bluuebunny/crossref_metadata_2025 huggingface dataset:
Perception of fear, distress and pain by parents of children undergoing a micturating cystourethrogram: A prospective study
Authors: Srivastava T , Betts G , Rosenberg AR , Kainer G
Published: March 2003

Objectives: To investigate whether parents’ expectations of their child's fear, distress or pain during a micturating cystourethrogram (MCU) are realized.

Methodology: Prospective study in which parents were asked to fill out two questionnaires using a visual analogue scale, one before (pre) and the other after the MCU procedure (post), was conducted at a tertiary level paediatric hospital in Sydney, Australia. The questionnaires were designed to compare the parents’anticipated and experienced anxiety about their child's procedure and their perception of fear, distress and pain in their child during and after the procedure. The parents’ satisfaction with information provided to them on the procedure was also recorded. Twenty‐five parents participated in the study.

Results: There were significant differences between anticipated and experienced parental anxiety. Parents’ reporting of fear, distress and pain in their child during the MCU and after the procedure was lower than they had anticipated. There was a significant correlation between the parents’ anxiety and their perception of severity of their child's fear (r = 0.52, P = 0.009), distress (r = 0.48, P = 0.017) and pain (r = 0.50, P = 0.01) during the procedure, but less so with the child's distress after the procedure (r = 0.39, P = 0.059). The parents were satisfied with the information given to them regarding the MCU procedure.

Conclusions: Parents’ perception of their child's fear, distress and pain during the MCU, as well as distress following the MCU, was not as severe as they had anticipated. Parental anxiety is an important factor in the perception of fear, distress and pain in children during and after the procedure.
Effect of recombinant human erythropoietin on transfusion needs in preterm infants
Authors: Yeo CL , Choo S , Ho LY
Published: March 2003

Objective: To study the efficacy, safety and cost effectiveness of recombinant human erythropoietin (r‐HuEPO) in reducing erythrocyte transfusion needs in very low birthweight (VLBW) infants.

Methods: We conducted a non‐blind randomized controlled trial and assigned 100 VLBW infants, less than 33 weeks gestation, to receive either r‐HuEPO 750 U/kg per week subcutaneously from day 5 to day 40 or no erythropoietin (EPO). Infants received oral iron 3–;6 mg/kg per day from day 10. Transfusion needs were analysed for all enrolled infants and in five weight subgroups: birthweight of less than 600 g, 600–;799 g, 800–;999 g, 1000–;1199 g and infants more than 1200 g.

Results: VLBW infants on r‐HuEPO attained higher reticulocyte counts and haematocrit than control infants but the mean number of transfusions and volume of erythrocyte transfused per infant were not statistically different. Of infants 800–;999 g at birth, the mean number of transfusions per infant was 2.1 compared with 3.5 transfusions per control infant (P = 0.04). Volume of erythrocytes transfused was 34.9 ± 32.1 mL/kg in r‐HuEPO‐treated infants and 56.6 ± 25.8 mL/kg in control infants (P = 0.03). The cost per patient for transfusion and EPO was S$388 for r‐HuEPO recipient and S$438 for control infant. Blood pressure, neutrophil count, platelet count and complications of prematurity were not significantly different in both groups of VLBW infants.

Conclusion: r‐HuEPO at 750 U/kg per week stimulates erythropoiesis in VLBW infants but significantly reduces the need for erythrocyte transfusion only in infants weighing 800–;999 g at birth.
Conductive hearing loss in preterm infants with bronchopulmonary dysplasia
Authors: Gray PH , Sarkar S , Young J , Rogers YM
Published: March 2003

Objective: To determine the risk of conductive hearing loss in preterm infants with bronchopulmonary dysplasia (BPD) and preterm controls.

Methodology: The study population consisted of 78 infants with BPD of 26–33 weeks gestation and 78 controls of similar gestational age matched for broad‐based birthweight categories. An auditory brainstem response (ABR) audiology was performed shortly before hospital discharge. Visual reinforcement orientation audiometry (VROA) and impedance audiometry were performed at 8–12 months corrected for prematurity. Infants with persistent audiological abnormalities were referred for evaluation to paediatric ENT surgeons.

Results: Infants with BPD had a significantly higher rate of ABR abnormalities (BPD: 22%, controls: 9%; P = 0.028). On VROA and impedance audiometry, the infants with BPD also had a higher rate of persistent abnormalities. Following ENT assessment, 22.1% of infants with BPD and 7.7% of controls had persistent conductive dysfunction requiring myringotomy and grommet tube insertion (P = 0.03). Most of these infants had normal ABR audiometry at hospital discharge.

Conclusions: Preterm infants with BPD are at high risk of persistent conductive hearing loss late in the first year of life compared to controls. An ABR audiology conducted at the time of hospital discharge does not predict accurately later conductive hearing problems. Infants with BPD should have routine audiological evaluation toward the end of the first year of life.
Predictors of neurodevelopmental outcome of Malaysian very low birthweight children at 4 years of age
Authors: Ong LC , Boo NY , Chandran V
Published: March 2003

Objective: To determine neonatal, early developmental and social risk factors that predict the neurocognitive and behavioural outcome of very low birthweight (VLBW) preschool children at four years of age.

