bluuebunny/crossref_metadata_2025 huggingface dataset:
Adaptive trials in paediatric development: dealing with heterogeneity and uncertainty in pharmacokinetic differences in children
Authors: Cella Massimo , Danhof Meindert , Della Pasqua Oscar
Published: January 2012

WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT

• In children, differences in treatment response may be influenced by the effect of developmental changes and maturation on drug disposition, which lead to ambiguous relationships between dose and exposure.

• Initial estimation of the paediatric dose is obtained by extrapolation. However, no consensus on dose selection methodologies has been reached so far.

• The paradigm compound used in this investigation is abacavir, a nucleoside reverse transcriptase inhibitor used to treat human immunodeficiency virus infection. The recommended paediatric dose is 8 mg kg−1 twice daily up to a maximum of 300 mg twice daily.

WHAT THIS STUDY ADDS

• The use of adaptive rather than fixed dose protocols enables the accurate selection of the paediatric dose.

• Adaptive procedures ensure shrinkage of the observed exposure distribution around the target range irrespective of study size.

• Modelling and simulation techniques provides the basis for the systematic evaluation of the implications of dose selection in a paediatric clinical trial.

AIMS To assess whether an adaptive design in early clinical trials based on the paradigm of variable dosing and controlled exposure can provide better dosing recommendations compared with the standard fixed dose approach.

METHODS In a clinical trial simulation setting, a paediatric study was simulated using a pharmacokinetic model previously developed for abacavir. Plasma concentrations following the current recommended dose (8 mg kg−1) were taken at standard sampling times, exposures (AUC) were calculated and doses individually adapted to reach the target exposure (i.e. effective exposure in adults). A second round of simulations followed with the adapted doses, and the resulting concentrations were fitted again with the same model. Exposure distributions in both conditions (i.e. fixed dose and controlled exposure) were compared with the target exposure.

RESULTS The AUC distribution after the current dose resulted in a median exposure of 6.43 mg h l−1 (90th percentile 3.13–10.67 mg h l−1). A total of 61 of 128 subjects showed AUC values either too low or to high compared with the target exposure. After dose adjustment, the median exposure was 6.94 mg h l−1 (5.57–8.25 mg h l−1), and only 14 subjects deviated from the target range.

CONCLUSIONS Adaptive randomization can be used to optimize dosing regimens in early paediatric clinical trials. The randomization of patients to target exposure rather than dose increases the probability of demonstrating efficacy (i.e. study power) compared with dose‐controlled trials. Furthermore, it contributes to further understanding of the role of dose on the total heterogeneity in clinical response.
Incidence of anaphylaxis in the city of Alcorcon (Spain): a population‐based study
Authors: Tejedor Alonso M. A. , Moro Moro M. , Múgica García M. V. , Esteban Hernández J. , Rosado Ingelmo A. , Vila Albelda C. , Gomez Traseira C. , Cardenas Contreras R. , Sanz Sacristán J. , Hernández Merino A.
Published: January 2012

Background

Relatively few studies have examined the incidence of anaphylaxis in the general population.

Objective

To report the incidence of anaphylaxis among the general population of the city of Alcorcon, Spain, using various public health care databases.

Methods

Episodes of anaphylaxis were recovered using validated alphanumeric strings in different fields of electronic clinical records used in the different public health settings in the city of Alcorcon (primary care, Emergency Department, hospitalized patients and Allergy Outpatient Clinic). Patients with anaphylaxis were tracked across the different clinical settings in Alcorcon.

Results

The incidence of anaphylaxis in Alcorcon was 103.37 episodes per 100 000 person‐years (total standardized incidence rate of 112.2). There was a peak of 313.58 episodes in the 0–4 years age group and a different distribution of incidence rates (although non‐significant) among different age groups between male patients and female patients. In most age groups, incidence tended to be higher for female patients aged over 10 years. Patients were attended at two or more levels in 76.78% of episodes, and a new evaluation was often made at a primary care centre (71.43%), Allergy Outpatient Clinic (75.6%), or both after the episode (58.93%).

Conclusion and Clinical Relevance

This study revealed a higher rate of anaphylaxis than that in previous studies, although this incidence rate is probably lower than the real incidence rate. Studies exploring potential methodological, genetic and environmental factors accounting for these higher rates of anaphylaxis are required.
Disease severity impairs sleep quality in allergic rhinitis (The SOMNIAAR study)
Authors: Colás C. , