bluuebunny/crossref_metadata_2025 huggingface dataset:
Left ventricular and cardiac autonomic function in survivors of testicular cancer
Authors: Nuver J. , Smit A. J. , Sleijfer D. T. , Van Gessel A. I. , Van Roon A. M. , Van Der Meer J. , Van Den Berg M. P. , Hoekstra H. J. , Sluiter W. J. , Gietema J. A.
Published: January 2005

Background  Following cisplatin‐based chemotherapy, survivors of testicular cancer have a high prevalence of cardiovascular risk factors and an increased risk of cardiovascular disease. Cardiac function has not been extensively studied and no comparisons have been made with men from the general population.

Design  Left ventricular and cardiac autonomic function were evaluated in chemotherapy‐treated testicular cancer patients, in stage I patients after orchidectomy only, and in healthy men using Doppler echocardiography [wall motion score index, peak early (E) and atrial filling (A) velocities across the mitral valve, E/A‐ratio, isovolumetric relaxation time, and deceleration time of the early peak flow] and measurements of N‐terminal pro‐brain natriuretic peptide and baroreflex sensitivity. Furthermore, 24‐h ambulatory blood pressure was measured.

Results  Ninety chemotherapy‐treated patients (median age 37 years, range 20–65; median follow up of 7 years, range 3–13) were compared with 44 stage I patients (median age 36 years, range 24–63) and 47 healthy controls (median age 37 years, range 22–55). Wall motion score index was less than 1·5 in all participants. Chemotherapy‐treated patients had a higher peak A‐wave and a lower E/A‐ratio than stage I patients and controls. Isovolumetric relaxation and deceleration times did not differ between groups. Age, 24‐h diastolic blood pressure and treatment with chemotherapy were significantly associated with E/A‐ratio. Natriuretic peptide levels were normal. Baroreflex sensitivity was similar in the three groups.

Conclusions  Chemotherapy‐treated testicular cancer survivors have a lower E/A‐ratio than healthy subjects from the general population, which may indicate impaired relaxation of the left ventricle and reflect the high prevalence of cardiovascular risk factors previously reported in these men.
Tensegrity and type 1 dermal dendrocytes in acromegaly
Authors: Quatresooz P. , Hermanns‐Lê T. , Ciccarelli A. , Beckers A. , Piérard G. E.
Published: January 2005

Background  Skin is enlarged and doughy in acromegaly. Alterations have been reported in the structure of the extracellular matrix (ECM) and in the mechanical properties of the dermis. It is recognized that internal tensions in the dermis give rise to active cell‐ECM and cell–cell mechanical interactions. This mechanobiological aspect can lead to functional and conformational changes in the cells. Such alterations in connective tissue cells have not been explored so far in acromegaly. The aim of the study was to assess structural changes in the dermal ECM, and in the number and shape of factor XIIIa‐positive type I dermal dendrocytes (DDs) in acromegaly.

Materials and method  A total of 32 patients with acromegaly (three untreated, 17 with active disease under somatostatin analogues and 12 cured) were examined. Both the maximum and the most recent IGF‐1 (insulin‐like growth factor) dosages recorded in the patients’ files were retrieved. Skin biopsies were taken from their forearms. Histochemistry, immunohistochemistry, morphometry and electron microscopy were used.

Results  Collagen‐bundle coarsening and acidic glycosaminoglycan deposits were found irrespective of the current endocrine status. Dermal dendrocytes were often markedly reduced in numbers, but those present were plump with few dendrites. A negative correlation was found between DD numbers and the maximum IGF‐1 dosages recorded in the patients’ files. A similar although weaker trend was found with the most recent IGF‐1 dosages.

Conclusions  Collagen, glycosaminoglycans and DDs appeared affected in acromegaly, even when the hormonal status was controlled after surgery and/or somatostatin analogue treatment. The persisting conformational change of DDs suggests a modification in cellular tensegrity, perhaps initiated by hormonal effects and probably maintained by alterations in the ECM interactions.
Anti‐oxidants reverse uraemia‐induced down‐regulation of mitochondrial membrane potential and interleukin‐10 production
Authors: Perianayagam M. C. , Morena M. , Jaber B. L. , Balakrishnan V. S.
Published: January 2005

Background  The anti‐inflammatory cytokine, interleukin‐10 (IL‐10), has potent immunomodulatory effects. We hypothesized that previously reported defective synthesis of IL‐10 by immunocompetent cells exposed to a uraemic milieu may be due to impaired mitochondrial membrane potential (MMP).

Materials and methods  The human promonocytic THP‐1 cell line was differentiated to monocytes and incubated with pooled control or uraemic plasma with and without catalase or N‐acetyl l‐cysteine (NAC). Basal hydrogen peroxide (H2O2) production was measured by flow cytometry. To measure MMP, cells were stained with rhodamine 123 (Rh123) and the uptake of Rh123 assessed by flow cytometry. To assess the relative contribution of the NADPH oxidase and mitochondrial electron transport chain (ELT) to endotoxin (ET)‐stimulated IL‐10 production among monocytic cells, cells were incubated with and without a selective NADPH oxidase inhibitor, apocynin and mitochondrial ELT inhibitors, diphenyliodinium and rotenone, washed and ET‐stimulated IL‐10 production was measured. In other experiments, cells were incubated with pooled control or uraemic plasma in the presence or absence of antioxidants followed by overnight incubation with ET. IL‐10 production by monocytes in the cell supernatant was then quantified.