Methodology: From a cohort of 151 eligible VLBW survivors born in Kuala Lumpur Maternity Hospital, 116 (76.8%) were prospectively followed up from birth till four years. A standardised neurological examination was performed at one and four years to determine the presence of impairment and cerebral palsy, respectively. Cognitive development was assessed using the Mental Scale of the Bayley Scales of Infant Development (MDI) at one year and the Weschler Preschool and Primary Scale of Intelligence‐Revised (WIPPSI‐R) at four years. Motor coordination was assessed using the Movement Assessment Battery for Children (Movement‐ABC). Mothers completed the Child Behaviour Checklist (CBCL) and Parenting Stress Index (PSI) questionnaires. Logistic and multiple regression analyses were used to determine factors associated with cerebral palsy, IQ scores, Movement‐ABC and CBCL scores.

Results: Factors associated with cerebral palsy were lower MDI scores at one year (P = 0.001) and late neonatal cranial ultrasound abnormalities (P = 0.036). Minor (P = 0.016) or major impairment (P = 0.003) at one year of age and a low level of paternal education (P = 0.01) were associated with poor motor function on the Movement‐ABC scale. Lower levels of maternal education (P < 0.001), impairment at one year (P = 0.002) and late neonatal cranial ultrasound abnormalities (P = 0.039) predicted Full Scale IQ scores. Higher PSI scores (P = 0.001), younger mothers (P = 0.003) and late neonatal cranial ultrasound abnormalities (P = 0.009) were associated with worsened child behaviour scores on the CBCL scale.

Conclusion: Social factors and the caregiving environment were important determinants of cognitive and behavioural outcome. Cranial ultrasound abnormalities in the late neonatal period and the developmental status at one year might be useful in identifying high risk infants in need of long‐term surveillance.
Emerging viral infections in Australia
Authors: Daley AJ , Dwyer DE
Published: March 2003

Abstract: Emerging viruses include known viruses that have increased in incidence or geographic range (such as enteroviruses and Japanese encephalitis virus), new viruses associated with known diseases (Australian bat lyssavirus) and new viruses associated with previously unrecognized diseases (Hendra and Nipah viruses). Some may have a predilection for children (Japanese encephalitis, influenza viruses and enterovirus 71) and vigilance is essential to ensure early recognition of these agents.
Survey of the use of complementary medicines and therapies in children with asthma
Authors: Shenfield G , Lim E , Allen H
Published: March 2003

Objective:  To survey the frequency of use of complementary medicines (CM) and complementary therapies (CT) in asthmatic children.

Methodology:  A 3‐month survey of asthmatic inpatients and outpatients of a teaching hospital respiratory paediatrician was undertaken. Parents answered a structured questionnaire about their past and present usage and opinions of CM and CT. Parents and the physician independently assessed overall asthma control. ‘Users’ and ‘non‐users’ of CM and CT were compared for characteristics of asthma, usage of conventional medications and parental demographics.

Results:  One hundred and seventy‐four children with 331 parents were enrolled in the study. All of the children were on bronchodilators and 150 (86.2%) were on disodium cromoglycate or inhaled steroids. Control was assessed by a physician as good in 95 children (54.6%), fair in 65 (37.4%) and poor or very poor in 13 (7.5%). Ninety (51.7%) of the children had used at least one CM in their lifetime. Out of the 145 preparations used, 90 (62.1%) were in current use. Vitamins and minerals (53.2%) and herbal preparations (29%) were used most commonly. Only 47.8% of parents had told their doctors about the use of CM. Costs ranged from $A2−$A200 (median $A10) per month. Forty‐three (24.7%) of the children had been taken to an alternative practitioner at a cost of $A25−$A400 (median $A40) per month. Users of CM and CT were significantly more likely than non‐users to have persistent asthma (P < 0.02), be on high‐dose inhaled or oral steroids (P < 0.05), to have poor or very poor control of symptoms (P < 0.04), and more frequent doctor visits (P < 0.05). They also had more adverse reactions to relieving bronchodilators (P < 0.02) and were significantly older than non‐users (P < 0.02). The most common reasons for using CM and CT were dissatisfaction with conventional therapies and concerns about steroid side‐effects.

Conclusions:  Health professionals should be aware of the high rates of usage of CM and CT in asthmatic children and of parental attitudes to conventional and alternative therapies.
The quality of communication between hospitals and general practitioners: An assessment
Authors: BOLTON P , MIRA M , KENNEDY P , MOSES LAHRA M
Published: March 2003

The objective of this study was to assess the quality of communications between hospitals and general practitioners (GPs). The proportion of medical records in which the patient’s general practitioner (GP) was identified, the accuracy of medications recorded in the discharge summary, the proportion of GPs who received discharge summaries, and the timeliness of receipt of discharge summaries were all evaluated. Discussions were held with all stakeholders, the literature was reviewed and GPs were surveyed to identify potential measures of quality. These were then trialled to assess their utility and practicability. Timeliness, issues that required follow‐up and treatment provided in hospital were of greatest importance to general practitioners. The GP’s name was recorded in 88% of audited records. Few inaccuracies were detected in the medications recorded in the discharge summaries, and GPs received 77% of discharge summaries. Methods similar to those used in this study might be broadly applied to improve the quality of discharge communication throughout Australia.
Marycrest strength training group
Authors: Perryn Mary
Published: March 2003

