bluuebunny/crossref_metadata_2025 huggingface dataset:
ACCIDENTALLY FALLING INSTRUMENTS DURING ORTHOPAEDIC SURGERY: TIME TO WAKE UP!
Authors: Khan Shah A. , Kumar Ashok , Varshney Manish K. , Trikha Vivek , Yadav Chandershekar
Published: August 2008

Background:  The aim of the study was to evaluate statistically the occurrence and causes of accidental fall of instruments and implants during orthopaedic procedures.

Methods:  A prospective study was carried out over a period of 18 months. Total of 120 randomly chosen major orthopaedic surgeries were observed. The observer counted the number of times an instrument fell during surgery. The offending operating room personnel were identified. A note of the nature of instrument falling was made.

Results:  A total of 120 surgeries were observed. There were 15 falls (38.5%) during elective surgeries and 24 (61.5%) during emergency (trauma) surgeries. Falls were classified as major and minor. There were a total of 39 falls with 11 major and 28 minor falls. Seven surgeries had two or more falls. In 26 instances (66.7%) the operating surgeon was responsible for the fall. In seven (17.9%) assisting surgeon and in three (7.7%) of the instances the scrub nurse was responsible for the fall of the instruments. Three falls (7.7%) were unaccountable. An average delay of 7.6 min was noted after the fall of the instrument or implant.

Conclusions:  Fall of instruments in the theatre is a common problem all over the world. It leads to increased operating time and extra resources and can hamper the end result of surgery. Our study is the first of its kind to evaluate the problem. Most falls occurred because of the operating surgeon. A course in instrument handling similar to one conducted by the theatre nurses may be helpful in preventing such falls.
DEFICIENCIES IN PATHOLOGICAL REPORTING OF COLORECTAL CANCER IN VICTORIA
Authors: Winn Robert D. , Robinson Domenic R. , Farmer Keith C. , Bell Stephen W.
Published: August 2008

Background:  Colorectal cancer (CRC) pathological reporting deficiencies have been shown to be common, with deviations from the suggested minimum dataset. Information from both surgeon and pathologist is necessary for a complete report. These deficiencies have been shown to be correctable with the use of synoptic reporting. We carried out an audit on a random sample of CRC pathological reports from the first 6 months of 2004 in Victoria, Australia, with the aim of documenting current CRC pathological reporting deficiencies.

Methods:  A random sample of pathological reports for CRC was obtained from the Cancer Council of Victoria. One hundred and sixteen of these reports were reviewed by a team of surgical and pathology trainees. Presence or absence of the various fields of the 1999 National Health and Medical Research Council minimum dataset for CRC reporting was recorded.

Results:  There were deviations from the minimal dataset. Most notable was the absence of the information on the apical node, the presence of distant metastasis and perineural invasion.

Conclusions:  The opportunity exists for improvement in the pathological reporting of CRC in Victoria through the uniform introduction of synoptic reporting.
AN AUDIT OF OPERATIVE NOTES: FACTS AND WAYS TO IMPROVE*
Authors: Lefter Liviu P. , Walker Stuart R. , Dewhurst Fleur , Turner R. W. L.
Published: August 2008

Background:  Accurate operation record keeping is an important element of risk management. Handwritten surgical notes are often produced as evidence in medico‐legal malpractice cases and incomplete and illegible notes may be a source of weakness in a surgeon’s defence. Therefore, we audited the surgical notes in a teaching hospital surgical department.

Methods:  During 1 week 190 operative notes were audited for patient identity details, preoperative diagnosis, operation title and details, CMB code, postoperative instruction and author of the note. The operative notes were assessed by a medico‐legal lawyer and a medical expert to establish level of legibility and usefulness in a virtual court case.

Results:  Several operative notes were found incomplete (51.57%) missing important information as CMB code (13.68%), patient details (6.8%) preoperative diagnosis (6.31%), operation title (6.31%) and postoperative instruction (14.73%). Overall, only 92 notes were complete.

Conclusion:  This audit suggests that handwritten surgical notes generate several errors that could lead to confusion when notes are reviewed for further follow up or are produced as evidence in medico‐legal disputes.
Atypical variable deceleration in the first stage of labor is a characteristic fetal heart‐rate pattern for velamentous cord insertion and hypercoiled cord
Authors: Hasegawa Junichi , Matsuoka Ryu , Ichizuka Kiyotake , Kotani Mihoko , Nakamura Masamitsu , Mikoshiba Takao , Sekizawa Akihiko , Okai Takashi
Published: August 2008

Aim:  To evaluate whether various umbilical cord abnormalities, including velamentous, marginal cord insertion (VCI, MCI), hypercoiled cord (HCC) and nuchal cord (NC), affect the appearance of atypical variable deceleration (VD) during labor.

Methods:  A cohort study was conducted which included cases with cord abnormalities (314 cases) and without them (487 controls), both of which were delivered in our hospital between June 2005 and December 2006. The relationship between cord abnormalities and the intrapartum fetal heart‐rate (FHR) pattern were retrospectively investigated focusing on VD. Analysis of FHR patterns was performed for 30 uterine contractions at the end of the first stage and throughout the whole of the second stage of labor. FHR patterns were analyzed for the presence of VD, atypical and pure VD. The frequencies of each FHR patterns per uterine contraction were assessed. The type of atypical VD was diagnosed in sequence as loss of variability during VD, overshoot, slow return of the FHR to the baseline, VD with no acceleration, and biphasic deceleration. Pure VD was typical VD without signs of atypia.

