bluuebunny/crossref_metadata_2025 huggingface dataset:
Smokeless and Other Noncigarette Tobacco Use and Pancreatic Cancer
Authors: Alguacil Juan , Silverman Debra T.
Published: March 2006

Cigarette smoking is an important and well-established cause of pancreatic cancer. In contrast, little is known about the effects of smoking cigars, pipes, and use of smokeless tobacco on pancreatic cancer risk. The objective of the present study was to examine the association between noncigarette tobacco use (i.e., cigars, pipes, smokeless tobacco) and pancreatic cancer risk among nonsmokers of cigarettes. A population-based case-control study of pancreatic cancer was conducted during 1986–1989 among residents of Atlanta, Georgia, Detroit, Michigan,, and 10 counties in New Jersey. Direct interviews were successfully completed with 526 newly diagnosed pancreatic cancer patients and 2153 controls ages 30–79 years. This analysis was restricted to lifelong nonsmokers of cigarettes and based on interviews with 154 cases newly diagnosed with carcinoma of the exocrine pancreas and 844 population controls who reported no history of cigarette smoking. We observed a consistent pattern of increased risk associated with cigar smoking, although these elevations were not statistically significant. Participants who smoked cigars regularly (i.e., at least one cigar/week for ≥6 months) experienced a 70% increased risk [95% confidence interval (CI): 0.9–3.3], and those who never used other form of tobacco had a 90% increased risk (95% CI: 0.8–4.3). Risk was elevated among those who smoked more than one cigar/day [odds ratio (OR) = 1.8; 95% CI: 0.8–4.2) and among those who smoked cigars > 20 years (OR = 1.9; 95% CI: 0.9–3.9). Trends in risk with increasing amount and duration smoked were consistent but not statistically significant (P = 0.17 and P = 0.16, respectively). Subjects who used smokeless tobacco regularly had a 40% increased risk of pancreatic cancer (95% CI: 0.5–3.6) compared with nonusers of tobacco. We observed a marginally significant increasing risk with increased use of smokeless tobacco (P = 0.04); participants who used >2.5 oz of smokeless tobacco a week had an OR of 3.5 (95% CI: 1.1–11). Long-term use of smokeless tobacco (i.e., >20 years) was also associated with a nonsignificant increased risk (OR = 1.5; 95% CI: 0.6–4.0). In contrast, pipe smokers experienced no increased risk (OR = 0.6; 95% CI: 0.1–2.8). Our results suggest that heavy use of smokeless tobacco, and to a lesser extent, cigar smoking may increase the risk of pancreatic cancer among nonsmokers of cigarettes.
Dietary Patterns and Prostate Cancer Risk in the National Health and Nutrition Examination Survey Epidemiological Follow-up Study Cohort
Authors: Tseng Marilyn , Breslow Rosalind A. , DeVellis Robert F. , Ziegler Regina G.
Published: March 2006

Ecological studies implicate a “Western” diet in prostate cancer development, but whether dietary patterns measured in individuals are associated with risk has not been studied previously. We examined this issue using prospective data from the nationally representative United States Health Examination Epidemiological Follow-up Study. Among 3,779 men followed from 1982–84 to 1992, 136 incident cases were identified. Using principal component analysis on responses to a 105-item dietary questionnaire, the following three distinct patterns were identified: a vegetable-fruit pattern; a red meat-starch pattern characterized by red meats, potatoes, cheese, salty snacks, and desserts; and a Southern pattern characterized by such foods as cornbread, grits, sweet potatoes, okra, beans, and rice. In adjusted proportional hazards models, prostate cancer risk was not associated with the vegetable-fruit or red meat-starch pattern, but higher intake of the Southern pattern showed a reduction in risk (3rd versus 1st tertile relative risk, 0.6; 95% confidence interval, 0.4–1.1; trend P = 0.08) that approached statistical significance. The inverse association was observed in black and non-black men and was not attributable to intake of any individual foods or nutrients. A Southern dietary pattern may reflect a history of living in the South and serve as an integrative marker of sunlight exposure and protection through 1,25-dihydroxyvitamin D production. Further evaluation and better characterization of the pattern would offer more information on potentially beneficial features of the diet or its associated lifestyle.
Risk Estimation for Healthy Women from Breast Cancer Families
Authors: van Asperen Christi J. , Jonker M. A. , Jacobi C. E. , van Diemen-Homan J. E. M. , Bakker E. , Breuning M. H. , van Houwelingen J. C. , de Bock G. H.
Published: March 2006