Abstract The aim of the Marycrest Strength Training Group was to provide the frail elderly residents of the Marycrest Retirement Centre, Kangaroo Point, Queensland, with the opportunity to improve their muscle strength and functional abilities by participating in a supervised, safe and enjoyable group activity.
Management perspectives on a deep aquifer system for rural water supply in Olt and Vàlcea counties, Romania
Authors: Dinu Irina , Albu Marius , Moldoveanu Victor , Dassargues Alain , Olive Philippe
Published: March 2003

The water supply in the Romanian counties of Olt and Vàlcea is mainly from groundwater from a deep aquifer system in Pliocene formations. Isotope analyses have been used to establish the supply area of the deep aquifer system. The age of the groundwater has been estimated for two samples by using 14C analysis. A simplified numerical model for a north–south cross‐section has provided global values for the hydraulic conductivity and effective porosity of the aquifer system. The groundwater from permeable horizons deeper than 120–140 m is highly mineralised and is, therefore, inappropriate for use as a water supply. Because groundwater resources are limited, the water supply for industry and domestic use in urban regions cannot increase too much. Thus, the deep aquifer system could also be used as a water supply for rural regions.
Study of the chemical composition of suspended particles in Lake Baikal
Authors: Potyomkina Tatyana G. , Potyomkin Vladimir L.
Published: March 2003

Samples of suspended material (solid particles) from Lake Baikal were analysed by using X‐ray fluorescence elemental analysis with the excitation of monochromatized synchrotron radiation (SRXFA, Novosibirsk, Russia) and electron probe X‐ray microanalysis (EPXMA, Antwerp, Belgium). The chemical composition of particles in different depths and basins of the lake is discussed. The chemical composition of the central parts of the lake are stable, but concentrations are higher in the southern basin, which is liable to pollution.
Framework for surface water quality management on a river basin scale: Case study of Lake Iseo, Northern Italy
Authors: Al‐Khudhairy D. H. A. , Bettendroffer A. , Cardoso A. C. , Pereira A. , Premazzi G.
Published: March 2003

River (DESERT) and lake (EVOLA) water quality models are used to simulate the influences of alternative water quality management scenarios on the quality of receiving surface waters in the Lake Iseo basin, Northern Italy. The scenarios are representative of the European Union Directive on Urban Waste Water Treatment (91/271/EEC) and of the regional authority’s objective to reduce the total phosphorus loads from point sources entering Lake Iseo and to restore the lake as close as it is practically possible to its former natural qualitative state. Application of DESERT shows that the regional ‘Water Clean Up Plan’ can achieve similar reductions in total phosphorus concentrations in the basin’s main river system, Oglio River, to the 91/271/EEC directive, but at notably lower economic costs. Application of EVOLA to Lake Iseo shows that it is not practical to achieve the regional authority’s objective of a specific total phosphorus concentration in the lake by 2016. Instead, the results show that a more realistic, but higher, total phosphorus concentration can be achieved by 2016. The results of both modelling exercises indicate the usefulness of DESERT and EVOLA for comparing and assessing water quality management scenarios and for revising the regional authority’s final objectives with regards to total phosphorus concentration in Lake Iseo, as well as the regional ‘Water Clean Up Plan’ for restoring and safeguarding the quality of the basin’s surface waters.
P‐ANCA‐positive Wegener’s granulomatosis presenting with hypertrophic pachymeningitis and multiple cranial neuropathies: Case report and review of literature
Authors: Nagashima Toshiko , Maguchi Shiro , Terayama Yoshihiko , Horimoto Midori , Nemoto Masashi , Nunomura Mitsuru , Mori Masamitsu , Seki Takashi , Matsukawa Satoru , Itoh Tomoo , Nagashima Kazuo
Published: March 2003

An autopsy case of hypertrophic pachymeningitis and multiple cranial neuropathies is reported. A 53‐year‐old woman with paraplegia and various neurological signs which developed over a 2 year period was diagnosed as having an epidural mass with thickened dura mater extending from the lower cervical to the thoracic spinal cord. In addition, bilateral episcleritis, blephaloptosis, and blindness of the right eye with various cranial nerve deficits were found to be caused by the mass lesions involving the paranasal sinuses, orbit, and the cavernous sinus. Perinuclear antineutrophil cytoplasmic antibody (p‐ANCA) was positive, but cytoplasmic antineutrophil cytoplasmic antibody (c‐ANCA) was negative by enzyme‐linked immunosorbent assay. The partially removed epidural mass with hypertrophied dura mater and biopsy of the paranasal lesions showed chronic granulomatous inflammation with vasculitis. The remaining lesions resolved with steroid therapy with remarkable neurological improvement. The positive p‐ANCA test, paranasal involvement, the report of a similar histopathological case and a review of the literature on granulomatous pachymeningitis suggest the presence of p‐ANCA‐positive Wegener’s granulomatosis with central nervous system involvement characterized by hypertrophic pachymeningitis and/or multiple cranial neuropathies.
Delayed neuronal death
Authors: Kirino Takaaki
Published: March 2003