Results:  Frequencies of total VDs were significantly high in cases with VCI, HCC or NC in the first stage. Atypical VDs frequently occurred in cases with VCI, HCC and NC, and pure VDs did in cases with NC. In the second stage, frequencies of total and all types of VDs were not different.

Conclusion:  Mainly atypical VD in the first stage was a characteristic FHR pattern for VCI and HCC, and the appearance of such a pattern in cases with antepartum information on these abnormalities could suggest unfavorable fetal status.
Insulin resistance in women with a history of severe pre‐eclampsia
Authors: Soonthornpun Karanrat , Soonthornpun Supamai , Wannaro Prawit , Setasuban Worawong , Thamprasit Atchara
Published: August 2008

Aim:  This study investigated whether post‐partum insulin resistance existed in women with a history of severe pre‐eclampsia.

Methods:  The euglycemic hyperinsulinemic clamp technique was used to assess insulin sensitivity at least 6 months after delivery in 13 women who had had severe pre‐eclampsia and 26 age‐ and body mass index‐matched controls who had had normal pregnancy.

Results:  The mean (±SD) durations after delivery were 2.6 ± 1.6 years and 4.5 ± 2.8 years in the pre‐eclampsia and control groups, respectively. The systolic blood pressure was significantly higher in the pre‐eclampsia group (118 ± 11 mmHg vs 109 ± 12 mmHg, P = 0.028). Although the body mass indices were not different among the groups (25.8 ± 3.1 kg/m2 vs 24.6 ± 3.9 kg/m2), the waist and waist‐to‐hip ratio were significantly higher in the women with prior pre‐eclampsia. The pre‐eclampsia group had lower insulin sensitivity index than the controls (5.4 ± 2.5 mg/kg/min/mU/L vs 8.1 ± 4.0 mg/kg/min/mU/L, P = 0.036). Serum triglyceride levels were significantly higher in the pre‐eclampsia group (153 ± 74 mg/dL vs 82 ± 37 mg/dL, P < 0.01). High‐density lipoprotein‐cholesterol levels tended to be lower in the pre‐eclampsia group (42.1 ± 9.7 mg/dL vs 48.2 ± 9.6 mg/dL, P = 0.07).

Conclusion:  Women with a history of severe pre‐eclampsia had characteristics of metabolic syndrome and had lower insulin sensitivity compared with those who had had normal pregnancy. These may explain an increased risk of cardiovascular disease in women with pre‐eclampsia.
Periodic size changes in a supernumerary ovary with associated corpus luteal cyst
Authors: Matsubara Yuko , Fujioka Toru , Ikeda Tomoko , Kusanagi Yasuki , Matsubara Keiichi , Ito Masaharu
Published: August 2008

Supernumerary ovaries are extremely rare. Herein is reported a case of supernumerary ovary detected in a 31‐year‐old woman who complained of lower abdominal pain on her left side. Ultrasonography indicated a cystic mass in the pelvis, the size of which fluctuated periodically. A laparotomy was performed and indicated two normal ovaries in addition to a cystic mass in the cul‐de‐sac. Histology of the mass confirmed the presence of both normal ovarian tissue and cystic corpus luteal tissue consistent with the presence of a supernumerary ovary. Examination of the patient's medical history suggested that the supernumerary ovary was likely to be of embryonic origin, and not caused by surgical treatment or inflammation. This is the first report of a supernumerary ovary that was associated with periodic episodes of pain and changes in size, and a giant corpus luteal cyst near the rectum.
Quality of life and related factors in women, aged 15–49 in the 12‐month post‐partum period in Turkey
Authors: Akýn Belgin , Ege Emel , Koçoðlu Deniz , Demirören Nesime , Yýlmaz Sema
Published: August 2008

Aim:  The aim of the present study was to examine the quality of life (QoL) and related factors in women in a 12‐month postpartum period.

Methods:  A cross‐sectional study was undertaken to ascertain the factors related to QoL of postpartım women in Konya city, Turkey. Participants of the study consisted of 1749 first‐year postpartum women. Main outcome measures were Quality of Life Scale and factors potentially related to postpartum QoL.

Results:  It was found that being over the age of 35 years, having a spouse with a low level of education, having a low income, having a large number of children, not having social support from the spouse or other family members and not having time to rest or sleep were related to QoL.

Conclusions:  The QoL of postpartum women is related not only to sociodemographic and fertility characteristics, but also to the degree that social support is available and a woman's ability to find time for herself to rest and sleep.
Transcervical microwave myolysis for uterine myomas assisted by transvaginal ultrasonic guidance
Authors: Kanaoka Yasushi , Yoshida Chika , Fukuda Takeshi , Kajitani Koji , Ishiko Osamu
Published: August 2008

Aim:  The effects of transcervical microwave myolysis at 2.45 GHz after microwave endometrial ablation for menorrhagia were examined in patients with myomas.

Methods:  A transcervical microwave irradiation system assisted by transvaginal ultrasonic guidance was developed. Ten patients waiting for microwave endometrial ablation for menorrhagia caused by myomas entered the study after complete informed consent was obtained. Their outcomes were examined at least 6 months after transcervical microwave myolysis using the system. After completion of microwave endometrial ablation, interstitial microwave irradiation was performed using a guiding needle set in a puncture adaptor attached to a transvaginal ultrasonic probe and a microwave applicator of 1.6 mm in diameter. Shrinkage of the myoma was measured at 3 months and ≥6 months after the operation.