Results  Basal H2O2 production was significantly higher among differentiated THP‐1 cells exposed to uraemic plasma compared with normal plasma (180·57 ± 10·24 vs. 41·57 ± 8·98 MCI; P = 0·02). Uraemic plasma also down regulated MMP (4·60 ± 1·28 vs. 8·00 ± 1·59 MCI with normal plasma; P = 0·03). Both diphenyliodinium and rotenone, selective inhibitors of the mitochondrial ELT, inhibited ET‐stimulated IL‐10 production. In contrast, apocynin, a selective NADPH oxidase inhibitor, did not inhibit ET‐stimulated IL‐10 production. Further, ET‐stimulated IL‐10 production by cells incubated with uraemic plasma was significantly lower when compared to cells exposed to normal plasma. Pre‐incubation with catalase and NAC restored uraemia‐induced down regulation of MMP. In addition, ET‐stimulated IL‐10 production by cells incubated with uraemic plasma was also restored by both catalase and NAC.

Conclusions  Our observations suggest that ET‐stimulated IL‐10 synthesis by monocytic cells is mitochondrial ELT‐dependent and NADPH oxidase‐independent. Monocytic cells exposed to a uraemic environment exhibit higher basal ROS production, lower MMP, and impaired ET‐stimulated IL‐10 synthesis. Anti‐oxidants restore MMP and up‐regulate ET‐stimulated IL‐10 synthesis.
Management of oral bleedings with recombinant factor VIIa in children with haemophilia A and inhibitor
Authors: Laguna P. , Klukowska A.
Published: January 2005

Summary.  Dental extraction in patients with haemophilia A and high‐titre inhibitor is always a high‐risk procedure, which often presents a lot of problems associated with bleeding. Prothrombin complex concentrates or recombinant activated factor VII (rFVIIa) has been used to control bleeding. rFVIIa was administered to five boys with severe haemophilia A complicated with inhibitor, who underwent seven dental extractions. The age of the patients ranged between 8 and 13 years (median 10 years). The concentrate was administered in doses of 90–100 μg kg−1 body weight. Duration in the therapy and intervals between rFVIIa doses depended on the severity of bleeding. rFVIIa was proven to be highly effective and no side‐effects of the product were observed.
piggyBac internal sequences are necessary for efficient transformation of target genomes
Authors: Li X. , Harrell R. A. , Handler A. M. , Beam T. , Hennessy K. , Fraser M. J.
Published: January 2005

A previously reported piggyBac minimal sequence cartridge, which is capable of efficient transposition in embryo interplasmid transposition assays, failed to produce transformants at a significant frequency in Drosophila melanogaster compared with full‐length or less extensive internal deletion constructs. We have re‐examined the importance of these internal domain (ID) sequences for germline transformation using a PCR strategy that effectively adds increasing lengths of ID sequences to each terminus. A series of these piggyBac ID synthetic deletion plasmids containing the 3xP3‐ECFP marker gene are compared for germline transformation of D. melanogaster. Our analyses identify a minimal sequence configuration that is sufficient for movement of piggyBac vectored sequences from plasmids into the insect genome. Southern hybridizations confirm the presence of the piggyBac transposon sequences, and insertion site analyses confirm these integrations target TTAA sites. The results verify that ID sequences adjacent to the 5′ and 3′ terminal repeat domains are crucial for effective germline transformation with piggyBac even though they are not required for excision or interplasmid transposition. Using this information we reconstructed an inverted repeat cartridge, ITR1.1k, and a minimal piggyBac transposon vector, pXL‐BacII‐ECFP, each of which contains these identified ID sequences in addition to the terminal repeat configuration previously described as essential for mobility. We confirm in independent experiments that these new minimal constructs yield transformation frequencies similar to the control piggyBac vector. Sequencing analyses of our constructs verify the position and the source of a point mutation within the 3′ internal repeat sequence of our vectors that has no apparent effect on transformation efficiency.
The accumulation of specific mRNAs following multiple blood meals in Anopheles gambiae
Authors: Nirmala X. , Marinotti O. , James A. A.
Published: January 2005