A brief, transient episode of cerebral ischemia causes selective loss of CA1 pyramidal cells in the hippocampus. Interestingly, it takes 2–3 days for the neuronal damage of CA1 to become morphologically obvious; hence, the term ‘delayed neuronal death’ was coined to describe this phenomenon. Approximately two decades after it was first recognized, the precise mechanism of delayed neuronal death is not yet fully understood. The most widely supported explanation is the glutamate‐Ca2+ theory, in which vulnerability of CA1 neurons is ascribed to their property of neurotransmitters and their receptors. Although this theory explains the early phase of neuronal response to ischemia fairly well, it does not offer a satisfactory explanation for the delayed phase of the process. Excessive accumulation of Ca2+ is observed in CA1 following transient ischemia, but accumulating evidence suggests that additional changes at the molecular level have to follow to completing the dying process, including expression of various apoptosis‐related genes. Further studies are, therefore, necessary to elucidate the mechanism of delayed neuronal death which, in turn, may open a new window for the treatment of stroke.
Correlation of thrombospondin‐1 and transforming growth factor‐β expression with malignancy of glioma
Authors: Kawataki Tomoyuki , Naganuma Hirofumi , Sasaki Atsushi , Yoshikawa Hideji , Tasaka Kachio , Nukui Hideaki
Published: March 2003

The expression of thrombospondin‐1 (TSP‐1) and its role in gliomas have not been well examined. In the present study TSP‐1 expression in a panel of malignant glioma cell lines and the expression of TSP‐1 and transforming growth factor (TGF‐β) proteins in low‐grade and malignant glioma tissues were investigated. Reverse transcription‐polymerase chain reaction analysis showed that nine of nine malignant glioma cell lines expressed TSP‐1 mRNA, and seven of nine glioma lines expressed TSP‐2 mRNA. Production and secretion of TSP‐1 were examined in the T98G glioblastoma cell line by western blot analysis. Total TSP‐1 protein content in the supernatant was 10 times higher than that in the cell lysate. Secretion of TSP‐1 was examined in these glioma cell lines by western blot analysis. All glioma lines secreted significant levels of TSP‐1. Bioassay showed that all tumor lines had the capacity to activate latent TGF‐β. Localization of TSP‐1, TGF‐β1, ‐β2, and ‐β3 was examined immunohistochemically in surgically resected glioma tissues, including 11 glioblastomas, six anaplastic astrocytomas, and eight astrocytomas. Most glioblastomas expressed high levels of both TSP‐1 and TGF‐β. Anaplastic astrocytomas expressed moderate levels of TSP‐1 and TGF‐β. Most malignant gliomas expressed various levels of TGF‐β1, ‐β2, and ‐β3. The expression of both proteins, however, was weak in low‐grade gliomas. Normal brain tissues around the tumors were negatively or very weakly positively stained for TSP‐1 and TGF‐β. These results indicate that most malignant glioma cells express TSP‐1 in vitro and in vivo, and the expression of TSP‐1 and TGF‐βin vivo correlates with the histologic malignancy of glioma. Overexpression of both TSP‐1 and TGF‐β may increase the biologic malignancy of malignant gliomas, through generating the active form of TGF‐β in tumor tissues.
Delayed resolution of intracranial germinoma after radiotherapy: A preliminary study of the correlation between histology and magnetic resonance imaging
Authors: Ochiai Hidenobu , Yamakawa Yuzo , Fukushima Tsuyoshi , Sato Yuichiro , Hayashi Tohru , Yamada Hiroki
Published: March 2003

A central nervous system germinoma is curable in most cases by radiotherapy, and most of the tumor mass disappears promptly after 20–30 doses. However, some germinomas take a longer period to vanish completely from magnetic resonance imaging (MRI) or computed tomography (CT) scans. In such cases, the tumor may contain components such as teratoma. The aim of this study was to clarify the nature of the persistence of some germinomas. Five cases of histologically verified germinoma in which radiotherapy was performed to treat residual tumor were selected. The doses of focal radiotherapy and whole brain radiotherapy were 10–20 Gy and 20–34 Gy, respectively. In these cases, correlation was made between the degree of persistence of the tumor when assessed by MRI and the amount of interstitial content, as determined by histology. The histological evaluation, using hematoxylin–eosin stain, silver impregnation and Azan staining was carried out independently of clinical information. The tumor vanished soon after radiotherapy in three cases, but 3–15 months passed before the tumor completely vanished from the MRI scans in the other two cases. The histology of the cases in which the tumor disappeared rapidly was predominantly of large tumor cells and only small amounts of reticulin. However, in the persistent tumors, large amounts of reticulin and vascular components were present. Thus, it is proposed that tumors with a large parenchymal component disappear soon after radiotherapy, whereas tumors composed mainly of interstitial component persist. Long‐standing enhancement seen on MRI or CT scans of patients with an intracranial germinoma is indicative of a large amount of interstitial component in the tumor.
Different dynamic patterns of extracellular glutamate release in rat hippocampus after permanent or 30‐min transient cerebral ischemia and histological correlation
Authors: Yang Yi , Li Qiu , Miyashita Hero , Yang Tao , Shuaib Ashfaq
Published: March 2003