Results:  In nine patients with typical myomas, the major part consisting of a submucous or an intramural node 4.0–7.5 cm in size was necrotized. The typical myomas had shrunk by 41–68% at 3 months and 37–69% at ≥6 months after the operation. In one patient with a 6.8‐cm cellular leiomyoma, necrosis was limited to the neighborhood of the applicator tip. Shrinkage was 17% at both 3 and 6 months. This patient required a second microwave endometrial ablation at 6 months to treat recurrent menorrhagia. None of the patients underwent hysterectomy after the treatment. No remarkable complications were encountered.

Conclusions:  Typical myomas shrink after microwave myolysis following microwave endometrial ablation. Transcervical microwave myolysis seems to be applicable as a low‐invasive treatment for a typical myoma.
Restoration of bowel continuity after surgery for acute perforated diverticulitis: should Hartmann’s procedure be considered a one‐stage procedure?
Authors: Vermeulen J. , Coene P. P. L. O. , Van Hout N. M. , Van Der Harst E. , Gosselink M. P. , Mannaerts G. H. H. , Weidema W. F. , Lange J. F.
Published: August 2008

Objective  Hartmann’s procedure (HP) still remains the most frequently performed procedure in acute perforated diverticulitis, but it results in a end colostomy. Primary anastomosis (PA) with or without defunctioning loop ileostomy (DI) seems a good alternative. The aim of this study was to assess differences in the rate of stomal reversal after HP and PA with DI and to evaluate factors associated with postreversal morbidity in patients operated for acute perforated diverticulitis.

Method  All 158 patients who had survived emergency surgery for acute perforated diverticulitis in five teaching hospitals in The Netherlands between 1995 and 2005 and underwent HP or PA with DI were retrospectively studied. Age, gender, ASA‐classification, severity of primary disease, delay of stoma reversal, surgeon’s experience, surgical procedure and type of anastomosis were analysed in relation to outcome after stoma reversal.

Results  Of the 158 patients, 139 had undergone HP and 19 PA with DI. The reversal‐rate was higher in patients with DI (14/19; 74%) compared to HP (63/139; 45%) (P = 0.027) Delay between primary surgery and stoma reversal was shorter after PA with DI compared with HP (3.9 vs 9.1 months; P < 0.001). Cumulative postreversal morbidity after HP was 44%. Early surgical complications occurred in 22 of 63 patients. Morbidity after DI reversal was 15% (P < 0.001). Three patients died after HP reversal, none died after DI reversal. Anastomotic leakage was observed in 10 patients after HP reversal. This was less frequently observed when the operation was performed by a specialist colorectal surgeon (10%vs 33%; P = 0.049) and when a stapled anastomosis was performed (4%vs 24%; P = 0.037).

Conclusions  Reversal of HP should only be performed by an experienced colorectal surgeon, preferably performing a stapled anastomosis, or probably not be performed at all, as it is accompanied by high postoperative morbidity and even mortality. It is important that these findings are taken in account for when performing primary emergency surgery for acute perforated diverticulitis.
Long‐term surgical load in patients with ileal pouch‐anal anastomosis
Authors: Wasmuth H. H. , Tranø G. , Endreseth B. , Rydning A. , Wibe A. , Myrvold H. E.
Published: August 2008

Aim  To evaluate surgical workload and complications in patients who had undergone restorative proctocolectomy, through long‐term follow‐up in one single institution.

Method  From 1984 to 2006, 304 consecutive patients underwent Ileal Pouch‐Anal Anastomosis (IPAA). There were 182 stapled and 122 hand‐sewn anastomoses. A protective loop ileostomy was established in 256 patients (84%), whereas 48 patients (16%) were without a covering stoma.

Results  Twenty‐nine patients (10%) suffered from early anastomotic leakage. A protective stoma did not prevent early anastomotic dehiscence (P = 0.11) or the number of pelvic abscesses (P = 0.09). Early complications required 20 laparotomies with creation of a diverting stoma in nine patients. There were 16 (6%) complications related to closure of the loop ileostomy. Sixty‐six patients needed an additional re‐operation related to the IPAA procedure. There were 20 removals of pouches and three permanent diverting stomas. The estimated removal rate at 20 years of a functioning pouch was 11% (CI ± 6). Altogether 100 (33%) patients had one or more surgical procedures, excluding dilations of anastomotic strictures and closing of a loop ileostomy. These 100 patients underwent 187 surgical procedures. The estimated rate of a first re‐operation due to complications was 52% (CI ± 16) in 20 years. Hand‐sewn anastomoses had similar complications and failure rates as stapled anastomoses.

Conclusions  More than half of patients operated with restorative proctocolectomy will need surgical intervention within 20 years and the failure rate is more than 10%. The high risk of complications and failure inherent in the procedure should not be ignored.
Helicobacter species in the human colon
Authors: Keenan J. I. , Beaugie C. R. , Jasmann B. , Potter H. C. , Collett J. A. , Frizelle F. A.
Published: August 2008

Objective  To determine the prevalence, frequency and colonization patterns of Helicobacter species throughout the colon.

