bluuebunny/crossref_metadata_2025 huggingface dataset:
Single‐dose pharmacokinetics of levetiracetam in healthy Chinese male subjects
Authors: Zhao Qian , Jiang Ji , Li XiaoMing , Lu Zhihong (Sarah) , Hu Pei
Published: February 2007

What is already known about this subject

• Levetiracetam has been evaluated for epilepsy since 1992.

• Pharmacokinetic studies of levetiracetam have been conducted in healthy volunteers, in adults, children and elderly patients with epilepsy, and in patients with renal and hepatic impairment.

• Although this antiepileptic has been well studied in Western countries, this paper describes the first such trial of the drug in a Chinese population.

What this study adds

• Information is given on the pharmacokinetics, dose proportionality, safety and tolerability profile of levetiracetam in healthy male Chinese volunteers, and the results are compared with published data obtained in White subjects.

• The pharmacokinetics and the pattern of adverse events of levetiracetam in Chinese subjects are similar to the data reported in White subjects.

Aims

The main aims of this study were to evaluate the pharmacokinetics of levetiracetam in healthy male Chinese volunteers and to assess the dose proportionality between the 500‐mg and 1500‐mg single doses.

Methods

This was a randomized, single‐centre, single‐dose, two‐way crossover study. Twenty‐six healthy male Chinese subjects were enrolled. All subjects received a single dose of 500 mg or 1500 mg levetiracetam tablet(s) on the dosing day, and the wash‐out period was 7 days. Blood was obtained for a 36‐h pharmacokinetic evaluation.

Results

Following single‐dose administration of 500 mg and 1500 mg of levetiracetam, the median tmax was 0.5 and 0.5 h; t1/2 was 7.3 ± 0.8 and 7.3 ± 0.7 h; Cmax was 13.6 ± 3.2 and 47.1 ± 12.1 µg ml−1; AUC0–∞ was 109.3 ± 14.1 and 340.4 ± 50.6 µg h−1 ml−1; and AUC0–t was 105.7 ± 13.3 and 329.0 ± 47.9 µg h−1 ml−1, respectively.

Conclusions

Both Cmax and AUCs were dose‐proportional over the range of 500–1500 mg. The pharmacokinetic data obtained in these Chinese subjects were similar to the historical data from a matched group of White subjects.
Plasma microparticles and vascular disorders
Authors: Lynch Susan F , Ludlam Christopher A
Published: February 2007

Microparticles are circulating, phospholipid rich, submicron particles released from the membranes of endothelial cells, platelets, leucocytes and erythrocytes. Investigation into their biological activity has revealed diverse actions in coagulation, cell signalling and cellular interactions. These actions are mediated through their phospholipid rich surfaces and the expression of cell surface molecules which reflect their cell of origin and its state of activation.

Microparticle numbers are reported to be elevated in a number of conditions where vascular dysfunction and inflammation are important pathophysiological mechanisms, for example coronary artery disease or thrombotic microangiopathies. Currently, there are a variety of different methods used for the quantitation of circulating microparticles; however with standardisation their assessment may prove to be of clinical value, reflecting the state of the vasculature. Knowledge of the functional properties of microparticles will contribute to our understanding of the mechanisms underlying vascular dysfunction and prothrombotic states.
Robust, routine haematology reference ranges for healthy adults
Authors: WAKEMAN L. , AL‐ISMAIL S. , BENTON A. , BEDDALL A. , GIBBS A. , HARTNELL S. , MORRIS K. , MUNRO R.
Published: February 2007

Accurate, reliable laboratory reference ranges are essential for effective clinical evaluation and monitoring. We present robust reference ranges established for haematology, coagulation and haematinic parameters using the Sysmex XE 2100, CA 1500 and Beckman–Coulter Access analysers. Blood samples were taken from 250 healthy laboratory personnel and routine haematology, coagulation and haematinic parameter analysis performed. Our data represent findings from an extensive study to establish reference ranges in healthy adults.
Effects of the route of oestrogen administration on IGF‐1 and IGFBP‐3 in healthy postmenopausal women: results from a randomized placebo‐controlled study
Authors: Sonnet Emmanuel , Lacut Karine , Roudaut Nathalie , Mottier Dominique , Kerlan Véronique , Oger Emmanuel
Published: February 2007

Objective  Oestrogens can modulate the action or secretion of GH. Previous studies in postmenopausal women have shown a differential effect between transdermal 17β‐oestradiol and oral ethynyl‐oestradiol on GH and IGF‐1 concentrations. This secondary analysis, based on a large randomized trial, aimed to estimate the effect of the route of administration of 17β‐oestradiol in combined hormone replacement therapy with progesterone on IGF‐1 and IGFBP‐3 levels.

Design  IGF‐1 and IGFBP‐3 were evaluated in a randomized study of 196 healthy postmenopausal women who were randomly allocated to receive on a continuous basis either 1 mg of 17β‐oestradiol orally combined with a daily intake of 100 mg progesterone (group 1; n = 63), or 50 µg of 17β‐oestradiol transdermally combined with a daily intake of 100 mg progesterone (group 2; n = 68), or triple dummy placebo (group 3; n = 65) over a 6‐month period. IGF1 and IGFBP‐3 levels were available for 133 women.