One approach to genetic control of transmission of the parasites that cause human malaria is based on expressing effector genes in mosquitoes that disable the pathogens. Endogenous mosquito promoter and other cis‐acting DNA sequences are needed to direct the optimal tissue‐, stage‐ and sex‐specific expression of the effector molecules. The mRNA accumulation profiles of eight different genes expressed specifically in the midgut, salivary glands or fat body tissues of the malaria vector, Anopheles gambiae, were characterized as a measure of their suitability to direct the expression of effector molecules designed to disable specific stages of the parasites. RT‐PCR techniques were used to determine the abundance of the gene products and their duration following multiple blood meals. Transcription from the midgut‐expressed carboxypeptidase‐encoding gene, AgCP, follows a cyclical, blood‐inducible expression pattern with maximum accumulation every 3 h post blood meal. Other midgut‐expressed genes encoding a trypsin and chymotrypsin, Antryp2 and Anchym1, respectively, and the fat body‐expressed genes, Vg1 and Cathepsin, also show a blood‐inducible pattern of expression with maximum accumulation 24 h after every blood meal. Expression of the Lipophorin gene in the fat body and apyrase and D7‐related genes (AgApy and D7r2) in the salivary glands is constitutive and not significantly affected by blood meals. Promoters of the midgut‐ and fat body‐expressed genes may lead to maximum accumulation of antiparasite effector molecule transcripts after multiple blood meals. The multiple feeding behaviour of An. gambiae thus can be an advantage to express high levels of antiparasite effector molecules to counteract the parasites throughout most of adult development.
The effect of fibre insertion on fracture resistance of root filled molar teeth with MOD preparations restored with composite
Authors: Belli S. , Erdemir A. , Ozcopur M. , Eskitascioglu G.
Published: January 2005

Aim  To evaluate the effect of using flowable composite with or without leno woven ultra high modulus polyethylene fibre reinforcement on fracture resistance of root filled mandibular molars with mesio‐occluso‐distal (MOD) preparations.

Methodology  Sixty sound extracted human mandibular molars were randomly assigned to five groups (n = 12). Group 1 did not receive any preparation. From groups 2 to 5, the teeth were root filled and MOD preparations were created. Group 2 remained unrestored. Group 3 was restored with a dentine bonding system (DBS; SE Bond, Kuraray, Japan) and composite resin (CR) (AP‐X; Kuraray). In group 4, flowable composite resin (Protect Liner F; Kuraray) was used before restoring teeth with CR. In group 5, leno woven ultra high modulus polyethylene ribbon fibre (Ribbond, Seattle, WA, USA) was inserted into the cavities in a buccal to lingual direction and the teeth were then restored with DBS and CR. After finishing and polishing, the specimens were stored in 100% humidity at 37 °C for 1 day. Compressive loading of the teeth was performed using a universal testing machine at a crosshead speed of 0.5 mm min−1. The mean load necessary to fracture the samples were recorded in newtons (N) and were subjected to analysis of variance (anova) and Tukey post‐hoc test.

Results  The mean load necessary to fracture the samples in each group were (in N): group 1: 1676.75 ±154.63a, group 2: 376.51 ± 37.36b, group 3: 733.23 ± 133.33c, group 4: 786.48 ± 145.34c, group 5: 943.63 ± 121.15d. There were statistically significant differences between the groups annotated with different letters.

Conclusions  (i) Use of flowable composite resin under composite restorations had no effect on fracture resistance of root filled molar teeth with MOD preparations, (ii) use of polyethylene ribbon fibre under composite restorations in root filled teeth with MOD preparations significantly increased fracture strength.
Periapical status and quality of endodontic treatment in an adult Irish population
Authors: Loftus J. J. , Keating A. P. , McCartan B. E.
Published: January 2005

Aim  To determine the prevalence of apical periodontitis and the quality of root fillings in an adult Irish population using a retrospective analysis of orthopantomograms (OPGs).

Methodology  A systematic sample of clinical records and OPGs of 302 adult patients attending the Dublin Dental Hospital, Ireland, were screened by two examiners to determine the quality of root canal treatment and the prevalence of apical periodontitis. The operators who carried out the treatment were unknown. Two examiners inspected OPGs after inter‐examiner correlation. European Society of Endodontology (ESE) guidelines were used to determine adequacy of root treatment.

Results  Of the 7427 teeth examined 2% had root fillings. Apical periodontitis was evident in 1.6% of all nonroot filled teeth whilst 33.1% of the subjects had at least one tooth with apical periodontitis. Of the root filled teeth, 25% had apical periodontitis and 52.6% were considered technically inadequate by ESE guidelines. There was a statistically significant (P < 0.05) negative correlation between the quality of the root fillings and the prevalence of apical periodontitis. Posterior root filled teeth (premolars and molars) had a greater prevalence of apical periodontitis than anterior root filled teeth.

Conclusions  The technical quality of root fillings in an adult Irish population was poor and was consistent with a high prevalence of apical periodontitis.
An evaluation of .06 tapered gutta‐percha cones for filling of .06 taper prepared curved root canals
Authors: Gordon M. P. J. , Love R. M. , Chandler N. P.
Published: January 2005

Aim  To compare the area occupied by gutta‐percha, sealer, or void in standardized .06 tapered prepared simulated curved canals and in mesio‐buccal canals of extracted maxillary first molars filled with a single .06 gutta‐percha point and sealer or lateral condensation of multiple .02 gutta‐percha points and sealer.