Method  Patients having initial colonoscopy for nonspecific gastrointestinal disturbance had colonic biopsies taken from up to four sites during colonoscopy and examined for evidence of the Helicobacteraceae family using a group‐specific PCR. Serum was also collected and examined for IgG reactivity to Helicobacter pylori.

Results  100 patients had colonoscopy of whom 35 were found to have DNA evidence of Helicobacter species throughout the colon, with 22 having H. pylori. Fifteen patients had a demonstrable serum IgG response to H. pylori that was not always associated with molecular evidence of H. pylori DNA in colon biopsies and vice versa. No specific association with colon disease was found in patients with H. pylori infection.

Conclusion  We found evidence of Helicobacter infection in a significant number of patients presenting for colonoscopy but no specific association between the presence of these bacteria and colon disease. Our finding of disparity between molecular and serological techniques to detect Helicobacter species suggests that future studies should not rely on serology alone to detect these bacteria in the human colon.
Morbidity and quality of life after continent ileostomy in the Netherlands
Authors: Hoekstra L. T. , De Zwart F. , Guijt M. , Bakx R. , Gerhards M. F.
Published: August 2008

Background  Continent ileostomy (CI) after proctocolectomy is an alternative technique compared to an ileal pouch‐anal anastomosis (IPAA). The question arises as to whether this technique is valuable. The aim of this study was to evaluate the role of the continent ileostomy, by patient follow‐up satisfaction and quality of life assessment.

Method  Twenty‐eight patients with a continent ileostomy operated between 1996 and 2007 were compared with patients who received an IPAA or a conventional ileostomy. SF‐36 and EORTC QLC‐CR38 questionnaires and a specific continent ileostomy questionnaire were used to assess differences and patient satisfaction.

Results  The quality of life in patients with a CI is not significant better or worse than patients with either a conventional ileostomy or an IPAA. On three scales (sexual enjoyment, gastro‐intestinal tract symptoms and male sexual problems) statistically significant differences were reported. Overall, nearly all patients are very satisfied with the CI. All patients would make the same decision again and would recommend this procedure to other patients.

Conclusion  The continent ileostomy remains to be a suitable alternative for the preservation of continence after a proctocolectomy, especially when an ileal pouch‐anal anastomosis is not an option. If a choice has to be made between a CI and conventional ileostomy good preoperative counselling is necessary to make a well founded decision. To minimize complications, these procedures have to be performed in centres with specific expertise. Therefore, knowledge about the CI should be preserved for the future.
Endoscopic transanal resection of rectal adenomas using the urological resectoscope
Authors: Modarai B. , Forshaw M. J. , Sankararajah D. , Murali K. , Stewart M.
Published: August 2008

Objective  Large sessile rectal adenomas are often difficult to excise and several different techniques have been described. This study evaluates the results of adenoma excision by endoscopic transanal resection using the urological resectoscope by a single surgeon in a UK district general hospital.

Method  Between January 1989 and November 2004, data on all patients treated by endoscopic transanal resection of benign rectal tumours using a urological resectoscope (ETAR) were prospectively collected and analysed.

Results  Forty patients (50% male, median age 72 years) underwent a total of 81 endoscopic transanal resections. The tumour characteristics were: size > 2 cm (83%), location in lower 2/3 of rectum (83%) and extensive circumferential carpet‐like appearances (13%). Fifty percent of the patients required only one procedure to achieve clearance. Mean operative time was 26 min (range 10–65 min). Seventy‐eight percent of the patients were discharged home within 24 h. Postoperative morbidity was 8% and in‐hospital mortality was zero. Histology revealed severe dysplasia in 48% of the tumours and five patients were incidentally found to have foci of rectal adenocarcinoma. With a median follow‐up of 47 months (range 2–162 months), local recurrences occurred in 13% (n = 5) of patients. All, except one, were treated successfully with further endoscopic transanal resections.

Conclusion  ETAR is simple and safe for managing rectal adenomas.
Self expanding wall stents in malignant colorectal cancer: is complete obstruction a contraindication to stent placement?
Authors: Stenhouse G. J. A. , Page B. , Rowan A. , Giles L. , Macdonald A.
Published: August 2008

Objective  Technical failures have previously been associated with complete clinical obstruction and complete block to the retrograde flow of gastrograffin is considered by some to be a contraindication to the procedure. We report on the technical and clinical success rates of self‐expanding metallic stents (SEMS) in both complete and incomplete obstruction in a prospective series of malignant colorectal obstructions.

Method  A prospective study of all patients undergoing attempted palliative and bridge to surgery SEMS placement for malignant colorectal obstruction over a 7‐year period (April 1999–October 2006) was undertaken.

Results  Seventy‐two patients (49 males) with a mean age of 71 years (range 49–98) were included. Technical success was achieved in 27 of 32 patients (84%) with complete obstruction and 33 of 36 patients (92%) with incomplete obstruction, P < 0.46, Fishers exact test. Clinical success was achieved in 17 of 26 patients (65%) with complete obstruction and 24 of 33 patients (73%) with incomplete obstruction, P < 0.58, Fishers exact test. Although placed correctly in 89% cases, relief of symptoms occurred in only 71%, P = 0.002, matched pairs test. There were two colonic perforations in the series with one procedure related death.