Results  Oral oestrogen significantly decreased IGF‐1 levels compared to placebo (P = 0·04) and transdermal oestrogen (P = 0·004), whereas transdermal oestrogen had no effect on IGF‐1 levels compared to placebo (P = 0·56). As regards IGFBP‐3, no significant difference was detected between the three groups.

Conclusions  Our data indicate that the route of oestrogen administration can influence IGF‐1 levels. IGF‐1 concentrations decreased significantly with oral oestrogen, whereas no significant change was observed with transdermal oestrogen at 6 months. The clinical relevance of these differential effects remains to be determined, particularly with regard to the risk for cardiovascular diseases.
Pharmacological prevention of atherothrombotic events in patients with peripheral arterial disease
Authors: Blinc A. , Poredoš P.
Published: February 2007

Peripheral arterial disease (PAD) is strongly associated with atherosclerosis in the coronary and carotid arteries, leading to a highly increased incidence of myocardial infarction, ischaemic stroke and cardiovascular death. Fortunately, pharmacological interventions in large clinical trials have been as effective in subgroups of patients with PAD as in subjects with other atherosclerotic disease. Antiplatelet treatment is indicated in virtually all patients with PAD. Aspirin 75–325 mg day−1 is considered as first‐line treatment, and clopidogrel 75 mg day−1 is an effective alternative. Statin therapy is indicated to achieve a target low‐density lipoprotein cholesterol level of ≤ 2·5 mmol L−1 in patients with PAD and there is emerging evidence that even lower levels are beneficial. Lowering of plasma homocysteine by supplementing folic acid, vitamin B12 and vitamin B6 is not recommended in patients with mild to moderate hyperhomocysteinaemia in the 12–25 µmol L−1 range, since it does not reduce the incidence of cardiovascular events. Antihypertensive treatment is indicated to achieve a goal blood pressure of ≤ 140/90 mmHg or ≤ 130/80 mmHg in the presence of diabetes or chronic kidney disease. All classes of antihypertensive drugs are acceptable for treatment of hypertension in patients with PAD, but angiotensin‐converting enzyme inhibitors ramipril or perindopril are especially appropriate because they reduce the incidence of cardiovascular events beyond their blood pressure‐lowering effects. Beta‐blockers should not be used as first‐line antihypertensive treatment. Diabetic patients with PAD should reduce their glycosylated haemoglobin to ≤ 7%. In conclusion, pharmacological secondary prevention of cardiovascular morbidity and mortality in patients with PAD should be as comprehensive as that in patients with established coronary or cerebrovascular disease.
Genetic and environmental determinants of the PON‐1 phenotype
Authors: Roest M. , Van Himbergen T. M. , Barendrecht A. B. , Peeters P. H. M. , Van Der Schouw Y. T. , Voorbij H. A. M.
Published: February 2007

Background  Paraoxonase (PON‐1) is a high‐density lipoprotein (HDL)‐associated enzyme that may protect against cardiovascular disease (CVD), because it hydrolyses oxidized phospholipids of low‐density lipoprotein (LDL) and therefore prevents the detrimental effects on the arterial wall. The current report describes the determinants of PON‐1 bioavailability and activity.

Materials and methods  This is the largest (n = 1527) cross‐sectional evaluation performed on PON‐1 genotypes (Q192R, T‐107C and L55M) and environmental determinants to PON‐1 catalytic activity and bioavailability in serum of postmenopausal women. PON‐1 catalytic activity and PON‐1 bioavailability were measured, in vitro, with a paraoxon hydrolysis assay and a phenylacetate hydrolysis assay, respectively.

Results  The major determinant of paraoxon hydrolytic activity is the Q192R genotype, but there was also a relation with the C‐107T and L55M genotype, HDL levels and alcohol consumption. Phenylacetate hydrolytic activity was most strongly affected by the C‐107T genotype followed by the L55M genotype, HDL levels, alcohol consumption and smoking.

Conclusions  PON‐1 Q192R, C‐107T and L55M genotype, alcohol consumption, smoking and HDL levels are determinants of serum PON‐1 phenotype. The contributions of the genetic markers to the PON‐1 phenotype are stronger than the contributions of the lifestyle determinants.
Vascular stiffness in familial hypercholesterolaemia is associated with C‐reactive protein and cholesterol burden
Authors: Cheng H. M. , Ye Z. X. , Chiou K. R. , Lin S. J. , Charng M. J.
Published: February 2007

Background  Familial hypercholesterolaemia (FH) is characterized by very high serum cholesterol and premature coronary atherosclerosis. Arterial stiffness and atherosclerosis are two major underlying pathophysiologies of arterial disease that are predictive of future cardiovascular events. The aims of this study were to quantify atherosclerosis and arterial stiffness and to evaluate their relationship with high sensitive C‐reactive protein (hs‐CRP) and the level of exposure to high serum cholesterol in FH patients.

