bluuebunny/crossref_metadata_2025 huggingface dataset:
Autoimmune haemolytic anaemia complicating haematopoietic cell transplantation in paediatric patients: high incidence and significant mortality in unrelated donor transplants for non‐malignant diseases
Authors: O'Brien Tracey A. , Eastlund Ted , Peters Charles , Neglia Joseph P. , Defor Todd , Ramsay Norma K.C. , Scott Baker K.
Published: September 2004

Haemolytic anaemia is a recognized complication of haematopoietic cell transplantation (HCT) and can result from alloimmune‐ or autoimmune‐derived antibodies. Unlike alloimmune haemolytic anaemia, autoimmune haemolytic anaemia (AIHA) is poorly understood, particularly in the paediatric population where only case reports have been published. Between January 1995 and July 2001, 439 consecutive allogeneic HCT were performed in paediatric patients at the University of Minnesota, 31% (n = 136) from related donors (RD) and 69% (n = 303) from unrelated donors (URD). Nineteen cases of AIHA were identified with documented significant haemolysis and a positive direct antiglobulin test. All cases of AIHA occurred in URD transplants, yielding a cumulative incidence of AIHA post‐transplant of 6% at 1 year. Patients transplanted for non‐malignant disease, particularly metabolic diseases, had a higher incidence of AIHA post‐HCT when compared with patients transplanted for malignancies (RR 4·2 95% CI 1·2–15·4,P = 0·01). Mortality was high in our series of 19 patients with 10 (53%) dying following the onset of AIHA, three as a direct consequence of haemolysis. Fifty per cent of deaths occurred from infection while on immunosuppressive therapy to treat haemolysis. Alternative treatment strategies were employed, with the majority of patients demonstrating disease refractory to traditional steroid therapy.
Platelet‐rich plasma serotonin levels in chronic myeloproliferative disorders: evaluation of diagnostic use and comparison with the neutrophil PRV‐1 assay
Authors: Koch Cody A. , Lasho Terra L. , Tefferi Ayalew
Published: September 2004

In a prospective study of 109 subjects, an enzyme‐linked immunosorbent assay (ELISA) was used to measure platelet‐rich plasma (PRP) serotonin levels in patients with polycythaemia vera (PV; n = 27), essential thrombocythaemia (ET; n = 14), myelofibrosis with myeloid metaplasia (MMM; n = 30), secondary or spurious polycythaemia (SP; n = 22) and controls (n = 16). Nine study subjects who were taking a selective serotonin reuptake inhibitor (SSRI) all displayed a markedly decreased PRP serotonin level (median, 24·2 ng/109 platelets; range, 0–49·3) and were therefore excluded from further analysis. Among the remaining 100 subjects, the median and range of PRP serotonin levels, in ng/109 platelets, was significantly lower in MMM (89·5; 0–278·3), PV (204·8; 0–496·0) and ET (385·3; 136·8–1025·7) compared with both SP (608·8; 369·0–1780·1) and controls (567·2; 359·9–1071·1). Neutrophil polycythaemia rubra vera‐1 (PRV‐1) expression was concurrently assayed by real‐time polymerase chain reaction in 69 patients (23 PV, 17 SP, 12 ET, seven MMM, 10 controls). PRP serotonin measurement performed as well as the PRV‐1 assay in distinguishing PV from SP (93% vs. 86% test accuracy). The current study suggests that PRP serotonin concentration might be considered as one of the several biological markers that complement each other for the diagnosis of PV.
RNA and protein evidence for haplo‐insufficiency in Diamond–Blackfan anaemia patients with RPS19 mutations
Authors: Gazda Hanna T. , Zhong Rong , Long Lilia , Niewiadomska Edyta , Lipton Jeffrey M. , Ploszynska Anna , Zaucha Jan M. , Vlachos Adrianna , Atsidaftos Evangelia , Viskochil David H. , Niemeyer Charlotte M. , Meerpohl Joerg J. , Rokicka‐Milewska Roma , Pospisilova Dagmar , Wiktor‐Jedrzejczak W. , Nathan David G. , Beggs Alan H. , Sieff Colin A.
Published: September 2004

The genetic basis of Diamond–Blackfan anaemia (DBA), a congenital erythroid hypoplasia that shows marked clinical heterogeneity, remains obscure. However, the fact that nearly one‐quarter of patients harbour a variety of mutations in RPS19, a ribosomal protein gene, provides an opportunity to examine whether haplo‐insufficiency of RPS19 protein can be demonstrated in certain cases. To that end, we identified 19 of 81 DBA index cases, both familial and sporadic, with RPS19 mutations. We found 14 distinct insertions, deletions, missense, nonsense and splice site mutations in the 19 probands, and studied mutations in 10 patients at the RNA level and in three patients at the protein level. Characterization of the mutations in 10 probands, including six with novel insertions, nonsense and splice site mutations, showed that the abnormal transcript was detectable in nine cases. The RPS19 mRNA and protein in CD34+ bone marrow cells identified haplo‐insufficiency in three cases predicted to have one functional allele. Our data support the notion that, in addition to rare DBA patients with the deletion of one allele, the disease in certain other RPS19 mutant patients is because of RPS19 protein haplo‐insufficiency.
The distal β‐globin CACCC box is required for maximal stimulation of the β‐globin gene by EKLF
Authors: Marini Maria Giuseppina , Asunis Isadora , Porcu Loredana , Salgo Maria Giulia , Loi Maria Giuseppina , Brucchietti Arianna , Cao Antonio , Moi Paolo
Published: September 2004