Risk estimation in breast cancer families is often estimated by use of the Claus tables. We analyzed the family histories of 196 counselees; compared the Claus tables with the Claus, the BRCA1/2, the BRCA1/2/ models; and performed linear regression analysis to extend the Claus tables with characteristics of hereditary breast cancer. Finally, we compared the Claus extended method with the Claus, the BRCA1/2, and the BRCA1/2/u models. We found 47% agreement for Claus table versus Claus model; 39% agreement for Claus table versus BRCA1/2 model; 48% agreement for Claus table versus BRCA1/2/u model; 37% agreement for Claus extended method versus Claus model; 44% agreement for Claus extended model versus BRCA1/2 model; and 66% agreement for Claus extended method versus BRCA1/2/u model. The regression formula (Claus extended method) for the lifetime risk for breast cancer was 0.08 + 0.40 ∗ Claus Table + 0.07 ∗ ovarian cancer + 0.08 ∗ bilateral breast cancer + 0.07 ∗ multiple cases. This new method for risk estimation, which is an extension of the Claus tables, incorporates information on the presence of ovarian cancer, bilateral breast cancer, and whether there are more than two affected relatives with breast cancer. This extension might offer a good alternative for breast cancer risk estimation in clinical practice.
Expression of the High Mobility Group Proteins HMGI(Y) Correlates with Malignant Progression in Barrett’s Metaplasia
Authors: Chen Xueyun , Lechago Juan , Ertan Atilla , Ergun Gulchin , Verm Ray , Bridges Margaret , Johnson Craig , Woods Karen , Meriano Frank , Chirala Minni , Younes Mamoun
Published: March 2006

Expression of the high mobility group proteins HMGI(Y) has been shown to be a marker of malignancy in thyroid and pancreatic lesions and to correlate significantly with malignant progression in the colon. The aim of this study was to determine whether HMGI(Y) expression is associated with malignant progression in Barrett’s metaplasia (BM). Immunoperoxidase staining for HMGI(Y) was performed on sections of formalin-fixed paraffin-embedded endoscopic esophageal biopsies from 42 patients with BM. These consisted of 19 biopsies negative for dysplasia (ND), 16 with low-grade dysplasia (LGD)/indeterminate for dysplasia (IND), and 7 with high-grade dysplasia (HGD)/adenocarcinoma (CA). The percentage of positive cells was recorded, and nuclear HMGI(Y) immunoreactivity in >10% of the cells was considered positive. Statistical analysis was performed using Fisher’s exact test. Positive HMGI(Y) staining was detected in 2 of 19 (11%) cases ND, 5 of 16 (30%) LGD/IND cases, and 7 of 7 (100%) HGD/CA cases. Biopsies with HGD/CA were significantly more likely to be positive for HMGI(Y) than biopsies ND (P < 0.0001) or with LGD/IND (P = 0.0046). We conclude that HMGI(Y) expression is significantly associated with malignant progression in BM. Additional studies are needed to determine whether BM biopsies that are ND or LGD/IND and positive for HMGI(Y) are more likely to progress to adenocarcinoma.
Ultraviolet Radiation and Incidence of Non-Hodgkin’s Lymphoma among Hispanics in the United States
Authors: Hu Shasa , Ma Fangchao , Collado-Mesa Fernando , Kirsner Robert S.
Published: March 2006

Non-Hodgkin’s lymphoma (NHL) is one of the most common cancers among American Hispanics. Several studies suggest that solar UV radiation (UVR) may be an environmental risk contributing to the rise of NHL over the past decades. These studies focused primarily on light-skinned Caucasian populations; it is unknown what role UVR plays in NHL for Hispanics. We described the incidence of NHL in Hispanics from selected states in the United States between 1989 and 2000. To evaluate the role of UVR, we correlated cancer rates with the UV index and latitude of residency. Variations in NHL incidence rates with estimated amount of UVR among whites and blacks from the selected states were also analyzed. We found that NHL occurred less frequently in Hispanics than in whites. Hispanic men had higher incidence of NHL than Hispanic women. Incidence rates of NHL in Hispanics were inversely associated with estimated amount of UVR as an increase in NHL was observed with decreasing UV index (r = −0.7 in men; r = −0.41 in women) or increasing latitude of residency (r = 0.59 in men; r = 0.48 in women). This trend, although it did not reach statistical significance, was also observed in whites and blacks. Our findings do not support previous reports of a positive association between solar radiation and NHL. The inverse relationship between UVR and incidence of NHL is unexplained but presents the need for generation of hypotheses regarding the epidemiology of causal factors for NHL in the United States. Additional studies should be conducted to clarify whether sunlight exposure contributes to the development of NHL.
Nonsteroidal Anti-inflammatory Drug Use Associated with Reduced Incidence of Adenocarcinomas of the Esophagus and Gastric Cardia that Overexpress Cyclin D1
Authors: Gammon Marilie D. , Terry Mary Beth , Arber Nadir , Chow Wong-Ho , Risch Harvey A. , Vaughan Thomas L. , Schoenberg Janet B. , Mayne Susan T. , Stanford Janet L. , Dubrow Robert , Rotterdam Heidrun , West A. Brian , Fraumeni Joseph F. , Weinstein I. Bernard , Hibshoosh Hanina
Published: March 2006