The extent and severity of neuronal damage is different in ischemia with reperfusion compared to ischemia and no reperfusion. To investigate the role of glutamate in cerebral ischemia–reperfusion injury, in vivo microdialysis was performed to examine the dynamic profile of glutamate in the hippocampus in a transient (30 min) or permanent middle cerebral artery occlusion (MCAo) in Wistar rats. The extracellular concentration of glutamate in the cornu ammonis (CA)1 sector of the ipsilateral hippocampus showed a significant but transient elevation of glutamate for both groups immediately following ischemic insult. The initial high peak in glutamate levels in the transient MCAo group was followed by two secondary elevations in glutamate at 50 min and 90 min after initialization of reperfusion. The histopathological outcome was also different in the two groups. The observation that glutamate releases occurred in the early reperfusion phase provided an evidence of additional excitotoxicity of glutamate and thereby a therapeutic base for extended use of glutamate antagonist in the ischemia–reperfusion injury.
An autopsy case of hemilaterally dominant and systematic/extensive border zone infarction: Sequela of preceding atherosclerotic obstruction of one common carotid artery followed by repeated episodes of systemic hypotension
Authors: Sugihara Hirosh , Akizawa Nobutatsu , Yanagisawa Toshiyuki , Horiuchi Masahiro , Takahashi Yoichi , Abe Mitsubumi , Sakiyama Takeshi , Tadokoro Mamoru , Fujisawa Kohshiro
Published: March 2003

A 68‐year‐old man was admitted to St Marianna University Hospital on account of loss of consciousness with left hemiplegia. During the hospital recovery course with a rehabilitation procedure, the patient's blood pressure was very unstable, fluctuating between high (210/110 mmHg) and low (110/70 mmHg) values accompanied by a fainting sensation. A second stroke of left hemiplegia took place 1 month later. Afterwards, his condition worsened to tetraplegia with dysarthria. Three months later, lung cancer with multiple metastasis including his left neck was found and he died from adynamic ileus 6 months after the onset of the present illness. Autopsy revealed nearly complete atheromatous obstruction and more than 50% stenosis, respectively, of his right common and internal/external carotid arteries. His intracranial arterial trunks and main branches were all patent with localized atherosclerosis of only moderate degree. The pathology of the brain existed predominantly in the right hemisphere in the border zone area between the anterior and middle cerebral arteries systematically with numerous disseminated foci of complete or incomplete necrosis, white matter and gray matter being involved independently. Involvement of centrum semiovale white matter is more extensive and intensive than that of gray matter. Of the gray matter, cerebral cortex as well as striatum, periventricular (the third ventricle) gray and cerebellar cortex was involved. The specific characteristic topography and distribution of the lesions together with their histopathology are described in detail with illustration. It is concluded that this case represents an outstanding example of hemodynamic cerebral circulatory insufficiency doubly caused by hemilateral carotid artery stenosis and repeated episodes of systemic hypotension.
Astroblastoma with unusual signet‐ring‐like cell components: A case report and literature review
Authors: Sugita Yasuo , Terasaki Mizuhiko , Shigemori Minoru , Morimatsu Minoru , Honda Eiichiro , Oshima Yuki
Published: March 2003

We report a case of astroblastoma with unusual signet‐ring‐like cell components. A 33‐year‐old‐woman presented with occasional partial seizures of the face. Radiological studies revealed an enhanced frontal mass lesion. At surgery, a gray, soft, well‐circumscribed mass was seen and shelled out. Histologically, the tumor showed a perivascular arrangement and papillary‐like patterns with compact cellularity. The tumor cells radiating from the hyalinized vessels showed broader, shorter, less tapered processes. A part of each tumor cell displayed prominent islands of signet‐ring‐like cells. Glial fibrillary acidic protein reaction revealed strongly positive staining of tumor cells and signet‐ring‐like cells. Eight years after the operation the patient remains well with no tumor recurrence. It remains to be determined whether, in this astroblastoma, the unusual signet‐ring‐like cell components were related to benign biological characteristics or to the tumor's low‐grade form with incidental signet‐ring‐like cell appearance.
The prevention of glomerulosclerosis in rats using traditional Chinese medicine, Sairei‐to
Authors: Li Ping , Kawachi Hiroshi , Suzuki Yasuhito , Saito Akihiko , Orikasa Michiaki , Shi Zhen Sheng , Shimizu Fujio
Published: March 2003

SUMMARY:

The effects of Sairei‐to on chronic irreversible lesions were examined by the administration of drugs after the initiation of irreversible renal lesions by uninephrectomy and anti‐thy‐1 antibody injection. Twenty‐one female Wistar rats were divided into three groups. Group 1 was treated with phosphate‐buffered saline (PBS) as a control and groups 2 and 3 were treated with Sairei‐to 400 mg/kg bodyweight per day on a daily basis beginning on day 1 (group 2) and day 7 (group 3) to day 42 after the intravenous administration of 500 μg anti‐thy‐1 monoclonal antibody (MoAb) into uninephrectomized rats, respectively. Statistically significant effects of Sairei‐to on proteinuria were observed on days 3, 7, 14, and 21 in group 2 and on day 21 in group 3 as compared with the PBS controls. On day 42, light microscopy showed that Sairei‐to ameliorated morphological lesions (Matrix score: 133.7 ± 50.35 for group 1 vs 40.0 ± 24.0 for group 2, P < 0.05). The weight of the kidneys in groups given Sairei‐to was also lower than that in the PBS control. In addition, immunofluorescent findings showed that Sairei‐to suppressed the expression of transforming growth factor‐beta (TGF‐β), alpha‐smooth muscle actin (α‐SMA) and collagen type I in glomeruli and decreased the number of ED1‐ and OX8‐positive cells in tubulo‐interstitium as well as in glomeruli. In conclusion, Sairei‐to blocked the progression of renal lesions in this model even when it was administered after the initiation of the disease. In addition, earlier treatment more effectively prevented the progression of the renal lesions.
Relationship between dialysis and nutritional adequacy in haemodialysis patients
Authors: Rutledge Claire , McMahon Lawrence P.
Published: March 2003