The transcription factor erythroid Kruppel‐like factor (EKLF) specifically activates the β‐globin gene by interacting with the proximal β‐globin CACCC box, a known hot spot for thalassaemia mutations. This study investigated whether EKLF could also bind to, and activate from, the distal CACCC, which is a rare site of thalassaemia mutations. Using band shift and transient expression analysis with wild type, single and double CACCC mutants, we established that the distal CACCC box is weakly bound by EKLF, but, when mutated, significantly impairs EKLF‐dependent β‐globin stimulation. Thus, EKLF requires both CACCC boxes to maximally stimulate the β‐globin gene.
Multiple platelet defects identified by flow cytometry at diagnosis in acute myeloid leukaemia
Authors: Leinoe E. B. , Hoffmann M. H. , Kjaersgaard E. , Johnsen H. E.
Published: September 2004

Previous findings of megakaryocytic hypogranulation and dysmegakaryocytopoietic features in acute myeloid leukaemia (AML) strongly indicate defects in platelet production. The bleeding tendency of these patients may result from dysregulated platelet production, resulting in thrombocytopenia as well as qualitative platelet defects. The present study examined platelet function at diagnosis in 50 AML patients by whole blood flow cytometry. Following in vitro platelet agonist stimulation, platelet activation markers were analysed and compared with 20 healthy individuals. To detect recent in vivo platelet activation, plasma soluble P‐selectin (sP‐selectin) was measured. Flow cytometric analysis of platelet activation markers demonstrated reduced CD62P [35·6 vs. 118·5 × 103 molecules of equivalent soluble fluorochrome (MESF); P < 0·0001], CD63 (11·3 vs. 50·7 × 103 MESF; P < 0·0001), and PAC‐1 (41·5 vs. 90·5%; P = 0·0001) while reductions in CD42b were abnormal (45·6 vs. 70%; P < 0·0001). sP‐selectin levels were similar in patients and healthy controls (0·04 vs. 0·27 fg/platelet; P = 0·84). The presented data indicate that AML pathogenesis may result in multiple platelet defects, involving adhesion, aggregation, and secretion and demonstrate that flow cytometry is a feasible method for platelet function analysis in patients with thrombocytopenia.
Different impacts of alleles αLEPRA and αLELY as assessed versus a novel, virtually null allele of the SPTA1 gene in trans
Authors: Delaunay J. , Nouyrigat V. , Proust A. , Schischmanoff P.‐O. , Cynober T. , Yvart J. , Gaillard C. , Danos O. , Tchernia G.
Published: September 2004

The family of two siblings with severe hereditary spherocytosis was investigated. The decrease was evident on both the α‐ and the β‐chains. The parents were haematologically normal. The mother was heterozygous for the low‐expression polymorphic allele αLEPRA. The father was heterozygous for a novel combination in which one allele showed the α‐spectrin low expression polymorphic alleleαLELY, while his other allele showed the αLELY polymorphism in cis with a G→A substitution, named Bicêtre, found at the extreme 3′ end of exon 51. This combination was designated . The children were compound heterozygotes for alleles αLEPRA and . Reverse transcription polymerase chain reaction detected only trace amounts of the mRNA coding for . Mutation is therefore an essentially null mutation with no functional protein product. The lack of disease in the αLELY/ father compared with the marked haemolysis in the αLEPRA/ children showed that expression of allele αLELY is not low enough to expose null α‐spectrin alleles on the other chromosome. Quantitative estimations from these findings suggest that, to evoke spherocytosis, it is necessary that α‐spectrin expression must be reduced to less than 25% of normal, while a reduction to 8% is sufficient.
Prospective application of a multiplex reverse transcription‐polymerase chain reaction assay for the detection of balanced translocations in leukaemia: a single‐laboratory study of 390 paediatric and adult patients
Authors: Olesen Lene Hyldahl , Clausen Niels , Dimitrijevic Andreja , Kerndrup Gitte , Kjeldsen Eigil , Hokland Peter
Published: September 2004

The upfront application of molecular methods for identifying the fusion transcripts arising from balanced translocations in haematopoietic malignancies has several advantages: sensitivity is independent of its frequency, i.e. rare ones are not missed, cytogenetically cryptic aberrations are identified and it provides a platform for minimal residual disease (MRD) detection. Employing a multiplex reverse transcription polymerase chain reaction (RT‐PCR) assay identifying 27 fusion transcripts we prospectively analysed blood and/or bone marrow samples from 390 patients referred for diagnosis and treatment for acute leukaemia and chronic myeloproliferative disorders (CMPD) from a geographically well‐defined region in Denmark. A total of 233 patients were diagnosed with acute myeloid leukaemia (AML), 95 with acute lymphoblastic leukaemia (ALL) origin and 62 patients were recorded as CMPD. Twenty‐three percent AML, 32% ALL and 55% CMPD patients exhibited chromosomal aberrations detected by the multiplex RT‐PCR. Cytogenetically cryptic translocations were seen in 15% of the cases. Conversely, the cytogenetic analysis identified chromosomal aberrations other than translocations in 45% of AML cases and 63% of ALL cases. We conclude that, while the fraction of translocation positive leukaemia patients in an unselected cohort is lower than hitherto believed, a molecular approach to their diagnosis is worthwhile, partly for identifying cryptic and rare translocations, partly for monitoring MRD.
Literature review of surgery management in inhibitor patients
Authors: Rodriguez‐Merchan E. C. , Rocino A.
Published: September 2004