Conclusion  Placement of SEMS for obstructing colorectal cancer is technically successful in a high proportion of cases. Complete radiological obstruction is not a contraindication to stent placement. The relief of obstructive symptoms following successful placement of a wall stent is less predictable.
Histopathology reporting in colorectal cancer: a proforma improves quality
Authors: Siriwardana P. N. , Pathmeswaran A. , Hewavisenthi J. , Deen K. I.
Published: August 2008

Aim  The histopathology report is vital to determine the need for adjuvant therapy and prognosis in colorectal cancer (CRC). Completeness of those in text format is inadequate. This study evaluated the improvement of quality of histopathology reports following the introduction of a template proforma, based on standards set by the Royal College of Pathologists (RCP), UK.

Method  Sixty‐eight consecutive histopathology reports based on 19 items for rectal cancer (RC) and 15 items for colon cancer (CC) using the proforma were prospectively analysed and compared with results of a previous audit of 82 consecutive histopathology reports in text format. The percentage of reports containing a statement for each data item for both series was compared using the Normal test for difference between two proportions. Completeness of each report was assessed and a percentage score (percentage completeness) was given. Mean percentage completeness was calculated for each format and compared using the two sample t‐test.

Results  Except for comments on the presence of ‘histologically confirmed liver metastases’ in CC and RC, ‘distance from dentate line’ and ‘distance to circumferential margin’ in RC, all other items were commented in more than 90% of reports, where 71% of the items based on the minimum data set were present in all reports. Compared to prose format, the mean percentage completeness (SD) improved from 74% (8) to 91% (4) (P < 0.0001) and from 81% (5) to 99% (1) (P < 0.0001) for RC and CC respectively in template proforma format.

Conclusion  A template proforma and surgeon’s contribution in relation to operative findings improves the quality of the histopathology report in CRC.
Prognostic variables to predict cancer‐related death in incidental renal tumours
Authors: Bensalah Karim , Pantuck Allan J. , Crepel Maxime , Verhoest Grégory , Méjean Arnaud , Valéri Antoine , Ficarra Vincenzo , Pfister Christian , Ferrière Jean‐Marie , Soulié Michel , Cindolo Luca , De La Taille Alexandre , Tostain Jacques , Chautard Denis , Schips Luigi , Zigeuner Richard , Abbou Claude C. , Lobel Bernard , Salomon Laurent , Lechevallier Eric , Descotes Jean‐Luc , Guillé Francois , Colombel Marc , Belldegrun Arie S. , Patard Jean‐Jacques
Published: August 2008

OBJECTIVE

To identify, in a large multicentre series of incidental renal tumours, the key factors that could predict cancer‐related deaths, as such tumours have a better outcome than symptomatic tumours and selected patients are increasingly being included in watchful‐waiting protocols.

PATIENTS AND METHODS

Data from 3912 patients were extracted from three international kidney‐cancer databases. Age, gender, Eastern Cooperative Oncology Group (ECOG) performance status (PS), Tumour‐Node‐Metastasis (TNM) stage, tumour size, Fuhrman grade, and final pathology were recorded. Benign tumours and malignant lesions with incomplete information were excluded from final analysis.

RESULTS

The mean (sd) age of the patients was 60.6 (12.2) years and the mean tumour size 5.5 (3.5) cm. Most tumours were malignant (90.2%) and of low stage (T1‐T2, 71.7%) and low grade (G1‐G2, 72.4%). There were nodal and distant metastases in 5.7% and 13% of the patients. In all, 525 (14.4%) patients died from cancer; in this group, tumours were >4 cm in 88.2% and had nodal or distant metastases in 20.2% and 49.3%, respectively. Multivariable analysis showed that tumour size >4 cm, ECOG PS ≥1, TNM stage and Fuhrman grade were independent predictors of cancer‐related death.

CONCLUSION

A significant proportion of incidental renal tumours can lead to the death of the patient. Standard prognostic variables for renal cell carcinoma appear to remain valid for this subset of patients. A watchful‐waiting strategy should not be recommended if the tumour diameter is >4 cm, if biopsy confirms high‐grade tumours, or if there is an impaired ECOG PS, or computed tomography findings suggest the presence of advanced T stage.
The use of capsaicin in loin pain‐haematuria syndrome
Authors: Uzoh Christopher C. , Kumar Vivekanandan , Timoney Anthony G.
Published: August 2008

OBJECTIVE

To highlight the implications of the use of capsaicin in managing loin pain‐haematuria syndrome (LPHS).

PATIENTS AND METHODS

Between February 2002 and February 2007, three patients (one male and two females; mean age 31.7 years) with LPHS were managed with capsaicin and followed up for a period of 8–48 months. All were diagnosed with LPHS after negative urological investigations including urine culture, urine cytology, renal tract ultrasonography, intravenous urography and flexible cystoscopy; and nephrological work‐ups including normal blood pressure measurements, creatinine clearance, urinary protein estimation and serum urea/creatinine.

Five original papers were reviewed in detail for this article. Including our own experience, a total of 52 (including five bilateral) cases of LPHS treated with capsaicin are reviewed.

RESULTS

Our patients received a total of four capsaicin instillations producing an average duration of pain relief per instillation of 17 weeks. There was evidence of renal deterioration in one, while another had worsened symptoms. The third patient continued his pain management within the pain clinic. The former two patients eventually underwent nephrectomy for poor function and extreme symptoms.

