted for surgery in a day surgery unit was invited to participate in the study. They were asked to respond to the Chinese version of the State Anxiety Scale (short form) before surgery and upon discharge home.

Results. The results of exploratory factor analysis showed that there are two factors underlying the short form, which is congruent with hypothesised configuration of the factor structure of the full form. Confirmatory factor analysis confirmed the construct validity, with a good fit between the factor structure of the short form and the observed data.

Conclusion. This study addressed a gap in the literature by examining the factorial structure of the short form. The results confirmed the factor structure of the short form is congruent with the hypothesised configuration of the factor structure of the full form.

Relevance to clinical practice. The availability of a valid, reliable and convenient instrument is crucial in evaluating the effectiveness of nursing interventions. The findings also suggest that the short form is an objective assessment tool and can be used by clinical nurses as objective assessment tool in measuring anxiety level of Chinese children in busy clinical settings, where time constraints make the use of the full form unfeasible.
Risk factors and prevention among patients with hospital‐acquired and pre‐existing pressure ulcers in an acute care hospital
Authors: Wann‐Hansson C , Hagell P , Willman A
Published: June 2008

Aims and objectives.  This study aimed to describe and identify risk factors associated with hospital‐acquired pressure ulcers among adults in an acute care hospital compared with patients with pre‐existing pressure ulcers present on admission. A further aim was to identify the preventive measures performed with both groups respectively.

Background.  Pressure ulcers occur most often in older and immobile persons with severe acute illness and neurological deficits. However, few studies have addressed risk factors that are associated with hospital‐acquired pressure ulcers compared with patients with pre‐existing pressure ulcers.

Design.  A point prevalence study with a cross‐sectional survey design was conducted at a Swedish university hospital.

Method.  Data on 535 patients were recorded using a modified version of the protocol developed and tested by the European Pressure Ulcer Advisory Panel, including the Braden scale for risk assessment.

Results.  The prevalence of pressure ulcers was 27% (95% confidence interval, 23–31%). Higher age and a total Braden score below 17 were significantly associated with the presence of pressure ulcers. Among individual risk factors higher age, limited activity level and friction and shear while seated or lying down were associated with hospital‐acquired pressure ulcers, whereas only higher age and friction and shear were associated with the presence of pressure ulcers in the overall sample. There was an overall sparse use of preventive measures to relieve pressure.

Conclusion.  The findings of the present study revealed that pressure ulcers and the insufficient use of preventive measure to relieve pressure is still a problem in acute care settings. A continued focus must be placed on staff training in identifying patients at risk for pressure ulcers development.

Relevance to clinical practice.  Increasing the ability to identify patients who are at risk for pressure ulcer development can assist in preventing unnecessary complications and suffering as well as reduce costs.
Nutritional status and patient characteristics for hospitalised older patients with chronic obstructive pulmonary disease
Authors: Odencrants Sigrid , Ehnfors Margareta , Ehrenberg Anna
Published: June 2008

Aim.  The aim of the study was to describe and compare nutritional status and social and medical characteristics among older patients with chronic obstructive pulmonary disease admitted to an acute care hospital ward for respiratory medicine.

Background.  Chronic obstructive pulmonary disease is a condition associated with risk of developing malnutrition. A body mass index <20 is predictive of hospitalisation for acute exacerbations of chronic obstructive pulmonary disease. Knowledge about patient characteristics is crucial for the identification of malnourished patients and the development of nursing care for these patients.

Design.  Quantitative descriptive study.

Methods.  Thirty‐three hospitalised women and 17 men with a mean age of 75·7 years (SD 6·9) were consecutively included. A very severe case of chronic obstructive pulmonary disease was indicated in 28 out of 39 patients who underwent a lung function test. Data were collected with measurement of nutritional status using Mini Nutritional Assessment, anthropometry and lung function.

Results.  Nearly half of the patients (48%) were identified as malnourished, an equal part as at risk for malnutrition and two patients as well nourished. The mean Mini Nutritional Assessment score of 17·2 (SD 3·99) for all patients was near the Mini Nutritional Assessment cut‐off score (i.e. 17) for malnutrition. Patients identified as malnourished had a mean body mass index of 18·9 and those at risk for malnutrition had a mean of 23·4. It was more common for those identified as malnourished to live singly, to not live in own property and to be dependent on daily community service. Seven patients identified as malnourished died during the data collection period.

Conclusions.  This study provides important knowledge about further risks of impaired nutritional status among older patients with chronic obstructive pulmonary disease.

Relevance to clinical practice.  This knowledge can provide registered nurses with the necessary knowledge to make them aware of certain patients needing particular kinds of attention.
Evaluation of negative emotional care experiences in burn care
Authors: Wikehult Björn , Hedlund Mathilde , Marsenic Milica , Nyman Sofi , Willebrand Mimmie
Published: June 2008

Aim and objective.  To assess recollection of negative emotional experiences during burn care.

Background.  Patients in intensive care frequently report negative emotional experiences. Patients with severe burns who are treated in intensive care units undergo painful care procedures, but there have been no recent evaluations of their care experiences.

Design.  Former burn patients (n = 42) were randomly assigned to three groups: postal questionnaire, telephone interview and face‐to‐face interview.

Methods.  Assessments included negative care experiences (feelings of uncertainty, powerlessness, being afraid, insecure, being a nuisance, or neglected), severity of injury, patient satisfaction, personality traits and psychological symptoms.