Summary.  A careful review of the available literature has shown with a moderate degree of evidence that surgery can be safely performed in haemophilic patients with either low‐responding or high‐responding inhibitors. Until recently, it was generally advised that surgery should be carried out in high responding haemophilic patients only if absolutely necessary, i.e. in emergency situations. Elective surgery was usually discouraged, with the exception of the placing of an indwelling catheter to carry out immune tolerance protocols. However, in reality elective surgery is often advisable in haemophilic patients with inhibitors because it may lead to an improved quality of life. At the present time, several options of treatment exist which appear to be sufficiently safe to assure haemostasis in different surgical procedures However, a more informed choice between different treatment options, based on estimation of advantages and risks linked to each treatment modality is desirable. Furthermore, the choice between different options has to be made taking into consideration costs of treatment. Ideally, randomised prospective studies are needed in order to provide a higher level of evidence of safety and efficacy of different treatment options and specifically comparing the two main bypassing options:activated prothrombin complex concentrates (aPCCs) and recombinant factor (rF)VIIa. In addition, such studies should be done with an adequate protocol, providing sufficient haematological data and an appropriate prolonged postoperative assessment.
Promoting psychiatric student nurse well‐being
Authors: MORRISSETTE P. J.
Published: September 2004

Although students are often attracted to the profession of psychiatric nursing, they are rarely prepared for the realities associated with clinical seminars and direct clinical practice. Subsequently, student nurses commonly report the resurgence of painful life events or symptoms of psychological injury when learning about or witnessing patient behaviour. This paper underlines the importance of student–faculty collaboration when promoting and monitoring student nurse well‐being. Along with providing descriptions and case vignettes depicting two specific forms of psychological injury, this paper suggests practical steps that are designed to promote student nurse well‐being.
The use of touch to enhance nursing care of older person in long‐term mental health care facilities
Authors: GLEESON M. , TIMMINS F.
Published: September 2004

The self‐care deficits experienced by older clients in long‐term mental health settings, because of cognitive impairment, are likely to impact upon the clients’ higher‐order needs. The practice of nursing the elderly involves a lot of personal contact, during the delivery of fundamental physical care. While physiological and safety needs are crucial to clients in long‐term settings, higher‐order needs need also to be addressed. From the clients’ perspective nurse's use of touch provides comfort, warmth and security, although there is a dearth of empirical evidence of these benefits. This paper explores the nurse's use of touch, the impact of touch and the experiences of touch on the older person in long‐term settings. Because of the dearth of research in the use of touch with elderly clients in long‐term care mental health facilities, a review of the literature was performed on the topic. This revealed that touch by nurses is frequently associated with routine tasks within nursing, and is less likely to be a caring touch intervention. Recommendations include further research on the topic and caution with widespread adoption of caring touch as an intervention.
Judging the other: psychiatric nurses’ attitudes towards identified inpatients as measured by the semantic differential technique
Authors: LILJA L. , ORDELL M. , DAHL A. , HELLZÉN O.
Published: September 2004

Nurses’ attitudes towards psychiatric patients can be expressed in terms of either a symptom‐oriented approach or a personhood‐focused approach where the latter is characterized by the ambition to establish a genuine and lasting relationship, while the former places the emphasis on correcting ‘defective’ patient behaviour. To study whether previous typologies found in a qualitative in‐depth interview study exist in a larger quantitative investigation and, if so, to identify and describe a structure for the nurses’ attitudes connected to each of the identified typologies. Six psychiatric group dwellings and six acute psychiatric hospital wards participated in the study. In all, 2700 assessments of 163 patients were sent out to 160 respondents and 2436 answers were returned, that is, the external dropout rate was 9.8%. The semantic differential technique was used. This is a method for quantifying the meaning that is attached to an identified phenomenon through series of bipolar pairs of adjectives. The scale has 57 bipolar pairs of adjectives, which estimates an unknown number of dimensions of nurses’ attitudes towards an identified patient. The respondents’ answers were analysed through entropy‐based measures of association combined with structural plots. The analysis revealed that the four typologies existed as a delimited group, especially the groups of ‘good’ and ‘evil’ patients, while the ‘crazy’ and ‘invisible’ patients existed in a more blurred form. The analysis also revealed that the two groups, ‘good’ and ‘evil’, were connected to the nurses’ ethical and aesthetic attitude structure, while the ‘crazy’ patients were linked to the cognitive structure and the ‘invisible’ patients to the empathetic structure. The study indicates that the two typologies, ‘good’ and ‘evil’, could be seen as each other's antithesis and, together with the other two typologies, ‘crazy’ and ‘invisible’, they touched upon a structure of the nurses’ attitudes that was closely connected to a negative view of the patient except in one case –‘the good’ patients, which was probably based on his/her exterior symptoms.
Relapse signatures and insight: implications for CPNs
Authors: SUTTON D. L.
Published: September 2004