Materials and methods  We measured traditional risk factors, hs‐CRP, intima‐media thickness (IMT) of carotid artery, and brachial‐ankle pulse wave velocity (baPWV) in 35 heterozygous FH subjects and 17 healthy control subjects. Cholesterol‐year score (CYS) was calculated to estimate the lifetime cholesterol burden in FH subjects.

Results  FH subjects had significantly elevated total cholesterol, low‐density lipoprotein cholesterol, and carotid IMT compared with those without mutations. Among FH patients, the baPWV and carotid IMT were higher in cases with high cholesterol burden than those without. Similarly, the baPWV and carotid IMT were also higher in cases with elevated hs‐CRP (> 1 mg L−1) than those without. Multiple linear regression analysis demonstrated CYS and hs‐CRP were significant independent predictors of baPWV and IMT in FH patients.

Conclusions  Both high cholesterol burden and vascular inflammation are not only associated with atherosclerosis, but also contribute to the development of arterial stiffness in FH patients. Early detection of hypercholesterolaemia in FH patients is warranted to prevent the untoward pathophysiologies.
A systematic approach to controlling problem bleeds in patients with severe congenital haemophilia A and high‐titre inhibitors
Authors: TEITEL J. , BERNTORP E. , COLLINS P. , D'OIRON R. , EWENSTEIN B. , GOMPERTS E. , GOUDEMAND J. , GRINGERI A. , KEY N. , LEISSINGER C. , MONAHAN P. , YOUNG G.
Published: February 2007

Summary.  The presence of inhibitory antibodies to clotting factors complicates the treatment of bleeding in haemophilia patients. For patients with high‐titre inhibitors, bypassing agents are essential to haemostatic management. To determine optimal treatment practices, an international panel of physicians convened to develop a systematic treatment approach for problem bleeds (i.e. bleeds that are unresponsive to initial therapy with a single agent within a reasonable amount of time) in haemophilia patients with inhibitors. Aim: The goal of this panel was to develop a consensus algorithm that would aid physicians in considering a variety of treatment approaches to optimize patient care by preventing extensive therapy with inadequate treatments that may lead to suboptimal patient outcomes and unnecessary costs. Methods: Consensus opinions were analyzed for clinical preferences at different time periods, depending on patient response to treatment. Decision‐making points were defined based on the type of bleed: every 8–12 h for the first 24 h, then every 24 h thereafter for limb‐threatening bleeds; every 2–4 h for 2–7 days for life‐threatening bleeds. Results: The resultant consensus guidelines provide a generalized methodology to guide the treatment of problem bleeds in patients with severe haemophilia A and inhibitors, and emphasize changing treatment at the first sign of an inadequate haemostatic response. The treatment algorithms apply to both paediatric and adult patients, although the differences between the two groups were reviewed. Conclusion: These guidelines are focused on optimising the timing of treatment decisions, which may lead to faster responses and improved outcomes.
Response to alkaline stress by root canal bacteria in biofilms
Authors: Chávez de Paz L. E. , Bergenholtz G. , Dahlén G. , Svensäter G.
Published: February 2007

Aim  To determine whether bacteria isolated from infected root canals survive alkaline shifts better in biofilms than in planktonic cultures.

Methodology  Clinical isolates of Enterococcus faecalis, Lactobacillus paracasei, Olsenella uli, Streptococcus anginosus, S. gordonii, S. oralis and Fusobacterium nucleatum in biofilm and planktonic cultures were stressed at pH 10.5 for 4 h, and cell viability determined using the fluorescent staining LIVE/DEAD BacLight bacterial viability kit. In addition, proteins released into extracellular culture fluids were identified by Western blotting.

Results  Enterococcus faecalis, L. paracasei, O. uli and S. gordonii survived in high numbers in both planktonic cultures and in biofilms after alkaline challenge. S. anginosus, S. oralis and F. nucleatum showed increased viability in biofilms compared with planktonic cultures. Alkaline exposure caused all planktonic cultures to aggregate into clusters and resulted in a greater extrusion of cellular proteins compared with cells in biofilms. Increased levels of DnaK, HPr and fructose‐1,6‐bisphosphate aldolase were observed in culture fluids, especially amongst streptococci.

Conclusions  In general, bacteria isolated from infected roots canals resisted alkaline stress better in biofilms than in planktonic cultures, however, planktonic cells appeared to use aggregation and the extracellular transport of specific proteins as survival mechanisms.
Vicariance patterns in the Mediterranean Sea: east–west cleavage and low dispersal in the endemic seagrass Posidonia oceanica
Authors: Arnaud‐Haond Sophie , Migliaccio Marianna , Diaz‐Almela Elena , Teixeira Sara , Van De Vliet Mirjiam Susanne , Alberto Filipe , Procaccini Gabriele , Duarte Carlos M. , Serrão Ester A.
Published: February 2007

Aim  The seagrass, Posidonia oceanica is a clonal angiosperm endemic to the Mediterranean Sea. Previous studies have suggested that clonal growth is far greater than sexual recruitment and thus leads to low clonal diversity within meadows. However, recently developed microsatellite markers indicate that there are many different genotypes, and therefore many distinct clones present. The low resolution of markers used in the past limited our ability to estimate clonality and assess the individual level. New high‐resolution dinucleotide microsatellites now allow genetically distinct individuals to be identified, enabling more reliable estimation of population genetic parameters across the Mediterranean Basin. We investigated the biogeography and dispersal of P. oceanica at various spatial scales in order to assess the influence of different evolutionary factors shaping the distribution of genetic diversity in this species.