Results.  Overall, the degree of recalled negative experiences was low and associated with greater severity of injury, more symptoms of post‐traumatic stress disorder and lower satisfaction with care. The feeling of powerlessness was the most common, as 67% of participants had such feelings to some extent.

Conclusions.  Overall, negative care experiences were uncommon and most prevalent among the severely injured. Such experiences were also associated with psychological symptoms and lower patient satisfaction.

Relevance to clinical practice.  Although relatively uncommon, negative emotional care experiences should be monitored more closely during care.
Isolation, motivation and balance: living with type 1 or cystic fibrosis‐related diabetes
Authors: Tierney Stephanie , Deaton Christi , Webb Kevin , Jones Andrew , Dodd Mary , McKenna Diane , Rowe Rachel
Published: June 2008

Aims and objectives.  To explore patients’ responses to developing and managing cystic fibrosis‐related diabetes and to contrast their views with those of individuals with type 1 diabetes mellitus.

Background.  The incidence of diabetes among people with cystic fibrosis has increased with improvement in life expectancy. However, little is known about how patients respond to and manage cystic fibrosis‐related diabetes, and how this compares with people living with type 1 diabetes mellitus.

Design.  Qualitative research was undertaken in order to fully explore meanings and views.

Methods.  Semi‐structured telephone or face‐to‐face interviews were conducted with patients who had cystic fibrosis‐related diabetes or type 1 diabetes mellitus, during which, they discussed diagnosis and management of diabetes. Framework analysis was employed to identify themes and to consider similarities and differences between the two groups.

Results.  Eleven cystic fibrosis‐related diabetes and 12 type 1 diabetes mellitus patients were interviewed in 2006. Patients with cystic fibrosis‐related diabetes described their diabetes diagnosis as a progression of their primary illness, management of which was important owing to the benefits it brought to their cystic fibrosis. Those with type 1 diabetes mellitus were more likely to report feeling psychologically low because of diabetes and to list long‐term complications as a key factor motivating self‐management. Both groups struggled to balance the demands of diabetes with other life and health obligations, and experienced isolation because of diabetes.

Conclusions.  Variation in perceptions recalled during interviews stemmed from diabetes being part of an existing life‐threatening chronic illness in people with cystic fibrosis‐related diabetes. Similarities and differences in attitudes and management practices were found, with less urgency regarding glucose monitoring and fewer information resources available for those with cystic fibrosis‐related diabetes.

Relevance to clinical practice.  Both groups need support for optimal diabetes management and access to appropriate resources outside specialist clinics. Web‐based technologies could prove useful for those with cystic fibrosis‐related diabetes as face‐to‐face interaction may be prevented owing to the risk of cross‐infection.
People with heart failure and home health care resource use and outcomes
Authors: Madigan Elizabeth A
Published: June 2008

Aims and objectives.  Patients with heart failure represent a common patient population in home health care, yet little is known about their outcomes.

Background.  Patients with heart failure, regardless of site of care, experience substantial numbers of rehospitalisations in the United States. Home health care is a common postacute care service for patients with heart failure.

Design.  Retrospective analysis.

Methods.  The study employed a large administrative data base from 2003 – the Outcomes and Assessment Information Set, which is required for all US Medicare and Medicaid patients receiving home health care.

Participants.  There were 145 191 patients with a primary diagnosis of heart failure represented in the data set. The outcomes of interest were the trajectory of care (point of entry and discharge from home health care), hospitalisation, length of stay and change in functional status.

Results.  Almost three‐quarters (73·9%) of patients entered home health care following a hospital stay. Nearly two‐thirds (64%) remained at home at discharge from home health care. Approximately 15% of patients are hospitalised during the home health care episode, most often for symptoms consistent with exacerbation of the heart failure, if a reason could be identified. The average length of stay in home health care was 44 days. There was only a small improvement in functional status: 0·50 points for activities of daily living and 0·57 points for instrumental activities of daily living. Similar small improvement occurred in depressive symptoms, 0·68.

Relevance to clinical practice.  There may be room for improvement in these outcomes with more recent evidence that suggests strategies for reducing hospitalisation and improving patient functional status abilities. Yet, the chronic progressive nature of heart failure may also provide a limiting factor in the outcomes that can be attained.
Women with newly diagnosed breast cancer and their perceptions of needs in a health‐care context
Authors: Landmark Bjørg Th , Bøhler Ann , Loberg Kari , Wahl Astrid K
Published: June 2008

Aim.  The purpose of this study was to investigate how women with newly diagnosed breast cancer experience their needs in a health‐care context.

Design.  A qualitative design, using a focus group, was used to identify women’s perceptions of needs.

Method.  A group of seven women met six times over a period of 10 weeks during 2004. Meetings were audio‐recorded, and the data were coded and analysed using Kvale’s methods of qualitative content analysis.

Findings.  Women described experiences related to two categories of needs that influenced their ability to cope with changed life situations: the need for knowledge and the need for psychosocial support. These categories may be divided into three themes: knowledge and psychosocial support related to physical, emotional and social perspectives of daily living.

Conclusions.  Findings suggest that health‐care services provided by breast diagnostic centres should be based on requirements defined by women with breast cancer. In addition to medical treatment, services ought to meet women’s needs for knowledge and psychosocial support at the time of diagnosis, and during and after treatment. This study can provide nurses and other health professionals with a deeper understanding of women’s demands as they face challenges related to breast cancer.

Relevance for clinical practice.  The findings from this study underline the need to include emotional and social perspectives in standards for breast cancer diagnosis and treatment, and can provide a foundation for the development of user‐designed health services.