This study was undertaken to determine whether selected risk factors for esophageal and gastric cancer are associated with tumors that overexpress cyclin D1. Archived tumor tissue was available for 630 esophageal and gastric cancer patients who participated in a population-based case-control study. Patients were categorized into case groups based on whether protein overexpression of the cyclin D1 gene, as assessed by immunohistochemistry, was present (cyclin D1+, n = 285) or not (cyclin D1−, n = 345) in the tumor. The distribution of risk factors in each of these case groups was then compared with the distribution among the 695 controls. Multivariate-adjusted odds ratios (OR) for esophageal adenocarcinoma were reduced in relation to use of aspirin and other nonsteroidal anti-inflammatory drug (NSAID) use but only among patients with cyclin D1+ tumors (0.45, 95% confidence interval [CI] = 0.26, 0.79) and not among those with cyclin D1− tumors (1.12, 95% CI = 0.67, 1.86). A similar pattern was observed for gastric cardia adenocarcinomas. In contrast, ORs for esophageal squamous cell carcinoma and noncardia gastric adenocarcinomas in relation to NSAID use were reduced, regardless of cyclin D1 status. ORs did not vary with cyclin D1 status in relation to alcohol, body size, or cigarette smoking, with the following exception; for noncardia gastric adenocarcinomas the cyclin D1− tumors showed a 2-fold elevation in the OR with ever smoking. These data suggest that the reduction in risk associated with NSAID use may be restricted to those esophageal and gastric cardia adenocarcinomas that overexpress cyclin D1.
Hydrolysis of Glucosinolates to Isothiocyanates after Ingestion of Raw or Microwaved Cabbage by Human Volunteers
Authors: Rouzaud Gabrielle , Young Sheila A. , Duncan Alan J.
Published: March 2006

Cabbage contains the glucosinolate sinigrin, which is hydrolyzed by myrosinase to allyl isothiocyanate. Isothiocyanates are thought to inhibit the development of cancer cells by a number of mechanisms. The effect of cooking cabbage on isothiocyanate production from glucosinolates during and after their ingestion was examined in human subjects. Each of 12 healthy human volunteers consumed three meals, at 48-h intervals, containing either raw cabbage, cooked cabbage, or mustard according to a cross-over design. At each meal, watercress juice, which is rich in phenethyl isothiocyanate, was also consumed to allow individual and temporal variation in postabsorptive isothiocyanate recovery to be measured. Volunteers recorded the time and volume of each urination for 24 h after each meal. Samples of each urination were analyzed for N-acetyl cysteine conjugates of isothiocyanates as a measure of entry of isothiocyanates into the peripheral circulation. Excretion of isothiocyanates was rapid and substantial after ingestion of mustard, a source of preformed allyl isothiocyanate. After raw cabbage consumption, allyl isothiocyanate was again rapidly excreted, although to a lesser extent than when mustard was consumed. On the cooked cabbage treatment, excretion of allyl isothiocyanate was considerably less than for raw cabbage, and the excretion was delayed. The results indicate that isothiocyanate production is more extensive after consumption of raw vegetables but that isothiocyanates still arise, albeit to a lesser degree, when cooked vegetables are consumed. The lag in excretion on the cooked cabbage treatment suggests that the colon microflora catalyze glucosinolate hydrolysis in this case.
Relation of Isolated Tonsillar Hypertrophy with Body Mass Index
Authors: Egeli Erol , Belli Seyda Bayyel , Oghan Fatih , Ozturk Ozcan
Published: March 2006

Objective: The purpose of this study was to investigate the relationship between tonsillar hypertrophy and body mass index (BMI). Material and Methods: This is a cross-sectional study which was conducted in three primary schools located in Duzce. A total of 1,282 children between 7 and 12 years of age were evaluated and the size of their tonsils was investigated with regard to height and weight. This study was performed in the course of school screening, and the correlation between estimated tonsil size and BMIs of the children was investigated. Results: Sixteen of 1,282 students were excluded from the study, leaving 1,266 children in the study. The mean (±SD) age of the children was 9.13 ± 1.45 (range 7–12) years. The mean height of the 1,266 children was 129.07 ± 9.95 (range 105–163) cm, the mean weight was 28.81 ± 6.96 (range 15–68) kg, and the mean BMI was 17.09 ± 2.33 (range 12.07–30.0) kg/m2. There was no statistically significant effect of tonsil size on BMI. We could not find a significant relation of isolated tonsillar hypertrophy with BMI. Conclusions: No relation could be found between tonsillar hypertrophy and BMI.
Preoperative Postural Control of Patients with Vestibular Schwannoma Assessed by Visual Feedback Posturography
Authors: Hirvonen M. , Aalto H. , Hirvonen T.P.
Published: March 2006

Background: The need for an objective method to describe the functional postural control of patients with vestibular schwannoma in agreement with their subjective sensation of balance. Objectives: The objective was to compare the postural control of 49 patients with unilateral vestibular schwannoma (VS) with that of healthy subjects by using visual feedback posturography (VFP). We aimed to find out if preoperative postural control of the patients correlates with their subjective sensation of balance. Methods: In the VFP, while standing on the platform, patients were instructed to move their center of gravity (COG) marker to the targets as fast and accurately as possible. Hit delay (HD) to the targets, hold percentage (HP) within the targets, COG marker velocity (CMV) to the targets, and balance index (BI) were calculated. We rated intensity of balance disturbance using a 5-point qualitative scale. Results: Twenty-two (45%) patients had at least one abnormal VFP parameter, and 49% of patients were simultaneously symptomatic. Mean hit delay (HD), hold percentage (HP), and balance index (BI) were significantly worsened in patients with VS (p < 0.05). Increased HD and BI correlated significantly with subjective sensation of imbalance (p = 0.02). Conclusions: The overall deficit in preoperative postural control of the VS patients was not severe, and this finding agreed well with their subjective sensations.
Scatter Factor Mitigates HIV-1 gp120-Induced Human Mesangial Cell Injury
Authors: Kapasi Aditi A. , Fan Saijun , Singhal Pravin C.
Published: March 2006