Location  The Mediterranean.

Methods  We used seven hypervariable microsatellite markers, in addition to the five previously existing markers, to describe the spatial distribution of genetic variability in 34 meadows spread throughout the Mediterranean, on the basis of an average of 35.6 (± 6.3) ramets sampled.

Results  At the scale of the Mediterranean Sea as a whole, a strong east–west cleavage was detected (amova). These results are in line with those obtained using previous markers. The new results showed the presence of a putative secondary contact zone at the Siculo‐Tunisian Strait, which exhibited high allelic richness and shared alleles absent from the eastern and western basins. F statistics (pairwise θ ranges between 0.09 and 0.71) revealed high genetic structure between meadows, both at a small scale (about 2 to 200 km) and at a medium scale within the eastern and western basins, independent of geographical distance. At the intrameadow scale, significant spatial autocorrelation in six out of 15 locations revealed that dispersal can be restricted to the scale of a few metres.

Main conclusions  A stochastic pattern of effective migration due to low population size, turnover and seed survival is the most likely explanation for this pattern of highly restricted gene flow, despite the importance of an a priori seed dispersal potential. The east–west cleavage probably represents the outline of vicariance caused by the last Pleistocene ice age and maintained to this day by low gene flow. These results emphasize the diversity of evolutionary processes shaping the genetic structure at different spatial scales.
Comparative historical biogeography of Plateumaris leaf beetles (Coleoptera: Chrysomelidae) in Japan: interplay between fossil and molecular data
Authors: Sota Teiji , Hayashi Masakazu
Published: February 2007

Aim  In an attempt to use molecular and fossil data interactively in historical biogeography, we studied the phylogeography of five Plateumaris leaf beetles in Japan using mitochondrial cytochrome oxidase subunit I (COI) sequence data to explore interspecific differences in phylogeographical patterns and estimate the timings of colonization and geographical differentiation.

Location  A total of 461 beetles from five species on Hokkaido, Honshu and Kyushu islands of Japan were analysed with 117 beetles from three conspecies and two congeners from the mainland (Russia, including Sakhalin; Korea; Mongolia; Belgium; France; hereafter, the continent).

Methods  Using the sequence data from a 750‐bp portion of the COI gene, we studied the phylogeny of COI haplotypes, intraspecific population differentiation using analysis of molecular variance and the Mantel test, and intraspecific phylogeography using nested clade analysis. In addition, divergence times between the continental and Japanese lineages, as well as among the various Japanese lineages, were estimated using a Bayesian approach with node constraints based on fossil records of extant species.

Results  Three widely distributed species showed different degrees of geographical differentiation corresponding to their different colonization history in Japan. Bayesian estimates of divergence time revealed that one of two endemic species, which originated before the late Pliocene, attained intraspecific differentiation through the Pliocene and Pleistocene, whereas another endemic species has been confined in one locality, and three non‐endemic species colonized Japan after the mid‐Pleistocene.

Main conclusions  Molecular analyses of an insect group with relatively abundant fossil data can contribute greatly to the understanding of diverse biogeographical histories of related species in a region. Bayesian estimates of divergence time could be used to assess the variable evolutionary rates of the COI gene, and may be applied to other related insect species.
A Qualitative study explaining nurses’ perceptions of quality care for older people in long‐term care settings in Ireland
Authors: Murphy Kathy
Published: February 2007

Aim. The aim of this research was to explore nurses’ perceptions of the attributes of quality care and the factors that facilitate or hinder high‐quality nursing care in long‐term care.

Background. The quality of care for older people living in long‐term care has been identified as an issue of concern in many nursing research studies. While many factors have been identified, it is difficult to determine key factors from current research.

Method. The study was a qualitative exploration of nurses’ perceptions of quality care for older people and the factors that facilitate or hinder quality care. It involved 20 interviews with nurses. Respondents were asked to illustrate their accounts with examples from practice. This phase of the research was guided by the principles of hermeneutic phenomenology and the analysis process by Van Manen.

Findings. The findings indicated that nurses perceived quality care for older people in Ireland as holistic, individualized and focused on promoting independence and choice. The research revealed, however, that care in many practice areas was not individualized, patient choice and involvement in decision making was limited and some areas engendered dependency. While staffing was identified as a factor which had an impact on the provision of patient choice, other issues, such as the motivation of staff, the role of the ward manager and the dominance of routine were also highlighted.

Conclusion. There is a need to review organizational approaches to care, develop patient centred approaches to care and provide educational support for managers.

Relevance to practice. This research focuses on care for older people; it helps practitioners identify key factors in the provision of quality care for older people living in long‐term care.
Examining the correspondence of theoretical and real interpretations of health promotion
Authors: Irvine Fiona
Published: February 2007

Aims and objectives.  The aim of the research was to identify how the development of concept analyses have influenced practising nurses’ understanding of health promotion. More specifically the aim gives rise to the objective of establishing how they translate their understanding into practice.