Schizophrenia is, largely, an episodic illness with periods of remission and relapse. Early warning signs (EWS) strategies provide a guide to patients, their carer and mental health worker, to collaboratively manage relapse by identifying each individual's EWS of relapse, and agree a plan of action should EWS occur. Although there is evidence to suggest these strategies can reduce hospitalization, the psycho‐educational component is likely to impact on the patient's insight. Rapid increases in insight have been associated with low mood. Consequently the clinician using this strategy risks unintended negative consequences. This paper argues that the flexible and broad community psychiatric nurse role means they are in an ideal position to address this possible pitfall, whilst maximizing the benefits of the strategy.
Conversation starters: re‐examining and reconstructing first encounters within the therapeutic relationship
Authors: MCALLISTER M. , MATARASSO B. , DIXON B. , SHEPPERD C.
Published: September 2004

This paper describes, analyses and reconstructs early encounters between nurse and client. Too often nurses take for granted ordinary encounters with clients and thus overlook opportunities to develop the nurse–client relationship. Common encounters, drawn from reflection on practice, are analysed using contemporary cultural theories. Creative alternatives are suggested and we argue that they represent opportunities to make meaningful connections with and for clients. As conversation starters, these ideas may be used by nurses to facilitate a more trusting therapeutic relationship. They may help to deepen understanding or insight into mental health problems and help to reveal hidden strengths and solutions. By noticing, valuing, discussing and developing this space, we as mental health nurses are extending our discipline base and articulating, with more precision and persuasion, exactly how we contribute to better health outcomes.
Psychiatric ethics; a critical introduction for mental health nurses
Authors: ROBERTS M.
Published: September 2004

Drawing upon the author's experience as a mental health nurse lecturer, this paper suggests that many mental health nurses seem to have difficulty engaging with the ethical issues in psychiatry, and appreciating the relevance of those issues to their everyday practice. In an attempt to address this difficulty, this paper will present a framework that can serve as an accessible introduction to the ethical issues in psychiatry. Reflecting upon general, clinical examples from psychiatric practice, it will be suggested that many ethical issues in psychiatry are concerned with acts of paternalism and with the common justification for those acts. Having presented this framework, the paper will then subject it to a preliminary critique by drawing upon contemporary, critical approaches to health care ethics. It is hoped that this will serve to stimulate both a deeper appreciation of the relevance of ethics to the practice of mental health nursing and an ongoing critical consideration of the ethical issues in psychiatry.
Challenging gender stereotypes in the counselling of adult survivors of childhood sexual abuse
Authors: SIMPSON P. E. , FOTHERGILL A.
Published: September 2004

When working with adult survivors of childhood sexual abuse, the pairing of client with practitioner has implications for both parties. Many therapeutic pairings are ad hoc or based on stereotypical assumptions made by referrers or practitioners themselves. This paper reports on a small‐scale study of practitioners working in the mental health directorate of an NHS Trust in Wales. One aim of the study was to explore practitioners’ views on appropriate therapeutic pairings. Fifty‐three respondents completed a postal questionnaire and six face‐to‐face interviews were also conducted. Key themes emerged from the study. These were social and cultural stereotyping, gender specific issues, the therapeutic relationship, service and professional issues and special opinions and unique angles. The terms ‘therapist’ and ‘practitioner’ will be used interchangeably in this paper.
Acute psychiatric ward rules: a review of the literature
Authors: ALEXANDER J. , BOWERS L.
Published: September 2004

This literature review forms a background element of a comparative study of two acute psychiatric wards in the East End of London. The research focused on ward rules as a means of investigating the relationship between the flexibility/inflexibility of ward nursing regimes and patient outcomes. Previous studies identified a relationship between ward rules and patient aggression. Other studies identified a link between absconding by inpatients and nurses’ attitudes towards rule enforcement. However, an in‐depth exploration of psychiatric ward rules from the perspective of nurses and patients has not been undertaken previously.
Developing and testing instruments for improving cooperation and patient's participation in mental health care
Authors: LATVALA E. , SARANTO K. , PEKKALA E.
Published: September 2004

The main purpose of the project was to develop computerized instruments that could be used by nurses and patients to assess their cooperation and mutual contributions to care. This paper presents a part of the project: the reliability and validity testing phase of a process of instrument development. To test the validity and reliability of the instruments, data were collected with questionnaires from nurses (n = 146) and patients (n = 286). The validity evaluated as construct validity and the reliability evaluated as internal consistency of the instruments were quite good. Construct validity was tested by factor analysis, and internal consistency was tested by Cronbach's alpha coefficient, which varied from 0.69 to 0.79. The instruments, which consisted of a software application that can be operated in a www environment, were meant to be used as tools in the psychiatric nursing context for assessing the cooperation between the nurses and patients and the patient's participation in his/her care. Furthermore, the computer programme can be used as a tool for developing and assessing the patient orientation in nursing.
Return to the asylum: the search for clients with enduring mental health problems in Italy
Authors: SHARP D. M. M.
Published: September 2004

Deinstitutionalization and community care were the most influential movements in the field of mental health in the last 30 years. In 1978 Italy was the first country to pass laws that would eliminate mental hospitals and replace them with community‐based services. Italian ideas about community care provided inspiration for care in the community legislation when this was introduced in the UK. In order to be able to fairly assess and describe the benefits of Italian mental health care, the author visited a range of care facilities in a prescribed region in the north of Italy. In the course of investigation, the author sought to discover if the implementation of what were regarded by some as radical community attitudes in the care of people with mental health problems had led to innovative approaches when dealing with patients/clients requiring long‐term care and treatment. Although the Italian approach is enlightened in many areas of care, the system still has to face up to the problems presented in caring for clients/patients with enduring mental health problems. The circumstances relating to care were unexpected and caused the author to revise his opinion of the Italian approach to community care.
Anesthetic management in Joubert syndrome
Authors: Vodopich Darko J. , Gordon Gregory J.
Published: September 2004