HIV-1 gp120 protein has been shown to promote mesangial cell (MC) injury. Scatter factor (SF) is a growth factor that plays a reparative role in various experimental models of renal lesions. We hypothesize that SF protects MC against HIV-1 gp120-induced MC injury. gp120 at a low dose, stimulated HMC proliferation (p < 0.0001). SF (50 ng/ml) further enhanced low-dose gp120-induced HMC proliferation. However, gp120 at higher doses (10–100 ng/ml) promoted HMC apoptosis. Nevertheless, SF attenuated the high-dose gp120-induced HMC apoptosis. Interestingly, gp120 at a low dose not only induced NF-ĸB activation but also increased p21cip1/waf1 andp27kip1 protein levels.
Transactivation of the Epidermal Growth Factor Receptor by Angiotensin II in Glomerular Podocytes
Authors: Flannery Patrick J. , Spurney Robert F.
Published: March 2006

Background/Aims: Activation of angiotensin II (ANG2) receptors stimulates extracellular signal-regulated kinases (ERKs) that, in some cell systems, are mediated by transactivating the epidermal growth factor (EGF) receptor (EGFR) through mechanisms involving matrix metalloprotease (MMP)-stimulated processing of heparin-binding EGF (HB-EGF) from its precursor. Methods: The signaling pathways linked to ANG2-dependent ERK activation were determined in an immortalized mouse podocyte cell line by monitoring ANG2-stimulated phosphorylation of ERK1/2. Results: ANG2 induced transient ERK phosphorylation that was maximal at 5 min and then rapidly dissipated. ANG2-dependent ERK activation was inhibited by: (1) the type-1 ANG2-selective antagonist losartan; (2) the type-2 ANG2-selective antagonist PD123319; (3) an inhibitor of MMP2/9; (4) the EGFR kinase inhibitor AG1478, and (5) the HB-EGF antagonists CRM197 and heparin. ANG2-dependent ERK activation was mediated by both protein kinase C (PKC)- and calcium-dependent mechanisms and was associated with tyrosine phosphorylation of EGFR. To determine if ANG2-dependent HB-EGF release could act in a paracrine fashion on adjacent cells, HEK293 cells were stably transfected with green fluorescent protein-tagged ERK2 (GFP-ERK2). In stably transfected HEK293 cells, EGF stimulated phosphorylation of endogenous ERK1/2 as well as GFP-ERK2. In contrast, ANG2 had no effect on ERK phosphorylation in stably transfected HEK293 cells. When podocytes were co-cultured with stably transfected HEK293 cells, however, treatment with ANG2 rapidly stimulated GFP-ERK2 phosphorylation. Both the MMP2/9 inhibitor and AG1478 attenuated ANG2-dependent phosphorylation of GFP-ERK2 in the co-culture system. Conclusions: These data indicate that ERK activation is induced by ANG2 in podocytes by mechanisms involving ANG2-dependent release of HB-EGF which, in turn, may act in an autocrine and paracrine fashion to stimulate ERK activity.
Effect of Repeated Oral Administrations of the Oral Adsorbent AST-120 on Serum Creatinine and Other Markers of Renal Function
Authors: Marier Jean-Francois , Lee James , Kambhampati Siva Rama Prasad , Galitz Lawrence , Vargas Ramon , Moberly James , Salazar Daniel E.
Published: March 2006

Background: AST-120 is an orally administered adsorbent used in Japan for prolonging time to initiation of hemodialysis and improving uremic symptoms in patients with chronic kidney disease (CKD). As AST-120 is suspected to reduce the progression of CKD by adsorbing renal toxins in the gastrointestinal tract, the objective of the current study was to determine whether binding of AST-120 to creatinine in the intestines could acutely alter creatinine balance, thereby limiting the utility of serum creatinine (sCr) as a measure of progression of renal function. Such information may be critical for the design of future studies to assess the efficacy of AST-120 in CKD patients. Methods: Patients with CKD (n = 20) received oral doses of AST-120(3 g t.i.d.) and placebo in a two-way crossover study. Blood and urine were collected for determination of sCr, 24-hour urinary creatinine (UcrV), creatinine clearance (Ccr), and urea nitrogen clearance (URCL). Differences between treatments were assessed using an ANCOVA model. Results: Following AST-120 and placebo treatments, mean sCr (1.73 and 1.79 mg/dl, respectively) and UcrV (1,264.73 and 1,286.05 mg) values were not significantly different. No significant differences were observed for Ccr and URCL. Conclusion: These results indicate that AST-120 has no acute impact on creatinine balance in patients with CKD. Consequently, sCr and other markers of renal function are acceptable measures for assessing changes in renal function following AST-120 treatment.
Infectious Burden as a Determinant of Atopy – A Comparison between Adults in Finnish and Russian Karelia
Authors: von Hertzen Leena C. , Laatikainen Tiina , Mäkelä Mika J. , Jousilahti Pekka , Kosunen Timo U. , Petäys Tuula , Pussinen Pirkko J. , Haahtela Tari , Vartiainen Erkki
Published: March 2006