Background.  The acknowledgement that nurses are confused about health promotion has led to attempts to define the term through the production of concept analyses, which aim to clarify the term for nursing education, research, policy and practice.

Design and methods.  A qualitative approach, using semi‐structured interviews was undertaken with a purposive sample of 21 district nurses, based throughout Wales. Thematic content analysis was used to order, describe and interpret the data.

Results.  Generally the respondents gave definitions of health promotion that were confined to the traditional conceptualization of health promotion, comprising actions aimed at changing the behaviour of individuals. These interpretations were translated into practice, where district nurses adopted a mainly reactive and individualistic approach to health promotion.

Conclusions and relevance to clinical practice.  The paper concludes that the more contemporary definitions of health promotion that focus on empowerment, community development and socio‐political action are yet to reach practising district nurses. Considerable effort is required from educationalists and practitioners if nurses are to include these ‘new paradigm’ approaches to health promotion in their practice.
Hand hygiene among nurses in Turkey: opinions and practices
Authors: Akyol Asiye D.
Published: February 2007

Aims and objectives.  This study aims to identify nurses’ practices and opinions of handwashing during routine patient care.

Background.  Transmission of microorganisms from the hands of healthcare workers is the main source of cross‐infection in hospitals and can be prevented by handwashing.

Design and methods.  A questionnaire survey was used for this study. A total of 129 clinical nurses at University of Ege Faculty of Medicine Application and Investigation Hospital at Internal Medicine Clinics was surveyed with a response rate of 100%. Data analysis was carried out using SPSS version 10.

Results.  The study revealed that nurses have a poor level of knowledge concerning quality of hand washing. All nursing actions related to ‘clean’ and ‘dirty’ activities were evaluated using the Fulkerson scale. The majority of nurses reported that they always wash hands after contact with contaminated and non‐contaminated patients, equipment and environment. It was found that they did need to wash their hands often but that they were not able to do this because of dense working conditions, insufficiency of necessary materials and drying and sore of hands after frequent washing.

Conclusion.  To improve hand hygiene and quality of handwashing compliance, additional factors must be considered. These factors include improving healthcare workers – especially nurses’– skin conditions, hand hygiene techniques and disinfections substantially.

Relevance to clinical practice.  Hospitals need to develop and implement innovative educational and motivational programmes tailored to specific groups of health personnel.
An exploration of best practice in multi‐agency working and the experiences of families of children with complex health needs. What works well and what needs to be done to improve practice for the future?
Authors: Carter Bernie , Cummings Julie , Cooper Lorraine
Published: February 2007

Aims and objectives.  This Appreciative Inquiry study aimed to explore appreciatively examples of best multi‐agency working practice with families (mothers, n = 20; fathers, n = 7; children, n = 1) and people working with children with complex needs (n = 41), to determine what works well, why it has worked well and what best practice in the future could be.

Background.  The term ‘children with complex health needs’ encompasses a diverse group of children and this population is increasing. This diverse group of children often requires high levels of physiological, psychological and social care which brings them and their families into therapeutic contact with a wide range of health, social and education professionals and people from other agencies.

Design.  The study used appreciative interviews, nominal group workshops and consensus workshops to develop a set of 10 ‘best practice’ guidelines that reflected the views of all participants. Two of these are discussed in detail in this article. All participants were seen as co‐researchers whose expert contributions were vital to understanding of what works well and what needs to be done in multi‐agency working practice.

Results.  The study resulted in ‘best practice’ statements that illuminated ‘what works well’ in multi‐agency working practice that spanned issues including information, decision making, communication, accessibility, collaboration, respect and sharing a common vision.

Conclusions.  The guidance that results from this study suggests that parents need the opportunity to share and receive support from other parents who understand the lived reality of caring for a child with complex needs. Parents and people from across various agencies need to work together to ensure that the most appropriate person acts in the role of a long‐term coordinator, where the family wants this aspect of support. This study adds a multi‐disciplinary and appreciatively oriented focus on what works well in complex care. It contributes to an understanding of the value of an Appreciative Inquiry approach within health‐care research.

Relevance to clinical practice.  The guidelines arose from and are grounded in practice and as such they provide clear, workable directions for enhancing practice and for considering what already does work well.
The experiences of older people on discharge from hospital following assessment by the public health nurse
Authors: McKeown Fiona
Published: February 2007

Aims and objectives.  The aim of the study was to explore the experiences of older people on discharge from hospital following assessment by the public health nurse. The objectives of the study were to: (i) identify needs as perceived by older people, (ii) examine if older people felt that these needs were met, (iii) examine the support/care/services received by older people, and (iv) explore any unmet needs of older people.

Background.  A review of the literature revealed that discharge from hospital remains an area of concern as older people had varying degrees of met and unmet need following discharge from acute hospital.

Design/methods.  A qualitative study using a phenomenological approach was undertaken. The researcher carried out interviews with a purposive sample of 11 older people in their homes two weeks following discharge from acute hospital. Data were analysed using Colaizzi's method.