We review the anesthetic implications of Joubert syndrome and report that spinal anesthesia under intravenous propofol sedation proved satisfactory for repair of an inguinal hernia in a spontaneously ventilating infant with this syndrome. We caution that anatomical peculiarities may complicate performance of a caudal epidural block and suggest consideration of the use of caffeine to ameliorate the apneic episodes seen in early infancy in this syndrome.
Anesthetic management of a patient with Freeman‐Sheldon syndrome
Authors: Agritmis Aysin , Unlusoy Ozlem , Karaca Saffet
Published: September 2004

The Freeman‐Sheldon syndrome (FSS) is rare congenital myopathy and dysplasia. The musculoskeletal and soft‐tissue manifestations of FSS often require orthopedic and plastic reconstructive surgery. We report a case of 19‐month‐old girl with FSS.
Perioperative care of the patient with nephropathic cystinosis
Authors: Ray Theresa L. , Tobias Joseph D.
Published: September 2004

Cystinosis is an autosomal recessive disease that results in a defective integral membrane protein responsible for the transport of cystine out of lysosomes. This results in the accumulation of cystine in the lysosomes of almost every tissue, with subsequent formation of damaging crystals. The cystinotic process may affect every system of the body, but is particularly damaging to the kidneys and eyes. We discuss the perioperative care of a cystinotic patient with renal insufficiency, Fanconi's syndrome, and photophobia. Other organ systems affected by the cystinotic process are also discussed, with suggestions for the perioperative management of each. Issues of primary concern during perioperative care include preservation of renal function and maintenance of fluid and electrolyte homeostasis.
Caudal analgesia in children: S(+)‐ketamine vs S(+)‐ketamine plus clonidine
Authors: Passariello M. , Almenrader N. , Canneti A. , Rubeo L. , Haiberger R. , Pietropaoli P.
Published: September 2004

Background:  The aim of this study was to evaluate postoperative analgesia provided by caudal S(+)‐ketamine and S(+)‐ketamine plus clonidine without local anesthetic.

Methods : Forty‐four children aged 1–5 years consecutively scheduled for inguinal hernia repair, hydrocele repair or orchidopexy were randomly assigned to receive a caudal injection of either S(+)‐ketamine 1 mg·kg−1 (group K) or S(+)‐ketamine 0.5 mg·kg−1 plus clonidine 1 μg·kg−1 (group KC). Postoperative analgesia and sedation were evaluated by CHEOPS and Ramsay scale from emergence from general anesthesia for 24 h.

Results : No statistical difference was observed between study groups with respect to pain and sedation assessment. A slight trend toward a reduced requirement for rescue analgesia in group KC was observed, although not statistically significant.

Conclusions : Caudal S(+)‐ketamine 1 mg·kg−1 and S(+)‐ketamine 0.5 mg·kg−1 plus clonidine 1 μg·kg−1 are safe and provide effective postoperative analgesia in children without adverse effects.
Tracheal sealing characteristics of pediatric cuffed tracheal tubes
Authors: Dullenkopf Alexander , Schmitz Achim , Gerber Andreas C. , Weiss Markus
Published: September 2004

Background : The aim of the study was to compare sealing characteristics of the new Microcuff pediatric tracheal tube featuring a high volume–low pressure (HVLP) cuff with ultrathin membrane with three conventional pediatric cuffed tracheal tubes.

Methods : After obtaining approval of the local ethical committee, 80 children aged 2–4 years were tracheally intubated with the following tubes (i.d. 4.0 mm) in random order: Microcuff P‐HVLP, Mallinckrodt Hi‐Contour P, Rüschelit Super Safety Clear, and Sheridan CF. Cuff pressure to prevent air leakage at standardized ventilator setting (PIP 20 cm H2O/PEEP 5 cm H2O/RR 20 min−1) was assessed within 5 min after intubation by auscultation of audible sounds at the mouth. Cuff pressures required with each group were compared with Kruskall–Wallis test (P < 0.05). Values are median and range.

Results : No significant differences in patient characteristics were found between the four groups. The Microcuff tube required significantly lower sealing pressures [11 cm H2O (6–26)] compared with the other tracheal tube brands [Mallinckrodt: 36 cm H2O (18–48); Rüschelit: 21 cm H2O (8–46); Sheridan: 26 cm H2O (18–60), (P < 0.0001)].

Conclusion : This preliminary investigation suggests that the new Microcuff pediatric tracheal tube with ultrathin high volume–low pressure cuff membrane allows effective tracheal sealing at very low cuff pressures. This represents a benefit for children with regard to their lower mucosal perfusion pressures compared with adult patients.
The effect of remifentanil on cerebral blood flow velocity in children anesthetized with propofol1
Authors: Lagace Annie , Karsli Cengiz , Luginbuehl Igor , Bissonnette Bruno
Published: September 2004

Background : Cerebrovascular stability and rapid anesthetic emergence are desirable features of a neuroanesthetic regimen. In this randomized crossover study the effect of a low‐dose remifentanil infusion on cerebral blood flow velocity (CBFV) in children anesthetized with propofol was evaluated.