Background: Evidence of the influence of pathogen exposure on the development of atopy and atopic disease is not unequivocal. We investigated the association between markers of infections and occurrence of atopy among adults in eastern Finland and western Russia, two adjacent areas with profound differences in living conditions and lifestyles. Methods: Randomly selected adults aged 25–54 years from Finland (n = 790) and from Russia (n = 387) participated in the study. Skin prick tests were performed to 11 common airborne allergens, and at least one positive prick reaction was considered to indicate atopy. Antibodies to different pathogens including hepatitis A virus (HAV), Helicobacter pylori, Toxoplasma gondii, herpes simplex virus (HSV), Chlamydia pneumoniae and the periodontal pathogens Porphyromonas gingivalis and Actinobacillus actinomycetemcomitans were measured. Results: In Finland 34.3% and in Russia 23.3% of the study population was atopic (p < 0.001). Seroprevalences to all these pathogens were significantly higher among the Russians. In multivariate logistic regression analysis, only H. pylori was inversely associated with atopy in Russia. A further stepwise analysis revealed that H. pylori alone can explain 32% of the difference in atopy between the countries, and T. gondii, A. actinomycetemcomitans, HSV and C. pneumoniae had a slightly additive effect, whereas, unexpectedly, seropositivity to HAV and, to a lesser extent, P. gingivalis had an opposite effect. The net result of the stepwise analysis showed that 44% of the difference in atopy between the countries could be explained by seropositivity to these seven pathogens. Conclusions: Seropositivity to select pathogens, particularly to H. pylori, could explain a substantial part of the difference in atopy prevalence between Finland and Russia. Exposure to HAV was not associated with protection against atopy in this adult population.
What Race and Ethnicity Measure in Pharmacologic Research
Authors: Doyle Jamie Mihoko
Published: March 2006

Advances in genomic technology have put the utility of collecting racial and ethnic data into question. Some researchers are optimistic about the potential of moving toward “personalized medicine” by using a person's genome to administer medications. Genetics will not erase the importance of race and ethnicity because race and ethnicity do not measure genetic composition. Unlike genes, race and ethnicity are social constructs; 2 persons with identical genetic makeup may self‐identify as being of different race or ethnic origin. Race and ethnic categories have been subject to change over time; a person's self‐identification may vary according to the context, wording, and format of the question asked. Despite the fluid nature of the concept, self‐identified race and ethnicity can capture something that genes cannot, namely, aspects of culture, behavior, diet, environment, and features of social status that commonly used measures of socioeconomic status, such as income, education, and occupation, cannot measure.
Patterns of Drug Utilization in a Neonatal Intensive Care Unit
Authors: Warrier Indulekha , Du Wei , Natarajan Girija , Salari Vali , Aranda Jacob
Published: March 2006

The objective of this study was to determine drug use in newborns at an inborn tertiary care neonatal intensive care unit, serving a predominantly African American population, to identify educational/research priorities in neonatal drug therapy. Data on demographics and exposure rates to all drugs from 6839 neonates born between January 1997 and June 2004 were analyzed. Number of drugs used was correlated with race, gender, gestational age, birthweight, and survival status. The contribution of these factors to mean drug use was predicted by multivariate regression analysis. In this population of 80% African Americans, mean drug use was 3.6/infant, with the highest use in the 24‐ to 27‐week gestational age group (11.7/infant). Ampicillin and cefotaxime had the highest exposure rates. Premature infants had high use of surfactant, pressor agents, and diuretics. Caucasians, males, gestational age <28 weeks, and birthweight <1000 g were the risk factors for higher drug exposure. Future research/education must emphasize these therapeutic areas with priority assigned to low‐birthweight infants.
On the Observed Large Interspecies Overprediction of Human Clearance (“Vertical Allometry”) of UCN‐01: Further Support for a Proposed Model Based on Plasma Protein Binding
Authors: Tang Huadong , Mayersohn Michael
Published: March 2006

The prediction of a human clearance (CL) value for UCN‐01, an extreme example of vertical allometry (a large overprediction by allometric scaling), was examined using commonly used simple allometry and the “rule of exponents,” as well as a newly proposed model, which quantitatively incorporates plasma protein‐binding information from rats and humans. Simple allometry and the rule of exponents were shown to overpredict the human CL value of UCN‐01 by about 5000‐ and 1750‐fold, respectively. The new model incorporating the ratio of fraction unbound between rats and humans improved the prediction by about 20‐fold compared to the rule of exponents. The model is expected to improve if a more accurate measurement of the unbound fraction in human plasma is obtained. The prediction of volume distribution for UCN‐01 by allometric scaling was also shown to be dependent on the difference of fraction unbound between animal species and humans. In summary, plasma protein binding has been demonstrated to be an important measure for interspecies scaling of pharmacokinetics.
Antiplatelet Activity During Coadministration of the Selective Serotonin Reuptake Inhibitor Paroxetine and Aspirin in Male Smokers: A Randomized, Placebo‐Controlled, Double‐blind Trial
Authors: Kotzailias Nicole , Andonovski Toni , Dukic Alexander , Serebruany Victor L. , Jilma Bernd
Published: March 2006