Methodology  Simulated canals in resin blocks with either a 30° curve and radius of 10.5 mm (n = 20) or a 58° curve and 4.7 mm radius (n = 20) and curved mesio‐buccal canals of extracted maxillary first molars (n = 20) were prepared using .06 ProFiles® in a variable tip crown‐down sequence to an apical size 35 at 0.5 mm from the canal terminus or apical foramen. Ten 30° and 58° curved resin canals and 10 canals in the extracted teeth group were obturated with .02 taper gutta‐percha cones and AH 26 sealer using lateral condensation. The time required to obturate was recorded. The remaining canals were obturated with a single .06 taper gutta‐percha cone and AH 26 sealer. Excess gutta‐percha was removed from the specimens using heat and the warm mass vertically condensed. Horizontal sections were cut at 0.5, 1.5, 2.5, 4.5, 7.5 and 11.5 mm from the canal terminus or apical foramen. Colour photographs were taken using an Olympus 35 mm camera attached to a stereomicroscope set at ×40 magnification, and then digitized using a flatbed scanner. The cross‐sectional area of the canal contents was analysed using Adobe PhotoShop®. The percentage of gutta‐percha, sealer or voids to the total root canal area were derived and data analysed using unpaired Student's t‐test and the Mann–Whitney U‐test.

Results  In the 30° curved canals the levels had between 94 and 100% of the area filled with gutta‐percha with no significant difference (P > 0.05) between the lateral condensation and single cone techniques. In the 58° curved canals the levels had 92–99% of the area filled with gutta‐percha, with the single cone technique having significantly (P < 0.05) more gutta‐percha fill at the 2.5 mm level only. In the mesio‐buccal canals of the teeth the levels had between 72 and 96% of the area filled with gutta‐percha with no significant difference (P > 0.05) between the lateral condensation and single cone technique. The time for obturation was significantly (P < 0.05) greater for lateral condensation compared with the single cone technique in all groups.

Conclusions  The .06 taper single cone technique was comparable with lateral condensation in the amount of gutta‐percha occupying a prepared .06 tapered canal. The .06 single cone technique was faster than lateral condensation.
Frequency and distribution of root filled teeth and apical periodontitis in a Greek population
Authors: Georgopoulou M. K. , Spanaki‐Voreadi A. P. , Pantazis N. , Kontakiotis E. G.
Published: January 2005

Aim  To investigate the prevalence of root filled teeth and apical periodontitis (AP) in a Greek population.

Methodology  A random sample of 320 patients who required full mouth periapical radiographic examination as a part of diagnostic and planning procedures were included. The age of the patients ranged from 16 to 77 years. A total of 7664 teeth were assessed and the frequency of root filled teeth and periapical status was recorded. Two observers evaluated the radiographs under standardized conditions. AP was defined as distinct periapical radiolucency or widening of the periodontal ligament space exceeding two times the normal width. Statistical evaluation of differences in proportions between groups was performed using random effects logistic regression models.

Results  The periapical status of 286 (3.7%) teeth was impossible to evaluate because of radiographic faults; these teeth were excluded from further analysis. A total of 1040 (13.6%) teeth had radiographic signs of AP and 680 (9.2%) teeth had been root filled. Of the root filled teeth, 408 (60.0%) had AP. There was no difference in the number of root filled teeth between males and females; the prevalence of root filled teeth increased with age. Significantly more molars (13.1%) and premolars (11.9%) than anterior teeth (5.8%) had been root filled (P < 0.001). The prevalence of AP was significantly higher (P < 0.001) in molars (23.9%) and premolars (14.0%) than anterior teeth (9.4%).

Conclusions  The prevalence of AP and the frequency of root filled teeth with AP in this Greek population were higher than those found in many other European countries. The frequency of root filled teeth was comparable with findings in other epidemiological studies.
Probability of removing fractured instruments from root canals
Authors: Suter B. , Lussi A. , Sequeira P.
Published: January 2005

Aim  To evaluate in a clinical case series the location of fractured instruments, how many of them could be removed and to compare these findings with the results of a similar study.

Methodology  Within an 18‐month period all referred endodontic cases involving fractured instruments within root canals were analysed. The protocol for removal of fractured instruments was: create straight‐line access to the coronal portion of the fractured instrument, attempt to create a ditched groove around the coronal aspect of the instrument using ultrasonic files and/or to bypass it with K‐Files. Subsequently, the fractured instrument was vibrated ultrasonically and flushed out of the root canal or an attempt was made to remove the instrument with the Tube‐and‐Hedström file‐Method or similar techniques. The location of the fractured instrument and the time required for removal were recorded. Successful removal was defined as complete removal from the root canal without creating a clinically detectable perforation.

Results  In total, 97 consecutive cases of instrument fracture were included in the time period. In all, 84 instruments (87%) were removed successfully. There was a significant correlation between the time needed to remove fractured instruments and a decrease in success rate. Curved canals had significantly more fractured instruments than straight canals (P < 0.05). Rotary instruments fractured significantly more often in curved canals (P < 0.05) compared with other instruments. Half of all instrument fractures occurred in mesial roots of lower molars and most often when using rotating instruments. There was no statistically significant difference in the success rate with respect to the location of the fractured instrument (tooth/root type), the type of fractured instrument or the different methods of instrument removal.