CONCLUSION

Intrarenal capsaicin at best produces only short‐term pain relief in more than half of patients with LPHS. It produces significant side‐effects, i.e. UTI, bladder pain, and in up to half of patients, deteriorating symptoms. Further loss of functional renal tissue and a nephrectomy rate of 20–67% should be weighed against the benefits. We have therefore abandoned its use in treating LPHS or renal pain, and recommend that patients should be adequately counselled on its potential side‐effects, including nephrotoxicity and increased nephrectomy rate.
Metabolic and cardiovascular effects of androgen deprivation therapy
Authors: Hakimian Payam , Blute Michael , Kashanian James , Chan Sherman , Silver David , Shabsigh Ridwan
Published: August 2008

Prostate cancer is the most common gender‐specific malignancy in men in the USA. Androgen‐deprivation therapy (ADT) is commonly used in the treatment of metastatic or recurrent prostate cancer. The use of ADT is increasing with the advocacy of adjuvant and neoadjuvant ADT for treating asymptomatic patients with locally advanced prostate cancer. Although the use of ADT has resulted in improved survival in men with advanced prostate cancer, ADT, with its resulting severe hypogonadism, causes profound metabolic side‐effects. We comprehensively reviewed previous reports using Medline searches of English‐language literature (1950 to the present), with the keywords ‘hypogonadism’, ‘testosterone’, ‘androgen deprivation therapy’, ‘hormonal treatment’, ‘prostate cancer’, ‘diabetes’, ‘metabolic syndrome’, and ‘cardiovascular disease’. Men with prostate cancer who undergo long‐term ADT are at greater risk of developing dyslipidaemia, insulin resistance, hyperglycaemia and metabolic syndrome. These metabolic and physiological changes are a direct result of the induced severe hypogonadism and might predispose patients to a greater risk of cardiovascular morbidity and mortality. There is a need for prospective studies aimed and designed to investigate the metabolic and cardiovascular adverse effects of ADT, and assess the benefit/risk ratio, especially in special populations such as diabetics.
Signal transduction pathways of muscarinic receptor mediated activation in the newborn and adult mouse urinary bladder
Authors: Ekman Mari , Andersson Karl‐Erik , Arner Anders
Published: August 2008

OBJECTIVE

To study the role of M2and M3muscarinic receptor subtypes, sources of activator Ca2+, and mechanisms involved in increased force oscillations in muscarinic contractions in the bladders of newborn and adult mice, as in the adult bladder muscarinic M3receptors are considered to mediate the main part of bladder contraction, and this has not been established in the newborn bladder.

MATERIALS AND METHODS

Bladder preparations from newborn (0–2 days) and adult (10–12 weeks) mice were mounted forin vitroforce registration and activated with carbachol and high‐K+solution in the presence of M3(4‐DAMP 30 nm) or M2(methoctramine, 100 nm) receptor antagonists. Thapsigargin (1 µm) or ryanodine (10 µm) were used to inhibit sarcoplasmic reticulum Ca2+release. L‐NAME (300 µm) and 1H‐[1,2,4]oxadiazolo[4,3‐a]quinoxalin‐1‐one (ODQ; 10 µm) were used to inhibit nitric oxide synthase and guanylyl cyclase, respectively. Gap‐junction function was inhibited with by 18‐β‐glycyrrhetinic acid (18‐β‐GA; 0.1–100 µm). Big‐conductance (BK) and small‐conductance (SK) K+channels were inhibited by apamine and charybdotoxin (0.3 µm), respectively.

RESULTS

Concentration–response relations for carbachol in the presence of 4‐DAMP and methoctramine showed that M3receptors are the main activating pathway also in the newborn bladder. Neither thapsigargin nor ryanodine influenced the muscarinic responses of the newborn and adult bladders. Carbachol‐induced contractions were not influenced by L‐NAME or ODQ. The 18‐β‐GA inhibited carbachol‐induced contractions in both newborn and adult tissue in a similar manner. Apamine and charybdotoxin slightly increased the amplitude of the contractile responses.

CONCLUSION

These results suggest that in the newborn mouse bladder, as in adult bladders, the M3muscarinic receptor subtype is mainly responsible for carbachol‐induced contractile responses. The main mechanism for muscarinic receptor‐induced activation is influx of Ca2+from the extracellular medium, and there seems to be no major contribution of Ca2+release from intracellular stores. The phasic contractile activity induced by carbachol in the newborn bladder is not influenced by gap junction inhibition and does not involve SK and BK channels.
Slovenian midwives' and nurses' views on post‐natal depression: an exploratory study
Authors: Mivšek A.P. , Hundley V. , Kiger A.
Published: August 2008

Background:  Post‐natal depression affects approximately 10–15% of women. The literature suggests that midwives and nurses are key professionals in dealing with post‐natal mood disorders. However, this would be a new role in Slovenia for which it is not clear whether midwives and nurses are prepared.

Aim:  This study explored Slovenian midwives' and nurses' knowledge of, and attitudes towards, post‐natal mood disorders.

Methods:  Two focus groups were conducted, each with five participants, working in the maternity hospital and in the community centre in Postojna.

Findings:  Data were grouped into three main themes – knowledge of post‐natal mental health disorders, role in the management of these issues, and perceived problems and possible solutions in the health care of post‐natally depressed women. Participants lacked knowledge on post‐natal mental health and did not consider its management to be their role. They saw the main obstacle to caring for these women as being a lack of continuity of carer.