Depression is associated with an increased incidence of vascular events and develops after stroke and myocardial infarction. Beside potential clinical outcome benefits of selective serotonin reuptake inhibitors for vascular diseases, bleeding events were reported. We investigated whether paroxetine and aspirin synergistically inhibit platelet function. Paroxetine (20 mg/d) was administered over 18 days to 20 men in a randomized, placebo‐controlled, crossover design. Aspirin (100 mg/d) was coadministered within the last 4 study days. Platelet function was assessed by the platelet function analyzer and by flow cytometry. Paroxetine prolonged epinephrine‐dependent predictive index within 14 days (P < .02). Aspirin enhanced the predictive index (P < .004 vs baseline and P > .05 between periods). A trend toward decreased thrombin receptor‐activating peptide—induced CD62P expression after paroxetine was further enhanced by aspirin treatment (P > .05 between periods). The combination of paroxetine and aspirin did not further inhibit platelet plug formation under high shear stress in male smokers.
What is 'direct patient care'? Developing questions for a questionnaire survey
Authors: Tingle Alison , Hickey Gary
Published: March 2006

It has been suggested that the Project 2000 reforms to nurse education may lead to nurses becoming managers of care rather than direct providers of care (Elkan and Robinson, 1991; Naish, 1993; Ramprogus, 1995). This development is of particular importance given that the opportunity to provide care has been cited as a major factor in people joining the profession (Pratt, 1980; Chapman, 1983). Nurses' perceptions of, and involvement in, care-giving are being explored as part of a longitudinal, questionnaire survey investigating the careers of nurse diplomates. This paper outlines the problems which arose in defining 'care' for use in questionnaires, and explains how the concept of 'care' was operationalised using previous literature and work with a pilot cohort. Developing a common understanding of 'care' will enable comparison across studies which are exploring the concept.
Beneficial factors identified by members of a psychoanalytically informed group for nurse ward managers
Authors: Jones Alun
Published: March 2006

This paper describes a mutually collaborative action research project with six nurse ward managers who participated in 12 sessions of a psychoanalytically informed group. Yalom's (1975) therapeutic factors categories were administered in a questionnaire format. One week afterwards, the group members were interviewed and asked about their experiences. Analysis of the data revealed that catharsis, group cohesiveness, universality and altruism were highly rated factors, while identification, guidance and family re-enactment were considered less important. The study examined stress aroused occupationally, but also made links with personal issues. The results suggested, however, that beneficial factors are associated with the working environment, and it is therefore suggested that these factors are incorporated into nursing culture. Further research on nurses' experience of their work environments and the benefits of establishing effective groups is proposed.
Identifying opinion leaders in ward nurses: A pilot study
Authors: Cosens Mary , Ibbotson Tracy , Grirnshaw Jeremy
Published: March 2006

This pilot study assessed the validity of an instrument used to identify opinion leaders within a sample of nurses. Survey data were collected from all nurses within four surgical wards at a Scottish teaching hospital. The survey tool had three components: professional and personal characteristics; attitudes towards research; identification of opinion leaders. The main outcome measure was the identification of opinion leaders and the number of people who nominated each opinion leader. A total of 93 nurses were surveyed, of whom 61% (n=57) returned a questionnaire. However, only 40% (n=38) of the sample completed the opinion leader component of the survey tool. These response rates varied across the four wards. Four opinion leaders were nominated by more than five people: two in ward C; one in ward A; and one in ward D. Coverage across the wards was 58% (n=33) of those who had completed the questionnaire. This comprised just over one-third of the total sample (35%). All those identified as opinion leaders were of a significantly higher nursing grade than their non-opinion leader peers. The opinion leaders were also more likely to have academic qualifications and a greater awareness of research, and to participate actively in additional educational activities.

The findings of this pilot study indicate that the survey instrument may be able to identify nurse opinion leaders in a ward. However, doubts exist over the use of the instrument to identify opinion leaders nominated by enough nurses in the sample.
Squaring the circle: Developing public-health competencies in primary care
Authors: Carlson Cynthia L. , El Ansari Walid
Published: March 2006

Recent changes in UK Government health policy mark a shift towards giving greater prominence to public health, especially within primary care. These changes provide broad guidelines for improving public health practice but standards, beyond those for public health medicine specialists, on the competencies or skills needed to deliver the new public health agenda have not been agreed. This paper aims to explore the current policy agenda surrounding public health and primary care in England, and to consider its historical roots and new developments. Within the context of current health policy and practice in England it reviews the frameworks for defining a public health practitioner at primary care level and appraises the competencies and skill-mix required for delivering a public health-oriented programme. Focusing on community nursing, frameworks from other countries are discussed to elaborate a picture of what is needed for the future development of public health nurse specialists. It concludes by suggesting avenues for research and development that will promote the understanding of public health practice in primary care.
Essentials of a successful distance-learning experience
Authors: Upvall Michele j. , Decker Itent , Wilkerson Evelyn
Published: March 2006

The purpose of this study was to examine the quality of the registered nurse to bachelor in science in nursing (RN-BSN) completion programme delivered by two-way audio-video instructional interactive television (IITV). The sample comprised 25 registered nurses enrolled in a baccalaureate completion programme at five distance-learning sites throughout rural Arizona in the USA. Student perspectives of a quality distance-learning programme were elicited both through a questionnaire and focus groups at each of the five sites. ETHNOGRAPH was used to identify a model that best explained the elements of quality distance learning. Elements emerging from the model included three major categories: learning, teaching and support for learning/teaching.
Critical mass in nursing and midwifery research groups in the West Midlands
Authors: Frampton Carol , Maggs Christopher
Published: March 2006