SUMMARY:

The nutritional wellbeing and dialysis adequacy of 57 stable haemodialysis patients (34 males and 23 females) from two satellite dialysis centres were assessed. Nutritional and anthropometric assessment comprised a variety of serological, historical and somatic parameters. A previously validated urea monitor was used to assess dialysis dose (Kt/V) and normalized protein catabolic rate (nPCR). Over 70% were malnourished (19% severely), 60% had a nPCR < 1.2 g/kg per day, and 80% failed to reach an adequate energy intake. A close correlation was observed between the various measures of nutritional assessment. Almost half of the group (47%) demonstrated a Kt/V < 1.2, with a significantly higher level identified in females (1.3 ± 0.2 vs 1.0 ± 0.2, P < 0.05). This was in contrast to the nutritional data where there was an equal sex distribution. A close correlation was found between dialysis adequacy and the different nutritional and anthropometric parameters in subjects with a Kt/V < 1.2 (P < 0.01 to P < 0.001). Males appear to be at higher risk of malnutrition from inadequate dialysis, however, a higher than expected incidence of malnutrition was observed in both sexes who were adequately dialysed.
Transcription factor NF‐κB in glomerulonephritis
Authors: Auwardt Russell B , Mudge Stuart J , Power David A
Published: March 2003

SUMMARY:

It is becoming increasingly evident that the transcription factor, nuclear factor‐kappa B (NF‐κB) is at the heart of the inflammatory response in all tissues, including the kidney. Studies in both human glomerulonephritis and experimental disease models provide either direct or circumstantial evidence for the activation of NF‐κB. Moreover, it now appears that many existing anti‐inflammatory or immunosuppressive drugs appear to exert at least part of their action through the inhibition of NF‐κB. However, the widely used inhibitors of NF‐κB (especially steroids and cyclosporin) are not completely effective in the treatment of glomerulonephritis. These observations raise two critical questions; first, whether there are cell‐specific differences in the action of NF‐κB inhibitors and, second, whether it is more important to inhibit NF‐κB in glomerular cells or in cells of the immune system. At present, there is insufficient evidence to answer these questions as most work in this area has concentrated on NF‐κB in lymphocytes. Activation of NF‐κB in the cells of the kidney, however, suggests that they may actively contribute to inflammation. Whether agents known to inhibit NF‐κB in the immune system, such as steroids and cyclosporin, also inhibit NF‐κB in glomerular cells is not well established. Drugs able to effectively inhibit NF‐κB in tissues therefore could provide a new approach to the treatment of glomerulonephritis. It is possible that suitable agents already exist among the significant number of drugs reported to inhibit NF‐κB. If not, the recent identification of kinases that activate NF‐κB will lead to the development of agents to inhibit this central, proinflammatory pathway. It will be of great interest to determine whether they offer anything over corticosteroids and cyclosporin, the more ‘traditional’ inhibitors of NF‐κB in glomerulonephritis.
Atherosclerosis in patients with analgesic nephropathy treated with haemodialysis
Authors: HOJS Radovan , EKART Robert , DVORŠAK Benjamin
Published: March 2003

SUMMARY: Accelerated atherosclerosis was reported to be associated with chronic analgesic consumption, but most studies were retrospective, and individual findings have almost never been controlled with regard to other atherosclerotic risk factors. Ten haemodialysis patients with analgesic nephropathy (group I) and 19 haemodialysis patients where renal failure was not caused by analgesic nephropathy (group II) were included in the study. All patients were female without diabetes. Using B‐mode ultrasonography, we compared intima‐media thickness (IMT) in the carotid arteries and plaque occurrence, and their thickness in group I with that in group II. the possible differences in atherosclerotic risk factors in both groups were also investigated. In group I, the average age was 60.2 years, and the average dialysis treatment was 55.7 months. In group II, the average age was 54.6 years, and the average duration of dialysis treatment was 50.4 months. We found no statistically significant difference in the age and duration of dialysis treatment between groups I and II. the IMT values of the carotid arteries (0.97 vs 0.78 mm; P= 0.027) were significantly higher in group I. More patients had plaques in group I (90 vs 57.9%), and the number of plaques (P= 0.037) and their thickness (P= 0.043) were significantly higher in this group. There was no statistically significant difference in the atherosclerotic risk factors between groups I and II. the results indicate that patients with analgesic nephropathy treated with haemodialysis showed advanced atherosclerosis compared with other haemodialysis patients, despite no difference being found in the atherosclerotic risk factors between these patients.
Hermeneutic philosophy. Part II: a nursing research example of the hermeneutic imperative to address forestructures/pre‐understandings
Authors: Geanellos Rene
Published: March 2003

Hermeneutic philosophy. Part II: a nursing research example of the hermeneutic imperative to address forestructures/pre‐understandings