Results.  Older people experienced a wide variety of difficulties in managing aspects of their own care. A reassuring finding of this study is that older people received assistance in this initial discharge period, i.e. they experienced significant informal support complemented by statutory and voluntary support. Even though these older people were assessed by the public health nurse, their need to access services, for statutory service provision, social aspects of their lives and safety measures in their environment were not met. Older people expressed the wish to remain in their own homes.

Conclusion.  Assessment of older people by the public health nurse is meaningful to identify the needs of older people and provide for the needs of older people though this does not necessarily mean that all the needs of older people can be met by the public health nurse. This study supports the findings of other studies of the problems after discharge and provides an understanding of the experiences of older people on discharge from hospital following assessment by the public health nurse from their perspective.

Relevance to clinical practice.  The study will provide information that will contribute to current public health nurse practice and will contribute to the understanding of public health nurse practice.
Findings from non‐participant observational data concerning health promoting nursing practice in the acute hospital setting focusing on generalist nurses
Authors: Casey Dympna
Published: February 2007

Aim.  This paper reports on the non‐participant observational findings from a study, which examined hospital‐based nurses’ health promoting nursing practice in an acute setting.

Background.  Nurses are considered to have a key role in health promotion. However, the development of the role of the generalist hospital‐based nurse in health promotion has been slow and is not well‐understood.

Method.  The conceptual framework used was based on the Ottawa Charter (WHO 1986). A single qualitative embedded case study, employing data source and methodological triangulation was used. A framework for identifying nurse's use of health promotion methods was developed and used to collect non‐participant observations on a purposive sample of eight nurses working on an acute hospital ward. Following the observations a semi structured one‐to‐one interview was conducted with each observed nurse. One randomly selected patient that the observed nurse had cared for during the observations was also interviewed. Qualitative data analysis based on the work of Miles and Huberman was employed.

Results.  Two categories were identified ‘health promotion strategies and content’ and ‘patient participation’. The findings indicated that, overall, the strategies used by nurses to promote health were prescriptive and individualistic. The main strategy observed was information giving and the content was ‘preparatory information’. Predominantly, nurses practised traditional health education. Overall, patient participation was limited to minor personal aspects of care as nurses focused on the routine and getting the tasks completed. There was no evidence of a ward culture which valued health promotion.

Conclusions.  Ward managers are key in creating a culture for health promotion. A review of the methods of organizing nursing care is warranted.

Relevance to clinical practice.  Nursing programmes must highlight health promotion as integral to practice and emphasis the socio‐political dimensions of health promotion.
Nurses’ feelings and thoughts about using physical restraints on hospitalized older patients
Authors: Chuang Yeu‐Hui , Huang Hui‐Tzu
Published: February 2007

Aim.  To explore nurses’ feelings and thoughts about physically restraining older hospitalized patients.

Background.  The use of physical restraints is still highly prevalent in hospitals; furthermore, older patients are most likely to be so restrained. Studies in acute care settings have focused mainly on nurses’ knowledge, attitudes, or practice concerning physical restraints, on physical restraint reduction programmes, on nurses’ perceptions about the use of physical restraints, or on elderly patients’ experiences with physical restraints. To the best of our knowledge no studies have been conducted on hospital nurses’ feelings and thoughts about the use of physical restraints in Taiwan.

Design and methods.  A qualitative approach was used to understand this phenomenon. Semi‐structured interviews were carried out, from August 2002 to March 2003, with 12 nurses working in three hospitals. The interviews were audiotaped and transcribed verbatim; content analysis was used to analyse the data.

Results.  Nurses reported a variety of emotional responses regarding the use of physical restraints, including sadness, guilt, conflicts, retribution, absence of feelings, security, and pity for the restrained older people. Rationalization, sharing with colleagues, and compensating behaviours were ways that nurses used to manage their negative feelings.

Conclusions.  Most nurses had negative feelings towards the use of physical restraints. Among these nurses there was a struggle between patients’ autonomy and the practice of care. However, other nurses said they had ‘no feelings’ or ‘feeling of security’ while using physical restraints.

Relevance to clinical practice.  The findings of this study may contribute to filling the gaps in nursing knowledge, to improving protocols for physical restraint use in hospitals, and may also assist nurse managers to create a supportive practice environment. It is recommended that in‐service training programmes should cover misconceptions regarding physical restraint use, ethical issues and how to cope with feelings while using physical restraints.
The effects of different maternal positions on non‐stress test: an experimental study
Authors: Aluş Merlinda , Okumuş Hülya , Mete Samiye , Güçlü Serkan
Published: February 2007

Aims and objectives.  To determine the effects of different maternal positions on non‐stress test results and the preferences of mothers for involving positions.

Background.  The non‐stress test (NST) has become a common tool in diagnosing fetal risks. The major problem encountered in the application of the non‐stress test has been obtaining erroneous non‐reactive non‐stress test results when, indeed, the fetus is healthy and oxygenation is sufficient.

Study design.  Experiment design with randomly assigned four positions: supine, left lateral, semi‐fowler and sitting up. The sample included 408 women in a university hospital in Turkey. Women were randomly assigned to four groups in equal numbers of 102.

Data collection and analysis.  Data were collected through two instruments: Demographic and Pregnancy History Form and NST tracing. Main outcome measures were percentage of reactive NST and number of minutes for reactivity in each position.