Conclusions  Curved canals are a higher risk for instrument fracture than straight canals. In curved canals rotary instruments (including lentulo spirals) fractured more often than other instruments. In all, 87% of the fractured instruments were removed successfully. A decrease in success rate was evident with increasing treatment time. The use of an operating microscope was a prerequisite for the techniques used to remove the fractured instruments.
Detection of the second mesiobuccal canal in mesiobuccal roots of maxillary molar teeth ex vivo
Authors: Yoshioka T. , Kikuchi I. , Fukumoto Y. , Kobayashi C. , Suda H.
Published: January 2005

Aim  To assess the effectiveness of magnification and dentine removal (troughing) when locating the second mesiobuccal canal in mesiobuccal roots of maxillary molars.

Methodology  A total of 208 extracted human maxillary molars were examined. After crown and pulp removal, the MB1 and 2 canals in the mesiobuccal root were located in three stages that were performed by two undergraduate dental students. Stage 1: canals were located with an endodontic explorer; stage 2: additional canals in the same teeth were located under magnification with a digital microscope (VH‐8000, Keyence, Japan); stage 3: additional canals in the same teeth were located by removing dentine (troughing) from the pulp chamber floor within 3 mm from MB1 canal towards the palatal canal with an Enac ultrasonic tip (ST 21, Osada, Japan). In each group, the canals were prepared with Gates Glidden burs and K‐files. The distal and palatal roots were then removed, and Indian ink was injected into the canal system within the mesio‐buccal root. The root surfaces were washed with 6% NaOCl, and then rendered transparent to observe canal morphology. The root canal configurations were classified into five categories following the modified Weine's classification.

Results  More than one canal in the mesio‐buccal root was observed in 48% of specimens. Detection rates of multiple canals were 7, 18 and 42% following stages 1, 2 and 3, respectively. There was a significant difference between the stages for detecting the MB2 canal (P < 0.05, Friedman test).

Conclusions  Both magnification (stage 2) and dentine removal under magnification (stage 3) were effective in detecting the presence of the MB2 canal. However, MB2 canals could not be detected in 13% of the teeth because of canal calcification or branching located more apically.
Longitudinal study on microleakage of three root‐end filling materials by the fluid transport method and by capillary flow porometry
Authors: De Bruyne M. A. A. , De Bruyne R. J. E. , Rosiers L. , De Moor R. J. G.
Published: January 2005

Aim  (i) To compare the root‐end sealing ability of IRM Caps (IRM), Fuji IX Capsules (Fuji IX) and Pro Root MTA Tooth‐Coloured Formula (MTA) in teeth obtained from cadavers. (ii) Further research on leakage study methodology by means of comparison of the fluid transport method (FTM) and capillary flow porometry (CFP).

Methodology  Root canal treatment was performed on 33 cadaver teeth in situ 2 weeks prior to root resection and ultrasonic retropreparation (S12/90°D‐tip on Suni‐Max), after which the teeth were retrieved from the cadavers. Two teeth were kept as positive and negative controls. The other teeth were divided in three different groups at random, with each group receiving one of the retrofill materials. Retrofills were exposed to water 5 min after placement. The teeth were stored at 37 °C for 12 h after which the root filling was removed. Microleakage (L in μL day−1) was measured for 24 h under a pressure of 1.2 atm using FTM and recorded as L = 0, 0 < L ≤ 10, L > 10. The measurements were repeated after 1 and 6 months. After 6 months, leakage was also assessed by CFP in order to measure through pores and their diameters. Results were analysed statistically using nonparametric Kruskal–Wallis and Mann–Whitney U‐tests, and Spearman correlation coefficients between the results of both methods were calculated. The level of significance was set at 0.05.

Results  (i) A statistically significant difference could be demonstrated between Fuji IX and IRM at 1 month with FTM. FTM revealed a significant difference between Fuji IX and the other materials at 6 months, whereas CFP did not. However, using both methods, Fuji IX showed the best result. (ii) When comparing both techniques, CFP demonstrated through pores in all teeth, whereas with FTM in only 14 of the 31 teeth could through pores be demonstrated. A positive correlation between both methods was demonstrated.

Conclusions  Under the conditions of this study (i) the conventionally setting glass–ionomer cement Fuji IX showed the best results when used as a root‐end material and (ii) CFP appeared to be a useful method for leakage evaluation of through pores in endodontics.
Nutritional care: the effectiveness of actively involving older patients
Authors: Pedersen Preben Ulrich
Published: January 2005

Aims and objectives.  The purpose of the study was to test the effectiveness of nursing care based on active involvement of patients in their nutritional care. It was hypothesized that this type of care could improve energy and protein intake in elder orthopaedic patients.

Background.  Protein and energy malnutrition and deterioration in nutritional status is a common but neglected problem in hospital patients.

Methods.  The design was quasi‐experimental with an intervention and control group. The study included 253 patients aged 65 and above admitted for hip fracture, hip or knee replacement. Food intake was recorded on a daily basis during the hospital stay.

Results.  The daily intake of energy increased with 23% (P = 0.001) and of protein with 45% (P = 0.001). The intake increased from the very first day after the operation. The intake of energy and protein was not correlated with the patient's age, body mass index or type of surgery.

Conclusions.  The care based on patients’ active involvement in their own nutritional care and was found to be an effective method to raise the intake of energy and protein among elder orthopaedic patients.