Hermeneutic research requires that pre‐understandings are brought to consciousness in order to provide the phenomenon under investigation with the greatest opportunity to reveal itself. This hermeneutic imperative is dealt with in the present study. My research involved explicating the practice knowledge of nursing on residential adolescent mental health units, and as I had worked on such units I held pre‐understandings that would influence the research. I addressed pre‐understandings in three ways: (i) by developing understandings of practice knowledge through a hermeneutic conceptualisation of it; (ii) by working out forestructures of the phenomenon under investigation. Using Heidegger’s writing on forestructures, 20 statements were generated, interpreted and reconceptualised as my forestructures of residential adolescent mental health nursing. I used this work to review participant interviews in an effort to prevent myself from only finding what I already assumed I would find in relation to practice knowledge; and (iii) by formulating pre‐understandings of the phenomenon of interest. Using Gadamer’s writing on reflection, seven stories were written and interpreted as my pre‐understandings of adolescent mental health nursing practice. I used this work to consider the presence of pre‐understandings during textual interpretation in an attempt to prevent premature interpretive closure. In these ways, I brought my forestructures/pre‐understandings to consciousness, reflected on them, questioned their origins, adequacy and legitimacy and thereby took account of their influence on myself and the research.
The sexual embodiment of the cancer patient
Authors: Riet Pamela van der
Published: March 2003

The sexual embodiment of the cancer patient

This paper draws upon data from my doctoral studies and uses poststructuralism as a methodology to provide a way of seeing and understanding cancer patients’ complex experience of their bodies. Cancer patients were massaged for the purpose of this study and the themes addressed in this article are linked to the sexuality of the person being massaged and the masseuse (PVDR). In order to capture the richness of the cancer patients’ experience, the data are presented in an unconventional way — in the form of poetry. The poems show that the damaged bodies of cancer patients are still sexual in nature. In this research, the body of the cancer patient is a discursive one inscribed with power, culture, society and history. There are also themes of managing the body, altered embodiments of femininity, altered embodiments of masculinity, intimacy, and speaking the unspeakable.
A discursive exploration of nursing work in the hospital emergency setting
Authors: Heslop Liza
Published: March 2003

Emergency nurses apply specialist knowledge to the practice of emergency care. This paper discusses the ways in which three emergency nurses understand the nature of their care from their own frames of reference and experiences and presents some of the data collected in a larger study. Various discourses, which compete to inform emergency nurses' understandings of practice, are linked with the notion of nurses as subjects; that is, each discourse may inform, shape and constitute the practice of the nurse and, in turn, the ways in which the patient comes to be known and understood. I will examine the ways in which emergency nurses come to experience or position themselves vis‐à‐vis extant forms of knowledge of emergency care and the extent to which they articulate new or distinctive formulations of emergency care. This paper illuminates the commonalities that constitute the discourses of emergency nursing care, and also analyse nurses' language which demonstrates that within each discourse variations, contradictions and resistances exist. Emergency nursing care occurs in a context of a biomedical discourse that dominates, or tends to dominate, the work of the emergency setting and so to determine acceptable or possible practices. Nevertheless, nurses contest in various ways the ‘truths' that they understand to underpin their practice. Challenges to biomedical discourses are revealed, to some extent, by drawing attention to specific situations and particular struggles encountered in emergency nurses' everyday practice.
Virtual power: gendering the nurse–technology relationship
Authors: Fairman Julie , D’Antonio Patricia
Published: March 2003

To date, studies of the relationship between technology and its consumers have used the constructs of traditional paradigms of production and consumption as the foundation for analysis. These studies have served to reinforce traditional concepts of gender and hierarchy in the nursing–technology dichotomy. To propose a new and more relevant framework for analysing the technology–nursing relationship, the analysis of gender within the methodology of the social history of technology will be used. Healthcare will be viewed as a technologic network, and within that network multiple knowledge domains reside and interact. These domains, in turn, are socially constructed and historically contingent. This paper operationalizes this argument by examining the domain of the early nurse practitioner movement of the 1960s as part of a gendered technologic system. The findings of this study illuminate the agency of nurses in the shaping of traditionally male knowledge domains and as a crucial factor for understanding the evolution of not only the particularities of the nurse–technology relationship, but also the generalities of the gendered ways of knowing within the healthcare–technology relationship. Perhaps most importantly, different sets of questions can be formulated to analyse the history of the nurse practitioner movement from a technologic perspective that will provide new standpoints for the nursing‐technology dichotomy in the millennium.
A cross‐national study of differences in the identities of nursing in England and Australia and how this has affected nurses’ capacity to respond to hospital reform
Authors: Degeling Pieter , Hill Michael , Kennedy John , Coyle Barbara , Maxwell Sharon
Published: March 2003

A cross‐national study of differences in the identities of nursing in England and Australia and how this has affected nurses’ capacity to respond to hospital reform

This paper examines similarities and differences in the identity of nursing in England and Australia. In doing this we examine how in each country nursing has developed different ideologies and strategies. Our analysis draws on data derived from a cross‐national study of hospital staff in England and Australia. We demonstrate how differences in the occupational identity of nursing in each country are registered in their values, attitudes and beliefs. We suggest that these differences reflect the interplay of factors such as the strategic stances of nursing professional and industrial organisations and how nurses in each country have positioned themselves in responding to recent changes in health policy.
Working relationships between practice nurses and general practitioners in Australia: a critical analysis
Authors: Willis Eileen , Judith Condon , Litt John
Published: March 2003

Working relationships between practice nurses and general practitioners in Australia: a critical analysis