Results.  There were significant (P < 0·05) differences among four groups. Supine position showed the least fetal reactivity. In terms of time to reactivity, there were no statistically significant differences. Qualitative data showed that pregnant women were least comfortable in supine position reporting back pain and shortening of breath.

Conclusion.  Supine position yields the lowest non‐reactivity in tandem with physical discomfort such as back pain and difficulty in breathing.

Relevance to clinical practice.  Sitting up, semi‐fowler and left lateral positions are recommended to be used during the non‐stress test. In addition, the preferences of the pregnant women should be determined before the test to minimize discomfort which, when it occurs, may signal physiological alterations experienced during the test.
Falls in German in‐patients and residents over 65 years of age
Authors: Heinze Cornelia , Halfens Ruud JG , Dassen Theo
Published: February 2007

Aims and objectives.  The aim of the present study was to describe the first fall rates in hospitals and nursing homes throughout Germany. Relationships between age, gender, care dependency, medical disciplines, bed confinement and falls were investigated.

Background.  Little is known about fall rates in German hospitals and nursing homes.

Method.  Prevalence studies were conducted in the year 2002 and 2004. Forty hospitals and 15 nursing homes took part in 2002 (3923 patients and 1252 residents older than 65 years) and in 2004 there was a total of 39 hospitals and 29 nursing homes (4451 patients and 2374 residents older than 65 years). Staff nurses used a standardized instrument to collect data about falls in the last two weeks in their institutions and also about other patient problems. Descriptive and inferential statistics were used as well as logistic regression.

Results.  The first fall rate in 2002 (2004) in the hospitals was 4·7 (4·2) and in the nursing homes 4·5 (5·1) per 1000 patient/resident days. Most of the hospital patients fell on geriatric wards. The high care dependent patients fell more often than the low care dependent patients. In 2002, mobile nursing home residents were at a higher risk of falling than residents confined to bed, but those results could not be confirmed in 2004.

Conclusions.  Falls of patients over 65 years of age are as much of a problem in German hospitals as they are in German nursing homes.

Relevance to clinical practice.  Fall preventive methods should be implemented both in nursing homes and hospitals. Care dependency is a stable risk factor for falls in hospital patients.
Children's nurses and nurse prescribing: a case study identifying issues for developing training programmes in the UK
Authors: Pontin David , Jones Susan
Published: February 2007

Aims and objectives.  (1) To develop an insight into the opportunities and barriers to nurse prescribing for a case study of children's nurses. (2) To consider the implications of independent nurse prescribing for children's nurses and the potential for nurse prescribing to be developed in acute children's care settings. (3) To use research data to develop a training strategy.

Background.  Nurse prescribing in the UK is evolving and current initiatives aim to extend the range and scope of prescribing. Children's nursing presents interesting challenges because of off‐license drugs. Successful nurse prescribing lies in practice area preparation, local policy and practice development and identifying precourse training needs.

Design.  Case study.

Research questions.  (1) What opportunities do children's nurses identify as being appropriate for nurse prescribing? (2) Can children's nurses identify the benefits of patient group directives and the different levels of nurse prescribing? (3) What preparation do children's nurses need for nurse prescribing?

Methods.  Focus group of health visitors/district nurses to inform a survey of 500 nurses working in acute and specialist care settings in a large Children's Hospital.

Results.  Focus group main themes – training, supervision and the development of confidence, record keeping, benefits of nurse prescribing, autonomous practice, the formulary and its use in practice. Response rate was 27%. Senior nurses and specialists identified potential benefits for their practice. Course content needed to focus on children, i.e. children's physiology and pharmokinetics. Children's nurses frequently advise junior medical colleagues on prescribing issues. Patient group directives are a useful alternative to prescribing.

Conclusions.  The results provide an insight into the training needs of children's nurses and specialist nurses which may be used to develop nurse prescribing training and practice. Training may need to be targeted at senior nurses/specialist nurses initially to develop a critical mass to change organizational culture.

Relevance to clinical practice.  Pertinent for senior nurses responsible for developing children's nursing practice and services for children in acute settings.
The prevalence of enduring postnatal perineal morbidity and its relationship to type of birth and birth risk factors
Authors: Williams Amanda , Herron‐Marx Sandy , Knibb Rebecca
Published: February 2007

Aims and objectives.  To investigate the prevalence of perineal morbidity at 12 months postnatal and its relationship to type of birth and birth risk factors.

Background.  It is well documented that women endure short‐term postnatal perineal morbidity following childbirth (e.g. incontinence, perineal pain and sexual morbidity). However, to date, very little research has been carried out on the long‐term effects of perineal morbidity and its relationship to the type of birth the women experienced and other birth risk factors (e.g. ethnic origin, age, parity, length of labour, epidural anaesthesia).

Design.  A retrospective, cross‐sectional community survey of postnatal women within two maternity units in Birmingham.

Methods.  A total population sample of 2,100 women were surveyed using a self‐administered postal questionnaire. The questionnaire included self‐assessment of perineal pain, perineal healing, urinary incontinence, flatus incontinence, faecal incontinence, sexual morbidity and dyspareunia. Demographic details, type of birth and birth risk factors were taken from the hospital's computerized maternity information system.