Methods : Twenty healthy children aged 1–6 years undergoing urological surgery were enrolled. Following face mask induction with sevoflurane, anesthesia was maintained with a standardized propofol infusion. Rocuronium was used to facilitate tracheal intubation and normothermia, and normocapnia were maintained. All children received a caudal epidural block, and a transcranial Doppler probe was placed to measure middle cerebral artery blood flow velocity (Vmca). Each patient received a remifentanil regimen of 0.5 μg·kg−1 followed by 0.2 μg·kg−1·min−1 in a predetermined order of remifentanil + propofol or propofol alone. Vmca, mean arterial pressure (MAP) and heart rate (HR) were recorded simultaneously at equilibrium with and without remifentanil.

Results : The combination of remifentanil and propofol caused an 8.1% decrease in MAP (P = 0.0005) and an 11.8% decrease in HR (P < 0.0001) compared with propofol alone. Vmca was not different between the two groups (P = 0.4041).

Conclusion : The addition of remifentanil to propofol anesthesia in children causes a reduction in MAP and HR without affecting CBFV. This may imply that cerebral blood pressure autoregulation is preserved in children under propofol and remifentanil anesthesia.
Remifentanil vs fentanyl/morphine for pain and stress control during pediatric cardiac surgery
Authors: Bell G. , Dickson U. , Arana A. , Robinson D. , Marshall C. , Morton N.
Published: September 2004

Background : Remifentanil is a short acting, potent synthetic opioid that does not accumulate after infusion or repeated bolus doses. It may be rapidly titrated to the requirements of individual patients. Titrated infusion of remifentanil may be able to provide potent analgesia required for pediatric cardiac surgery and obtund the stress response in theater whilst not having the persistent respiratory depression and sedation seen with longer acting opioids.

Methods : Twenty patients were randomized to receive a titrated infusion of remifentanil (0–1 μg·kg−1·min−1) or a standard dose of fentanyl (30 μg·kg−1) prebypass plus morphine (1 mg·kg−1) on rewarming. Blood samples for glucose and cortisol were taken at regular intervals from induction through bypass and into the first 24 h of postoperative intensive care. In addition to biochemical indicators of the stress response we recorded baseline hemodynamic parameters and any acute physiological events.

Results : Ten patients received morphine, seven received remifentanil. There were no statistically significant differences between the two treatment groups in cortisol measurements, mean arterial pressure or heart rate recordings. In the last time period the remifentanil group had a larger rise in blood glucose concentration (baseline 3.9, rise 3 mmol·l−1) than the fentanyl/morphine group (baseline 4.2 rise 1.9 mmol·l−1), CI −4.3 to −0.2.

Conclusions : The only significant difference was in glucose in the postbypass time periods. Although statistically significant, this difference is insufficient evidence of increased stress in the remifentanil group. The results show that in the patients studied there was no clinically important difference between the two techniques.
Levobupivacaine spinal anesthesia in neonates: a dose range finding study
Authors: Frawley Geoff P , Farrell Tanya , Smith Sarah
Published: September 2004

Background : Our aim was to determine the clinical efficacy of levobupivacaine for awake spinal anesthesia in ex‐premature infants having lower abdominal surgery. The secondary aim was to determine the minimum local analgesic dose (MLAD) defined as the median effective local anesthetic dose for spinal anesthesia in neonates.

Methods : Fifty neonates <55 weeks postconceptional age having lower abdominal surgery were enrolled. The dose of levobupivacaine was determined by up–down sequential allocation. The first infant received 1.25 mg·kg−1 0.5% levobupivacaine with subsequent doses determined by the response of the previous patient. Dose interval was 0.25 mg·kg−1.

Results : There were no significant adverse effects attributable to levobupivacaine. Success rates for 1.25, 1, 0.75 and 0.5 mg·kg−1 were 100, 83, 81 and 46%, respectively. Mean duration (95% confidence interval) of lower limb motor blockade was 81.7 min (75.8–87.6 min). Duration of anesthesia far exceeded surgical duration in all but one case. The up–down sequences were analyzed with the Dixon and Massey method. The motor block MLAD (95% confidence interval) was 0.48 mg·kg−1 (0.42–0.54). Probit analysis was used to compare calculated ED50 and to calculate an ED95 by extrapolation of data into the clinical range. The ED50 (95% C.I.) was 0.52 mg·kg−1 (0.30–0.73). The calculated ED95 was 1.14 mg·kg−1 (0.78–1.50). These values were confirmed by logit analysis.

Conclusions : Levobupivacaine is an effective agent for spinal anesthesia in neonates at a recommended dose of 1 mg·kg−1. It appears to be of equivalent potency to racemic bupivacaine for motor blockade in ex‐premature infants requiring lower abdominal surgery.
Exaggerated insulin secretion in Pima Indians and African‐Americans but higher insulin resistance in Pima Indians compared to African‐Americans and Caucasians
Authors: Stefan N. , Stumvoll M. , Weyer C. , Bogardus C. , Tataranni P. A. , Pratley R. E.
Published: September 2004

Aims  African‐Americans have a higher prevalence of Type 2 diabetes than Caucasians, but a lower prevalence than Pima Indians. Studies suggest that both African‐Americans and Pima Indians are more insulin resistant and have higher acute insulin secretory responses to glucose than Caucasians; however, a direct comparison between these three populations is lacking.