Conclusion:  Slovenian midwives and nurses should be appropriately educated regarding this subject in order to become more capable of managing post‐natal mental health. Continuous relationships with women should be encouraged.

Limitations:  Further investigation is required and a questionnaire survey involving a larger sample of midwives and community nurses is planned on the basis of the findings of this study.
Causes and management of nursing practice errors: a questionnaire survey of hospital nurses in Iran
Authors: Anoosheh M. , Ahmadi F. , Faghihzadeh S. , Vaismoradi M.
Published: August 2008

Background:  Some human error in health care is inevitable. Research into the predisposing factors for these errors is an important step in their management.

Aim:  To survey nurse perceptions of the contributing factors to nursing practice errors.

Methods:  A descriptive survey was carried out in three selected educational hospitals in Tehran city. Data were collected by questionnaire and analysed using descriptive statistics. The study sample consisted of 96 nurses and nursing managers. A multistage sampling strategy was used.

Results:  Results showed that from nurses' and nursing managers' perspectives, various factors could contribute to the occurrence of nursing errors in the ‘management’, ‘environment’ and ‘nursing care’ sections. In addition, there were differences between nurses working on various wards about the causes of nursing errors in each section.

Conclusion:  A culture of safety recognizes that safety is ‘no accident’. Rather, it requires a change in management practices, providing a suitable environment with the requisite supply of resources and infrastructure, and increasing nurses' knowledge. Outcomes that are identified from the process of practice error management should promote interventions designed to prevent future practice errors based on the above contributing factors.

Limitations:  The study relied on self‐report by a sample of nurses. These responses should now be tested by empirical research into actual nursing practice errors in order to test whether the nurses' perceived ideas of causation are substantiated.
Discourses associated with nursing aged people who are dying in the Australian context: a review of the literature
Authors: Allen S. , Chapman Y. , O'Connor M. , Francis K.
Published: August 2008

Aim: To examine the discourses associated with nursing care of aged people who are dying in the Australian context.

Background: The discourses associated with nursing aged people who are dying are not universally understood, and there is confusion regarding the meaning of terminology used to describe specific nursing practices in the aged care setting in Australia.

Methods: A literature search was undertaken to identify nursing practices and the discourses associated with nursing aged people who are dying in the Australian context. Words used in the literature to describe practices related to nursing care of the dying were distilled, and a search of the Cummulative Index to Nursing and Allied Health Literature (CINAHL) database using this vocabulary was undertaken to explicate the meanings associated with specific terminology.

Findings: The review of literature highlighted a plethora of nursing practices related to caring for people who are aged and dying. Hospice care, palliative care, terminal care, end‐of‐life care and a palliative approach are terms used to describe specific practices associated with nursing people who are dying. These terms have distinct meanings; however, they are often used interchangeably in aged care settings adding to confusion and the potential for compromised nursing practice standards.

Implications for practice: Understanding the terminology associated with nursing practice provided to people who are aged and dying allows the profession to engage in dialogue that is universally understood. Dialogue allows for rigorous debate, research and ultimately the evolution of nursing practice, improved outcomes for this group and the avoidance of unnecessary legal challenge to individual and institutional practice standards.

Conclusion: The terminology associated with the provision of care to the aged who are dying is reflective of the broader healthcare discourse focused on dying and death. Shared agreement about this terminology will avoid unnecessary litigation resulting from misunderstanding of the discourses that describe and define practice and enhance health outcomes for the aged dying and their families and/or significant others.
Audit of patients with type 2 diabetes following a critical cardiac event
Authors: Wu C.‐J. (Jo) , Chang A.M.
Published: August 2008

Background:  Evidence indicates that type 2 diabetes leads to complications such as a cardiac event, which often requires admission to a coronary care unit (CCU). Although there is a considerable body of knowledge about the management and characteristics of people with type 2 diabetes and myocardial infraction, there are few reports of the disease and demographic characteristics of the entire group of patients with diabetes admitted to a CCU.

Purpose:  To gain greater understanding of the characteristics of patients with diabetes hospitalized for a critical cardiac event in order to assist in the development of an appropriate self‐management programme for CCU patients with diabetes.

Methods:  Data were collected retrospectively from computerized records and charts of all patients with diabetes admitted to the CCU from 1 January 2000 to 31 December 2003.

Findings:  The proportion of type 2 diabetic patients admitted to CCU with a critical cardiac event over the 4‐year study period was consistent at 14.7%, 233 in 1589 patients. More than 22% of CCU patients with diabetes were readmitted to hospital within 28 days compared with only 6% of CCU patients without diabetes. Predictors for readmission and length of stay were also examined.

Conclusions:  A considerable proportion of a CCU population had type 2 diabetes and these patients had significantly higher readmission rates. The implications of this study for the development of a self‐management programme for patients with diabetes who experienced a critical cardiac event are discussed.

Implications for practice:  Innovative programmes are required to reduce the rate of readmission for patients with both diabetes and a critical cardiac event. These should:

1 ensure transition programmes, such as self‐management, commence within the CCU environment and continue following discharge, and

2 integrate diabetes and cardiac self‐management programmes to condense the large amount of information provided to patients for managing two serious conditions.
Nurse migration: the effects on nursing education
Authors: Hancock P.K.
Published: August 2008

This paper is an opinion piece based on experience and supported where possible with literature, which addresses an issue of both national and international interest. It focuses on one aspect of the multifaceted social phenomenon of nurse migration, i.e. nurse education.