Relevance to clinical practice.  This way of organizing the care identifies patients who do not consume enough energy and protein according to their current requirements and to take appropriate actions to prevent further malnutrition.
Metabolic control, self‐management and psychosocial adjustment in women with type 2 diabetes
Authors: Whittemore Robin , Melkus Gail D'Eramo , Grey Margaret
Published: January 2005

Aims.  To examine factors associated with metabolic control, self‐management (diet and exercise behaviour), and psychosocial adjustment (diabetes‐related distress) in women with type 2 diabetes.

Design.  Cross‐sectional design using baseline data of women with type 2 diabetes enrolled to participate in a pilot study of a nurse coaching intervention (n = 53).

Ethical issues.  Appropriate ethical review and approval was completed. Informed consent from participants was obtained.

Outcome measures.  Physiological measures included body mass index and glycosylated haemoglobin (HbA1c). Self‐management measures included the Dietary Subscale of the Summary of Diabetes Self‐Care Activities Questionnaire and a modified Paffenbarger Physical Activity Questionnaire. Psychosocial measures included the Problem Areas in Diabetes Survey (diabetes‐related distress), the Diabetes Questionnaire, the Diabetes Self‐Management Assessment Tool Support and Confidence Subscale, and the Social Functioning Scale. Descriptive, bivariate, and multivariate analyses were completed.

Results.  The most consistent predictor of metabolic control, dietary self‐management, and diabetes‐related distress was support and confidence in living with diabetes. Additionally, women had difficulty meeting optimal goals for exercise, yet reported higher levels of other physical activity.

Limitations.  This study was an exploratory analysis with a homogeneous sample of women with type 2 diabetes enrolled in an intervention study and measurements included multiple self‐report instruments.

Conclusions.  Interventions to increase women's perceived self‐confidence and support may contribute to positive health outcomes in women with type 2 diabetes.

Relevance to clinical practice.  Assessment of social support and self‐confidence in diabetes self‐management in women with type 2 diabetes may assist in determining individualized goals and strategies. Enhanced social support and self‐confidence in diabetes self‐management may subsequently improve metabolic control, self‐management and psychosocial adjustment to diabetes.
Lower urinary tract symptoms: a hermeneutic phenomenological study into men's lived experience
Authors: Wareing Mark
Published: January 2005

Aim.  This was an investigation to discover the lived experience of men with lower urinary tract symptoms arising from benign prostatic hyperplasic.

Design.  A hermeneutic phenomenological study.

Methods.  Approval was granted by the local Applied and Qualitative Research Ethics Committee (AQREC) prior to the commencement of the study. Data were gathered via semi‐structured interviews that were audio taped, and subsequently transcribed. Each transcripted interview was analysed by the investigator and a team of ‘expert readers’. The team agreed on a total of 57 sub‐themes divided into seven categories with unanimity, therefore obviating the need for participant validation.

Findings.  The major findings of the study suggest that men experience a broad and dramatic spectrum of phenomena while living with a benign prostate condition. This includes profound embarrassment, fear, revulsion as well as humour that require a range of methods and life adjustments to manage and contain their symptoms.

Conclusions.  The participant's narratives provide a thick, rich and meaningful insight into how men understand their bodies, and make sense of prostate disease; a significant men's health issue.

Relevance to clinical practice.  Several studies have already been published describing men's lived experience of prostate surgery for benign prostatic hyperplasia. This research has captured men's lived experience of lower urinary tract symptoms ahead of surgical intervention. Men experience a broad scope of phenomena resulting from life with a benign prostate condition that encompasses fear and embarrassment and the development of coping mechanisms and changes in life style. Recent media awareness campaigns to raise public awareness of prostate disease as a men's health issue appear to be changing how men perceive their bodies, how they converse with one another, and their help seeking behaviour.
Breast cancer: relationship between menopausal symptoms, physiologic health effects of cancer treatment and physical constraints on quality of life in long‐term survivors
Authors: Schultz Pamela N , Klein Mary Jean , Beck Martha L , Stava Charles , Sellin Rena V
Published: January 2005

Aims and objectives.  The purpose of this study is to describe the relationship between menopausal symptoms, physiologic health effects of cancer treatment and the physical contributors to quality of life in long‐term survivors of breast cancer.

Background.  The treatment of menopausal symptoms is hotly debated, especially for women with breast cancer. Common treatments for menopausal symptoms are considered to be contraindicated in women with breast cancer.

Design.  This is a descriptive, cross‐sectional study of long‐term breast cancer survivors; a subset of a study that responded to a mailed survey targeting long‐term cancer survivors treated at The University of Texas M.D. Anderson Cancer Center.

Methods.  In 291 breast cancer patients information was available that included items that commonly relate to menopausal symptoms including hot flushes, painful sexual intercourse, inability to concentrate, fatigue and sleep disturbances.

Results.  Ninety per cent were Caucasian American and the mean time since diagnosis was 16 ± 8 years. All patients had been treated with surgery, (60%) with radiotherapy, (68%) with chemotherapy and (37%) with hormonal therapy. Forty‐six per cent of the breast cancer survivors indicated that having breast cancer affected their overall health. Self‐reported health effects were more common in those survivors who had received a combination of chemotherapy and radiotherapy. A menopausal quality of life score was determined using the items about hot flushes, ability to concentrate, painful sexual intercourse, fatigue, unhappiness and sleep disturbances.