This research set out to explore shared care between practice nurses and general practitioners in South Australia. Nine practice nurses (PNs), two nurse practitioners and 10 general practitioners (GPs) were interviewed in urban and rural practices in order to build up a picture of how GPs and PNs worked together. The interviews showed that shared care was not a reality, although practice nurses were very busy, enjoyed their work and were no longer performing as receptionists doing a little nursing on the side, but as highly skilled nurses. Questions that emerged included whether or not practice nurses are specialists or generalists; their relationship to nurse practitioners; the extent to which the doctor–nurse game explains the relationship between practice nurses and general practitioners; and the potential for expanding the practice nurse role.
Methodological strategies for the identification and synthesis of ‘evidence’ to support decision‐making in relation to complex healthcare systems and practices
Authors: Forbes Angus , Griffiths Peter
Published: March 2003

Methodological strategies for the identification and synthesis of ‘evidence’ to support decision‐making in relation to complex healthcare systems and practices

This paper addresses the limitations of current methods supporting ‘evidence‐based health‐care’ in relation to complex aspects of care, including those questions that are best supported by descriptive or non‐empirical evidence. The paper identifies some new methods, which may be useful in aiding the synthesis of data in these areas. The methods detailed are broadly divided into those that facilitate the identification of evidence and those that enable the interpretation of the data retrieved. To illustrate some of the issues involved, reference is made to a multimethod review recently completed by the authors, which aimed to identify factors that promote continuity in the transition from child to adult health and social care. It is argued that as healthcare organisations are becoming increasingly preoccupied with the evidence base of practice, such methods may help ensure that aspects of care and approaches that are outside the dominant pharmaco‐medical domain maintain a prominent position on the healthcare agenda while remaining open to external scrutiny. Healthcare professionals who use such approaches need to know their relative utility and benefits to inform clinical decisions, so as to ensure that best practice is observed.
The treatment of neuroleptic malignant syndrome using dantrolene sodium
Authors: TSUTSUMI YASUHIKO , YAMAMOTO KENJI , MATSUURA SHINSUKE , HATA SHUNJI , SAKAI MASAO , SHIRAKURA KATSUYUKI
Published: March 2003

The use of dantrolene sodium (DS) in the treatment of neuroleptic malignant syndrome (NMS) was studied from the data of 21 cases of NMS, which satisfied the diagnostic criteria of Pope et al. The mean dosage of DS was 0.97 ± 0.52 mg/kg per day and the mean duration of treatment was 8.3 ± 5.3 days. It was confirmed that the mean duration of treatment with DS tended to be longer in the cases involving disturbance of consciousness. However, there were no significant differences in the duration of treatment or the mean daily dosage, in the cases without disturbance of consciousness regardless of any other complications and symptoms. Also, there were no significant differences in the mean duration of treatment using DS and the mean dosage of DS between five cases that were considered to be `typical' and 16 cases that were considered to be `incomplete'. In addition, the prognoses of these cases were good such that not even one death occurred. In 13 cases, the treatment of psychiatric symptoms with thioridazine was started without recurrence of NMS.
Effects of morning bright light in healthy elderly women: Effects on wrist activity
Authors: Sakakibara Satoshi , Kohsaka Masako , Kobayashi Riko , Honma Hiroshi , Fukuda Noriko , Koyama Tsukasa
Published: March 2003

To investigate the effects of 8000 lux morning bright light in the elderly, home‐based motor activity on sleep was monitored for 5 days in 10 healthy women (mean age: 59.7 years old, range: 50–69 years old). The activity level and movement index on night 4 were significantly lower in bright light conditions, compared with the controlled condition. The activity level during the day was not significantly different between the two conditions. These results indicate that 8000 lux morning bright light improves sleep quality in healthy elderly women.
Diurnal fluctuation of sleep propensity across the menstrual cycle
Authors: Shibui Kayo , Uchiyama Makoto , Okawa Masako , Kudo Yoshihisa , Kim Keiko , Kamei Yuichi , Hayakawa Tatsuro , Akamatsu Tatsuya , Ohta Katsuya , Ishibashi Kenichi
Published: March 2003

Most women experience sleep changes across the menstrual cycle. We applied the ultra‐short sleep–wake schedule to healthy females to compare their 24‐h sleep propensity rhythms in the follicular and luteal phases. The daytime (09.00–16.30 h) subjective sleepiness and the number of slow wave sleep‐containing nap trials increased in the luteal phase compared to the follicular phase, but the mean sleep propensity did not change. During the periods of 17.00–00.30 h and 01.00–08.30 h there were no differences between the two phases. These results suggest that increased daytime sleepiness in the luteal phase may be related to brain mechanisms controlling slow wave sleep.
Development of the polysomnographic database on CD‐ROM
Authors: Ichimaru Y. , Moody G.B.
Published: March 2003

We have developed a polysomnographic database on CD‐ROM. The data were obtained from 16 subjects with sleep apnea syndrome. The physiological signals include electroencephalogram, electromyogram, electrooculogram, invasive blood pressure, respiratory wave, oxygen saturation, and cardiac volume as measured by VEST method. The CD‐ROM also include programs to analyze polysomnography (PSG) data. The CD‐ROM has values: (i) for researchers investigating clinical physiology or non‐linear dynamics during sleep apnea syndrome; (ii) for engineers developing a new algorithm for the computerized analysis of PSG data related to sleep apnea syndrome; (iii) for students learning sleep physiology.