Results.  Four hundred and eighty‐two women responded to the questionnaire (23·3%). Overall, a high level of enduring perineal morbidity was reported with 87% complaining of at least one index of morbidity. Instrumental births were associated with higher levels of certain types of perineal morbidity than women following a caesarean section or normal vaginal birth (stress and urge urinary incontinence, flatus incontinence, sexual morbidity and dyspareunia). In particular, women following a forceps birth reported higher levels of morbidity than normal or ventouse birth (continual, stress and urge urinary incontinence and flatus incontinence), even when comparing with the same degree of perineal trauma. Increasing age, increasing birth weight, length of labour and particularly Asian ethnic origin were also identified as risk factors for certain types of perineal morbidity.

Conclusions.  The study concludes that enduring perineal morbidity in women following childbirth is common, especially with women following a forceps birth and certain birth risk factors (i.e. age, ethnic origin, length of labour and birth weight).

Relevance to clinical practice.  These findings highlight the need for further research and provide a number of challenges for health‐care services and health‐care professionals.
Gallstone disease
Authors: Marschall H.‐U. , Einarsson C.
Published: February 2007

Gallstone disease is one of the most prevalent gastrointestinal diseases with a substantial burden to health care systems that is supposed to increase in ageing populations at risk. Aetiology and pathogenesis of cholesterol gallstones still are not well defined, and strategies for prevention and efficient nonsurgical therapies are missing. This review summarizes current concepts on the pathogenesis of cholesterol gallstones with focus on the uptake and secretion of biliary lipids and special emphasis on recent studies into the genetic background.
Increased formation of 8‐iso‐prostaglandin F2α is associated with altered bone metabolism and lower bone mass in hypercholesterolaemic subjects
Authors: Mangiafico R. A. , Malaponte G. , Pennisi P. , Li Volti G. , Trovato G. , Mangiafico M. , Bevelacqua Y. , Mazza F. , Fiore C. E.
Published: February 2007

Objectives. To investigate the relationship of 8‐iso‐prostaglandin (PG) F2α levels, a reliable marker of in vivo oxidative stress and lipid peroxidation, with bone mineral density (BMD), bone turnover markers, osteoprotegerin (OPG) and receptor activator of nuclear factor‐kappa B ligand (RANKL) in hypercholesterolaemia.

Design.  Cross‐sectional study

Setting.  University hospital centre

Methods.  Serum 8‐iso‐PGF2α levels were measured in 173 hypercholesterolaemic subjects and in 152 age‐ and sex‐matched normocholesterolaemic controls. Femoral neck and lumbar spine BMD, serum bone‐specific alkaline phosphatase (BAP), osteocalcin (OC), OPG and RANKL levels, as well as urinary levels of C‐terminal telopeptides of type I collagen (CTX‐I), were also assessed.

Results.  Hypercholesterolaemic subjects showed higher (P < 0.0001) serum 8‐iso‐PGF2α levels than controls. They also had decreased (P < 0.0001) femoral neck and lumbar spine BMD, and lower (P < 0.0001) serum BAP and OC levels. No significant differences between hypercholesterolaemic and control subjects were found when comparing urinary CTX‐I levels, or serum OPG and RANKL levels. In multivariate linear regression analysis, serum 8‐iso‐PGF2α was the only negative predictor for femoral neck BMD and serum BAP and OC levels in hypercholesterolaemic subjects. No significant correlation (all P > 0.25) was present between serum 8‐iso‐PGF2α levels and urinary CTX‐I levels, or serum OPG and RANKL levels, in hypercholesterolaemic subjects.

Conclusions.  We found an association between increased serum 8‐iso‐PGF2α levels and lower bone mass and reduced serum BAP and OC concentrations in hypercholesterolaemic subjects. These results would suggest a possible role for oxidative stress in the development of lower bone mass in hypercholesterolaemia.
Recurrent herpes simplex virus infection in a patient with autoimmune polyendocrinopathy–candidiasis–ectodermal dystrophy associated with L29P and IVS9‐1G>C compound heterozygous autoimmune regulator gene mutations
Authors: Nagafuchi S. , Umene K. , Yamanaka F. , Oohashi S. , Shindo M. , Kurisaki H. , Kudoh J. , Shimizu N. , Hara T. , Harada M.
Published: February 2007

Autoimmune polyendocrinopathy–candidiasis–ectodermal dystrophy (APECED) has characteristic clinical features with organ‐specific autoimmune polyendocrine diseases and candidiasis, caused by the mutations of autoimmune regulator (AIRE) gene. Although almost all patients are complicated with mucocutaneous candidiasis, no apparent susceptibility to other infections has yet been reported. We herein report that a patient with APECED suffered from recurrent herpes simplex virus type 1 (HSV‐1) infection after severe primary herpetic stomatitis, associated with sequential HSV‐1 isolates of the same genomic profile, consistent with endogeneous recurrence. Thus, not only candidiasis but also HSV infection should receive more attention in patients with APECED, with treatment being administered accordingly.