Conclusions.  This study reminds us that breast cancer and menopause are independent issues. Quality of life parameters need to be rigidly defined and time sensitive. There are complex interactions between quality of life indicators and specific physiologic consequences of treatment. However, menopausal signs and symptoms may not be different for the breast cancer survivor and they should not be confused with the quality of life/psychosocial issues of the cancer survivor.

Relevance to clinical practice.  Menopause is not a disease process but a normal developmental stage for women. It is important for nurses not only to understand the client needs of the menopausal woman, but also to be able to differentiate between quality of life issues related to menopause and to cancer treatment in order to provide holistic nursing care.
Health risks and occupational exposure to volatile anaesthetics – a review with a systematic approach
Authors: Nilsson Roland , Björdal Chatarina , Andersson Matts , Björdal Jörn , Nyberg Anna , Welin Bengt , Willman Ania
Published: January 2005

Aims and objectives.  To provide practicing nurse anaesthetists with evidence based knowledge as to whether they are at risk handling volatile anaesthetics by answering the question: What are the health risks threatening health care personnel occupationally exposed to volatile anaesthetics?

Background.  The interpretations of results from specific scientific studies vary and preliminary research results indicate that occupational exposure to volatile anaesthetics affects the health of operating room personnel.

Design.  Review of scientific literature with a systematic approach.

Method.  The review included a systematic search in three major databases, a screening process of abstracts/articles followed by a quality assessment of the included studies. The screening process and the quality assessment were done independently by the six reviewers and followed specific protocols.

Results.  A systematic search of The Cochrane Library, MedLine and CINAHL resulted in a screening of 413 abstracts of which 31 articles were assessed for quality, all done independently by the reviewers. Finally, the reviewers agreed upon how to interpret the results of the assessed articles.

Conclusions.  The 31 articles assessed covered areas such as genotoxic effects, neurobehavioural effects, immunology, and general health effects. In the scientific literature reviewed there is no evidence of occupational exposure to volatile anaesthetics either being associated with health risks or being harmless. Studies indicating a potential health risk are all investigating circumstances ignorant of modern environmental regulations and/or with no scavenging equipment.

Relevance to clinical practice.  Although no answer has been given, this review illuminates the methodological difficulties encountered in designing studies. The result of this review further stresses the need for scientific knowledge in this area and enhances the extensive use of scavenging equipment.
Music and its effect on anxiety in short waiting periods: a critical appraisal
Authors: Cooke Marie , Chaboyer Wendy , Hiratos Mary Anne
Published: January 2005

Aims and objectives. This paper undertakes a critical appraisal of the methodological issues associated with studies that have investigated the extent to which music decreased the anxiety experienced by patients in short‐term waiting periods such as day surgery.

Background. Investigations and surgery undertaken on a day basis have significantly increased in number over the last decade. Music has been evaluated as an appropriate nursing intervention in relation to pain, discomfort and anxiety in a number of clinical settings but its usefulness for decreasing anxiety in short‐term waiting periods such as day surgery is only beginning to be understood.

Conclusion. A number of methodological limitations are identified by this critical review, particularly in relation to the design of research studies. Recommendations to strengthen research in this area are suggested and include (i) describing methods clearly and with detail to allow assessment of the validity and rigour of study results; (ii) using permuted block randomization; (iii) recruiting from a variety of surgical procedures and cultural groups; and (iv) standardizing the health care provided during waiting period.

Relevance to clinical practice. Music as a simple and cost‐effective intervention to reduce the anxiety experienced in limited time periods will have enormous impact on clinical practice where patients wait and undergo invasive investigations, procedures or surgery. However, the evidence of its utility in these unique environments is only beginning to emerge and this critical review provides a basis for considerations for future research.
Prevalence of pressure ulcers in Germany
Authors: Lahmann Nils A , Halfens Ruud JG , Dassen Theo
Published: January 2005

Aims and objectives.  This article establishes the prevalence of pressure ulcers in hospitals and nursing homes for national and international comparison.

Background.  Although many European countries evaluate the prevalence of pressure ulcers, it has not recently been examined in German healthcare facilities.

Design.  Descriptive study design, point prevalence survey in 2001 and 2002. A total of 11 584 patients and residents in 66 institutions throughout Germany took part in the study.

Methods.  Prevalence rates were calculated for the different types of institutions, different years, different risk groups and different disciplines. All calculations were made by including as well as excluding pressure ulcer grade 1. The Braden scale (cut‐off ≤20) was applied to define at risk and not at risk patients/residents.

Results.  The prevalence including (excluding) grade 1 pressure ulcers was 11.7% (5.2%) for the whole sample, while in the group at risk it was 24.5% (11.5%). The size of the group at risk in the nursing homes was 63.9% and less than 40% in the hospitals. Comparisons between disciplines showed a great range of prevalence rates. The use of special surface devices for persons at risk was more common in nursing homes than in hospitals.