One way of encouraging the implementation of research findings in practice is to develop research interest groups. Another way is to provide opportunities for clinical staff to participate in research studies. This study reports on a postal survey in one NHS region that mapped the type, membership and aims of existing research interest groups. It also reports on the experience of a clinical nurse who took part in a research study. A self-completion postal questionnaire was sent to nurse executives in NHS trusts, heads of research and development in trusts, nurses in purchasing, heads of department of nursing and midwifery education in higher education institutions, people with entries on the King's Fund Research and Practice Database, research nurse specialists, matrons of nursing homes and hospitals in the private healthcare sector and primary care facilitators/practice nurses across the region. A total of 1,500 questionnaires was sent out and 600 (40%) were returned. The vast majority of those who returned the questionnaires (546, 91%) did not belong to a group. Of the returned questionnaires reporting membership of a group, 54 provided data for further analysis. Consent to take part was implied through the completion and return of the questionnaire.

The main findings are that 'successful' research interest groups are trust-based, have some key organisational characteristics and hold regular meetings. The core indicator for success is enthusiasm and leadership by an individual or group. The clinical nurse gained insight into study design, data collection and analysis as well as the writing of reports for publication. The limitations of the study relate to measuring hard outcomes of research interest in clinical practice and the limitation of the study to one region.
Working with resistance, tension and objectivity: Conducting a randomised controlled trial of a nursing intervention for breathlessness
Authors: Plant Hilary , Bredin Mary , Krishnasamy Meinir , Corner Jessica
Published: March 2006

It is vital that nurses wishing to recommend or introduce new strategies are able to provide supporting evidence that is acceptable to their colleagues. The methodology from which to derive such evidence remains to be clearly defined, as the research process is complex, demanding and, to a certain extent, uncharted. This paper examines the experience of nurses collaborating in a multi-centre randomised controlled trial which evaluated a nursing intervention for the management of breathlessness in patients with lung cancer. The study raised several important methodological issues: resistance among colleagues to innovative nursing practice; the difficulty of measuring well-being in patients whose physical condition is deteriorating; maintaining uniformity of practice within a diverse group of collaborating nurse researchers; and the tension between the nursing role and the necessity of an ethically demanding research design.

Analysis of the process of conducting a randomised controlled trial produced valuable insights which indicated the kind of support required to undertake research and successfully implement a new intervention into clinical practice. The study also highlighted the problems associated with asking ill people to complete standard measurement tools, particularly when such instruments might not be sensitive to the reality of the patient(s) problem, in this case, the experience of breathlessness.
Intershift report: A standard for handovers
Authors: Bourne Colin
Published: March 2006

An analysis of the nursing literature on the subject of handovers or 'intershift reports' revealed little authoritative literature on the subject and a lack of any conceptual consistency on the matter. Handovers appear to fit into two main camps: those that have adopted primarily a managerial agenda, and those that serve a predominantly psychosocial function. It is suggested that such a dichotomy of opinion is too rigid and that both agendas can be satisfied if handovers are utilised flexibly. A standard for handovers is constructed, which brings together some key findings in an attempt to define 'best practice' on this subject. Donabedian's structure-process-outcome framework is taken as the theoretical basis for the standard because it is widely used in standard-setting today and therefore can be seen as being authoritative.
North West Clinical Practice Benchmarking Group: Principles, processes and evaluations
Authors: Bland Michael
Published: March 2006

The principles and processes of the North West Regional Clinical Practice Benchmarking Group are explained. Using a series of data collected over the past four years, the paper demonstrates how practice has been standardised and developed across the regional children's hospital and community services. This is undertaken by exploring the Acute Pain benchmark. The group is currently undergoing an external evaluation and many issues raised in the preliminary draft of the evaluation are explored.
Older patients' experiences of pre-treatment discussions: An analysis of qualitative data from a study of colorectal cancer
Authors: Bailer Christopher
Published: March 2006

It has been suggested that cancer in the elderly is badly treated and that criteria other than chronological age should form the basis for treatment decisions. A study was conducted to discover whether there were age-related differences in the treatment received by a sample of older people with colorectal cancer, and to determine whether any differences were related to patterns of functional status. It was recognised that involvement in treatment decisions may be influenced by contextual factors, therefore additional qualitative data were collected from patients themselves.

Responses to semi-structured questions from 337 patients aged 58-95 years were analysed in the light of previous research, which suggests that only a minority want to share equally in medical decision-making with clinicians. Our aim was to determine whether a similar pattern was apparent in patients' responses, and to develop understanding of the determinants of involvement in treatment decision-making.