Methods  We measured insulin secretory responses to intravenous glucose (acute insulin response, AIR, 25 g ivGTT); insulin action at physiological (M‐low) and supra‐physiological (M‐high) levels of hyperinsulinaemia (2‐step hyperinsulinaemic clamp); basal and insulin‐suppressed endogenous glucose production in 30 African‐Americans, 30 Pima Indians and 30 Caucasians with normal glucose tolerance who were carefully matched for age, sex, and body fat (hydrodensitometry or DEXA). A subgroup of 24 subjects from each group additionally underwent a standardized mixed meal test.

Results  M‐low was lower in Pima Indians (0.50 ± 0.03) compared to Caucasians (0.59 ± 0.02, P = 0.02) and African‐Americans [0.58 ± 0.03 mg/kgEMBS/min, log10 (means ± SE), P = 0.03] but was not different between African‐Americans and Caucasians. Basal endogenous glucose production was lower in Pima Indians (2.43 ± 0.06) compared to African‐Americans (2.70 ± 0.06, P = 0.02) and was not different between Pima Indians and Caucasians (2.59 ± 0.09 mg/kgEMBS/min) or African‐Americans and Caucasians (all P > 0.18). Insulin‐suppressed endogenous glucose production during the clamp was not different among the groups (all P > 0.40). AIR was higher in both African‐Americans (13.51 ± 0.26) and Pima Indians (13.72 ± 0.27) compared to Caucasians (12.33 ± 0.25 pm, log10, both P < 0.01). The areas under the curve for glucose in response to the oral glucose tolerance test and mixed meal test were higher in Pima Indians compared to African‐Americans (P = 0.03 and P = 0.03, respectively) and Caucasians (P = 0.01, mixed meal test), but not different between African‐Americans and Caucasians.

Conclusions  Exaggerated glucose‐stimulated insulin secretion, manifested initially as an increased response to an intravenous glucose challenge, appears to be a characteristic in people with normal glucose tolerance at higher risk for diabetes. Lower whole‐body insulin sensitivity in Pima Indians compared to African‐Americans, however, may contribute to the higher risk for Type 2 diabetes in Pima Indians compared to African‐Americans.
A pilot quality assurance scheme for diabetic retinopathy risk reduction programmes
Authors: Garvican L. , Scanlon P. H.
Published: September 2004

Aims  We describe a pilot study of measurement of quality assurance targets for diabetic retinopathy screening and performance comparison between 10 existing services, in preparation for the roll‐out of the national programme.

Background  In 1999 the UK National Screening Committee approved proposals for a national diabetic retinopathy risk reduction programme, including recommendations for quality assurance, but implementation was held pending publication of the National Service Framework for Diabetes. Existing services requested the authors to perform a pilot study of a QA scheme, indicating willingness to contribute data for comparison.

Methods  Objectives and quality standards were developed, following consultation with diabetologists, ophthalmologists and retinal screeners. Services submitted 2001/2 performance data, in response to a questionnaire, for anonymization, central analysis and comparison.

Results  The 17 quality standards encompass all aspects of the programme from identification of patients to timeliness of treatment. Ten programmes took part, submitting all the data available. All returns were incomplete, but especially so from the optometry‐based schemes. Eight or more services demonstrated they could reach the minimum level in only five of the 17 standards. Thirty per cent could not provide coverage data. All were running behind. Reasons for difficulties in obtaining data and/or failing to achieve standards included severe under‐funding and little previous experience of QA. Information systems were limited and incompatible between diabetes and eye units, and there was a lack of co‐ordinated management of the whole programme.

Conclusion  Quality assurance is time‐consuming, expensive and inadequately resourced. The pilot study identified priorities for local action. National programme implementation must involve integral quality assurance mechanisms from the outset.
Release of endothelium‐associated proteins into blood by injection of heparin in normal subjects and in patients with Type 1 diabetes
Authors: Myrup B. , Yokoyama H. , Kristiansen O. P. , Østergaard P. B. , Olivecrona T.
Published: September 2004

Aims  Disturbances in heparan sulphate proteoglycans in patients with diabetic nephropathy might contribute to the pathogenesis of vascular disease in these patients. To investigate this possible link, we measured the heparin‐induced, immediate release of eight proteins with heparan sulphate binding properties in patients with nephropathy.

Methods  We studied three groups, Type 1 diabetic patients with (n = 10) or without (n = 15) albuminuria and matched controls (n = 12). Blood samples were obtained before and 5 min after the injection of 40 anti‐Xa IU low molecular weight heparin/kg body weight.

Results  Lipoprotein lipase increased more in diabetic patients without albuminuria than in controls and patients with albuminuria [261 (170–293) vs. 177 (103–438), P < 0.05 and 203 (159–280) mU/ml, P < 0.05]. Total tissue factor pathway inhibitor increased more in the diabetic patients [284 (198–449) and 275 (243–399)] than in the controls [221 (169–289) ng/ml, P < 0.005]. Vitronectin increased significantly only in the diabetic patients with albuminuria. The remaining proteins did not increase significantly (antithrombin, von Willebrand factor, fibronectin) or increased equally in the three investigated groups (extracellular superoxid dismutase and platelet factor 4).