Background:  Much has been written about the direct effects of nurse migration on the nurse migrant, the delivery of health care in the countries that supply the nurses, and the countries that receive them. However, there is little information regarding the direct effects of migration on nurse education within the literature.

Aim:  The aim of this paper is to raise awareness of the positive and negative effects of nurse migration on nurse education both in the countries that supply nurses and those which receive them.

Methods:  Both scholarly and ‘grey’ literature is used to support the discussion on the ‘real’ challenges faced by nurse educators and clinical nurses in those countries that supply or receive nurses. In addition, practical recommendations for nurse educators are presented. Furthermore, the nursing profession is challenged to become politically active, to become involved and to take responsibility for the decisions made about nurse education in order to protect the integrity of nurse education and patient safety.

Conclusion:  The quality of nurse education in many countries has been undermined as a result of rapid, mass migration. There is an urgent need to take practical steps to maintain the integrity of nurse education and the nurse's preparation for practice in order to protect patients' safety.
Does concept‐mapping strategy work for everyone? The levels of generativity and learners' self‐regulated learning skills
Authors: Lim Kyu Yon , Lee Hyeon Woo , Grabowski Barbara
Published: August 2008

The purpose of this study was to examine the effect of concept‐mapping strategies with three different generativity levels (expert‐generated concept map, partially learner‐generated concept map, fully learner‐generated concept map) on knowledge acquisition. Interaction between learners' self‐regulated learning (SRL) skills and different levels of generativity was also tested. One hundred twenty‐four undergraduate students, randomly assigned to three different concept‐mapping groups, were differentiated by high and low levels of SRL skills. The findings suggest that the participants in the fully learner‐generated map group significantly outperformed the participants in the expert‐generated map group, and participants with high SRL skills significantly outperformed those with low SRL skills across all treatment levels.
Making Boards Effective: An Empirical Examination of Board Task Performance
Authors: Minichilli Alessandro , Zattoni Alessandro , Zona Fabio
Published: August 2008

Despite the increasing attention of management scholars to boards of directors, there is still scant evidence on the antecedents of board task performance. The lack of significant results seems to be due to some theoretical and methodological choices followed by scholars, i.e. the almost exclusive reliance on agency theory and the use of demographic data. Following the call for dismantling the fortresses dominating past studies, this paper contributes to opening the ‘black box’ of boards of directors, developing a conceptual model that considers the impact of board members' diversity, commitment and critical debate on board task effectiveness in performing its service and control tasks. We collected primary data through a questionnaire survey, and we tested the model controlling for board, firm and industry characteristics. Our findings suggest that (i) the predictors we identified, and particularly the board members' commitment, are far more important than board demographics to predict board task performance; (ii) firm and industry contexts exert a significant influence on board task performance; (iii) predictors have a different impact on specific sets of tasks. Thus, our findings support the idea that several board characteristics and contingencies at both industry and firm level must be acknowledged in board design.
Nature of the Interactions among Organizational Commitments: Complementary, Competitive or Synergistic?*
Authors: Johnson Russell E. , Groff Kyle W. , Taing Meng U.
Published: August 2008

Although organizational commitment is a multidimensional construct, researchers have tended to examine the independent effects of its different forms. However, doing so creates potential problems of model misspecification and under‐prediction if interactions exist among different commitments. In this paper we discuss theoretically plausible interactions among different commitments, the patterns of which are expected to vary depending on the nature of the criterion and the foci of commitment. We then test these predictions via empirical data. Results revealed a ‘synergistic’ pattern of effects for discretionary outcomes, such that levels of organizational citizenship behaviour and strain were most favourable when employees reported high levels on multiple commitments. Importantly, no evidence was found for competitive effects between commitments, such that high levels on multiple commitments are detrimental. We discuss the implications of our findings for research and practice.
Single Mothers, Welfare, and Incentives to Work
Authors: González Libertad
Published: August 2008

Abstract.  This paper analyses the effect of a reform in the French single parents allowance on the labor supply of single mothers with very young children. The reform aimed at encouraging participation by allowing eligible single parents to accumulate welfare benefits and labor earnings for a limited period of time. The analysis shows that eligible single mothers were significantly more likely to work after the reform. During the same period, the employment rate of married mothers with young children did not experience a significant change, suggesting that at least part of the increase among single mothers was a consequence of the reform.
Employment Behaviour of Marginal Workers: The Roles of Preferences and Opportunities
Authors: Nordberg Morten
Published: August 2008

Abstract.  We use structural estimation techniques to analyse labour supply effects of changes in economic incentives for individuals who have just finished vocational rehabilitation in Norway. The complicated and sometimes non‐convex budget sets for this group of marginal workers are accounted for. We also focus on the limitation in the choice sets this group faces. Parametric bootstrap and simulation techniques are applied to construct confidence intervals for the predicted impacts of changes in the economic environment. The results show that there is a small to moderate effect of changes in economic incentives on the chance of vocational rehabilitation bringing individuals back to employment. We also find that individual health status and local labour market conditions are the most important factors affecting the transition from rehabilitation to work.