The analysis suggests that patients often lack a sense of agency in the face of disease- and treatment-related events, and that many do not believe they possess the relevant knowledge or authority to act positively in these circumstances. Concerns remain about the losses involved in taking a dependent approach and about the extent to which resisting dependency is possible.
An examination of the pre-registration preparation of nurses to work in secure environments
Authors: Storey Les , Dale Colin
Published: March 2006

As part of the UKCC Nursing in Secure Environments project, all pre-registration programme providers for mental health and learning disability were contacted and invited to complete a questionnaire concerning their involvement with, and preparation of, nurses for working in these settings. Details are provided of the analysis of these questionnaires, along with parallel data captured from the project's focus groups and from focused interviews which provided a commentary of the practitioners' views concerning the adequacy of pre-registration preparation for work in these specialised environments.
Clinical guidelines in community hospitals
Authors: Anthony Denis , Brooks Nicola
Published: March 2006

Nineteen F and G grade nurses, one practice development nurse, two physiotherapists and two occupational therapists working in 11 community hospitals in Leicestershire and Rutland were interviewed about their use of clinical guidelines and their attitude towards them. They were asked questions about sources of clinical guidelines, and a simple gap analysis was carried out.

The interviewees were able to identify clinical guidelines that were used locally, and human and organisational resources of guidelines: resource rooms, practice development nurses, link nurses and study days.

The use of link nurses, and regular study days, both of which provide cascade learning, work well. Furthermore, in the opinion of the ward nurses, the practice development nurse has a useful role in making nurses aware of guidelines.

Generally, the responses about the use of clinical guidelines were positive, although some reservations were noted. There was agreement that regular professional meetings and ward hand-overs provide a natural and effective dissemination route.

The interviewees were not aware of any national clinical guidelines. Despite many of the interviewees having access to the internet (generally from home rather than from the hospitals), none could identify any online resources for clinical guidelines or knew that they existed.
Young people and alcohol
Authors: Plant Martin , Plant Moira
Published: March 2006

The topic of young people drinking, and its related problems, continues to foster concern and controversy. This review highlights some of the main psychological, social and behavioural evidence related to the formation of children's attitudes to alcohol, the acquisition of drinking habits by young people and factors associated with patterns of alcohol consumption and its consequences. Some of the implications of this evidence are highlighted, and recommendations are suggested to curb levels of heavy/inappropriate drinking among youth.

Many children are hostile to alcohol consumption by adults. The onset of adolescence generally reverses such negative attitudes and drinking is widely viewed by teenagers and young adults in a positive light as a symbol of being adult and sociable. Many young people drink to intoxication as part of the process of learning how to drink. Recent studies show that rates of heavy drinking, intoxication and negative consequences among teenagers vary considerably in different countries. Teenagers in north west Europe (including Denmark, Finland, Iceland, Ireland and the UK) report the highest rates, while those in the Mediterranean area report much lower ones. It is concluded that a sensible approach by parents should involve teaching their children to drink in moderation at home and that parents should set boundaries to control and protect their children from harm associated with periodic heavy drinking. School-based alcohol education has generally produced disappointing results and it is suggested that harm minimisation policies should be devised that are relevant to young people.
Mapping research in primary care nursing: Current activity and future priorities
Authors: Ross Fiona , Vernon Susan , Smith Elizabeth
Published: March 2006

Capacity building for research in primary care is a government priority. There is little systematic information available on research activity in the field of primary care nursing or on its future priorities for research and development (R&D). This paper reports on the work of the nursing sub-group of the Primary Care Topic Review group, which formed part of the NHSE R&D Directorate Strategic Review. The UK mapping exercise carried out in 1999 identified a total of 243 projects from 115 organizations. These were mostly funded, descriptive and reflected a wide range of inquiry. The mapping exercise helped to inform a consultation exercise with key players from the NHS, academic departments of nursing, health services research, general practice, and user organisations who developed a framework, and identified research priorities and strategies to overcome perceived barriers. This was achieved in a consensus meeting and progressively refined through consultation with a wider network. The paper seeks to draw some conclusions for building research capacity in primary care nursing.
An investigation of the hospital experiences of parents with a child in paediatric intensive care
Authors: Dampier Sally , Campbell Steven , Watson Don
Published: March 2006

The experience of families of children admitted to paediatric intensive care units (PICUs) frequently results in their feeling disempowered. The following phenomenological study involved 15 families of children who were critically ill and explored their journey from the point the child became ill, to the crisis of admission to the PICU, the subsequent discharge to the ward and, finally, the child's return home. An analysis uncovered a series of pathways that the families' experiences inevitably followed, which frequently caused them to feel disempowered. The study pinpoints key issues faced by the families and concludes that it is possible to improve their experience.
Nursing and midwifery research in England: Working towards establishing a dedicated fund
Authors: Rafferty Anne-Marie , Newell Rob , Traynor Michael
Published: March 2006

This paper considers the case for establishing a strategic fund for research in nursing, midwifery and health visiting, and for building capacity in the field. It reviews the key policy documents and staging posts in the process and argues that both professional push and policy pull factors have provided the key catalyst for change.

The role and responsibilities of nurses, midwives and health visitors are increasing in the light of government policies and professional aspirations. An appropriate evidence base is essential to understanding, undertaking, commissioning and implementing research. Research capacity-building needs to be integrated into wider strategic plans for the profession, as well as R&D policy per se. Establishing a fund to develop high-calibre research is only the beginning of a much longer process to give nursing research greater influence. Researchers, educators, managers and clinicians need to join forces to build strong communities and strengthen their links with patient and user groups. However, the investment in nursing and midwifery R&D will have failed if it benefits the professional community only. Patient care needs to be part of what could be termed 'payback' for investment and it is essential to develop an evaluation strategy capable of measuring a range of impacts from the outset.