Conclusions  The different release of lipoprotein lipase and vitronectin in diabetic subjects with and without albuminuria may reflect novel aspects of vascular derangement in patients with albuminuria.
Prevalence and clinical characteristics of metabolic syndrome in a rural population of South Korea
Authors: Kim E. S. , Han S.‐M. , Kim Y. I. , Song K.‐H. , Kim M.‐S. , Kim W. B. , Park J.‐Y. , Lee K.‐U.
Published: September 2004

Aims  To determine the prevalence of metabolic syndrome according to the criteria of the Adult Treatment Panel III (ATP III) and the World Health Organization (WHO).

Methods  Data were collected from 1108 subjects over 40 years of age in the Chongup district, a rural area of South Korea. We evaluated the prevalence and clinical characteristics of metabolic syndrome according to the two criteria.

Results  According to the ATP III criteria, the prevalence of central obesity was 0.2% in men and 27.3% in women, which is much lower than the prevalence of central obesity in Americans. However, the prevalence of metabolic syndrome was similar to the prevalence in Americans. Of the Korean subjects over 40 years of age, 29.4% and 39.2% had metabolic syndrome according to the ATP III and WHO criteria, respectively. Metabolic syndrome according to the ATP III criteria was associated with insulin resistance, but not with microalbuminuria.

Conclusions  Metabolic syndrome has a high prevalence in South Koreans despite the low prevalence of obesity and/or central obesity.
Understanding patients’ lived experiences: the interrelationship of rhetoric and hermeneutics
Authors: Finch Linda P.
Published: September 2004

Abstract Understanding each patient's situation or lived experience evolves from a nurse's sincere communication with the patient. Through rhetoric, the nurse's use of competent language and expressions is more likely to engage the patient in a dialogical discussion that brings forth an open, honest display of feelings and emotions. Through hermeneutics, the nurse gains an accurate understanding and interpretation of a patient's beliefs, values, and situations that supports explanations of meaning. Thus, with rhetoric being the words or expressions that give rise to hermeneutics or the interpretation, the blending of the two creates a rhetorical–hermeneutical relationship that provides accurate understanding of a patient's true lived experience. Consequently,knowing the patientdepends upon the nurse's rhetorical competence and accurate assessment of each patient's authentic self. Nurses should seek to interpret and understand the lived experiences of patients in order to limit or prevent misunderstandings and inaccuracies in communication. The truth that emerges from the expressed rhetorical–hermeneutical interrelationship will enhance nurses’ sensitivity to patient matters, produce relationship outcomes that emerge from a consistent and effectively applied set of interpersonal principles, and more importantly, successfully influence nurses’ lives and those of their patients with meaning that ultimately improves the human condition. Thus, nurses’ communication and perceptive understanding of each patient's world or lived experience becomes an integral and necessary component to effectively carrying out the practice role of caregiving.
Concerning technology: thinking with Heidegger
Authors: Zitzelsberger Hilde M.
Published: September 2004

Abstract  In human lives, technology holds sway in mundane and extraordinary ways, such as in the ways we work, entertain, transport, and feed ourselves, and importantly in the ways we encounter and manage health, disease, illness, and death. A significant area of Heidegger's later work is questioning technology. Unlike many current inquiries that centre on contemporary technology's function, utility, and positive transformations, Heidegger offers a radical way of thinking about technology through developing an inquiry that uncovers technology's essence of revealing. In this article, Heidegger's thinking about technological modes of revealing in regard to bodies, health, and illness is explored. In Heidegger's view, the ordered revealing of modern technology has overshadowed other modes of revealing. This article highlights how remembering concealment and unconcealment in its many modes can be relevant to nurses and others involved in health care. Through tracing Heidegger's thinking about technology, a more critical approach to the effects and outcomes of modern technologies within health care systems can be generated.
Rhizomatic thought in nursing: an alternative path for the development of the discipline
Authors: Holmes Dave , Gastaldo Denise
Published: September 2004

Abstract  For decades, nursing as a discipline has tried to establish itself within the socio‐professional and the socio‐political arenas. To date, several theorists have attempted to thoroughly define the essence (ontology) of nursing while others have proposed means (syntax) to achieve this ‘collective’ objective. Considering that this preoccupation, rooted in essentialism, is pervasive in the nursing literature, our claim is that these quests should be criticized because they impede innovative and transdisciplinary approaches to nursing theory. Our criticism includes the perspective supported by the so‐called ‘postmodern nursing theorists’. We argue that the oeuvre of some nursing postmodern scholars is as prescriptive and linear as the ones they critique. Like it was done before, the discourse of these thinkers perpetuates the status quo by excluding alternative forms of knowledge that cross the boundaries of the discipline of nursing. Using the work of Deleuze and Guattari, this paper proposes an alternative way to conceive the development of nursing knowledge, which, we think, could represent an alternative way to explore the discipline of nursing.
Out of fertile muck: the evolving narrative of nursing
Authors: Spenceley Shannon M.
Published: September 2004

Abstract The ongoing debate over the appropriateness of embracing multiple research traditions in nursing is discussed, and the impacts of that debate on the development of nursing knowledge and the nature and structure of the discipline are explored. It is asserted that this previously healthy debate has become stalled between extreme positions of unbounded pluralism and critical exclusivism. The author suggests that one possible solution may lie in connecting the elements of human living, human healing, and human wholeness in an evolving narrative that crosses paradigmatic and theoretic boundaries, and reflects the unique meanings revealed in nursing practice and scholarship.