Conclusion.  The prevalence of pressure ulcers bears resemblance to results produced by other studies, but it is uncertain if these similarities are more than coincidental. Due to the influence of sampling the use of a standardized samples method is essential. For comparisons of groups with differences regarding their risk assessment it would be more appropriate to use the prevalence of patients and residents at risk.

Relevance to clinical practice.  The study provides accurate data about the extent of the problem of pressure ulcers in German healthcare facilities.
Noise levels in a General Surgical Ward: a descriptive study
Authors: Christensen Martin
Published: January 2005

Aims and objectives. This study was undertaken to measure and analyse levels of acoustic noise in a General Surgical Ward.

Method. Measurements were undertaken using the Norsonic 116 sound level meter (SLM) recording noise levels in the internationally agreed ‘A’ weighted scale. Noise level data and observational data as to the number of staff present were obtained and recorded at 5‐min intervals over three consecutive days.

Results. Results of noise level analysis indicated that mean noise level within this clinical area was 42.28 dB with acute spikes reaching 70 dB(A). The lowest noise level attained was that of 36 dB(A) during the period midnight to 7 a.m. Non‐parametric testing, using Spearman's Rho (two‐tailed), found a positive relationship between the number of staff present and the level of noise recorded, indicating that the presence of hospital personnel strongly influences the level of noise within this area.

Relevance to clinical practice. Whilst the results of this may seem self‐evident in many respects the problems of excessive noise production and the exposure to it for patients, hospital personnel and relatives alike continues unabated. What must be of concern is the psychophysiological effects excessive noise exposure has on individuals, for example, decreased wound healing, sleep deprivation and cardiovascular stimulation.
Child in hospital: family experiences and expectations of how nurses can promote family health
Authors: Hopia Hanna , Tomlinson Patricia S , Paavilainen Eija , Åstedt‐Kurki Päivi
Published: January 2005

Aims and objectives.  This study set out to explore, from the family's point of view, ways in which nursing staff can promote family health during the child's hospital stay.

Background.  Having a child in hospital is a major source of stress and anxiety for the whole family. Earlier studies have described parental coping strategies, ways to strengthen those strategies and to support parental participation in child care, but no one has studied the promotion of family health during the child's hospitalization from the family's point of view.

Design.  Interviews were conducted in 2002 with 29 families who had a child with a chronic illness which were receiving or had received treatment on the paediatric wards of two Finnish hospitals.

Methods.  Data analysis was based on the grounded theory method, proceeding to the stage of axial coding. Data collection and analysis phases proceeded simultaneously.

Results.  Five domains were distinguished in the promotion of family health: (1) reinforcing parenthood, (2) looking after the child's welfare, (3) sharing the emotional burden, (4) supporting everyday coping and (5) creating a confidential care relationship.

Conclusions.  The results strengthen the knowledge base of family nursing by showing how nursing staff can promote family health during the child's hospital stay.

Relevance to clinical practice.  The results have a number of practical applications for nursing, both for clinical practice and research. The results can be used in paediatric hospital wards caring for chronically ill children and their families. The five domains of family health promotion described here should be tested in other paediatric wards and in other geographical locations.
Percutaneous endoscopic gastrostomy (PEG): the role and perspective of nurses
Authors: Todd Vi , Rosendaal Guido Van , Duregon Kelly , Verhoef Marja
Published: January 2005

Aims and objectives.  To study the perspectives of nurses on (i) the process of decision‐making regarding the placement of feeding gastrostomies, (ii) their role in the process, (iii) the impact this participation has on them personally and (iv) gastrostomy placement in general.

Background.  The decision to commit patients to long‐term feeding using a gastrostomy tube can be very difficult, particularly when the anticipated benefits are uncertain. Strategies to improve such decision‐making are required. Nurses are in an excellent position to provide valuable insights regarding this decision‐making and their increased participation in this process might substantially improve it.

Design.  A cross‐sectional, exploratory design using in‐depth semi‐structured interviews and a self‐administered questionnaire.

Methods.  In‐depth semi‐structured interviews with 17 nurses experienced in percutaneous endoscopic gastrostomy decision‐making were undertaken and analysed.

Results.  Individuals making decisions regarding feeding gastrostomy placement were observed to be insufficiently informed regarding the device and the ramifications of its placement. Nurses were perceived to play an important, although underused, role in decisions to commit patients to long‐term feeding. Participation in the making of these decisions may be stressful to nurses, particularly when the only result anticipated is the sustaining of a life of poor quality. Sixteen nurses reported that they would not want to have a gastrostomy for themselves if they were unable to maintain some quality of life. Strategies that could improve decision‐making were suggested.

Conclusions.  Decision‐making could be improved by providing better information to decision makers. A team‐orientated approach and more active dialogue with regard to care planning among health professionals, especially between doctors and nurses is needed. Effective decisions regarding feeding gastrostomy placement require adequate resources, especially sufficient time for caregivers to communicate effectively with those who must make these decisions.

Relevance to clinical practice.  The role of nurses in decision‐making regarding commitments to long‐term feeding using gastrostomy tubes could be effectively augmented.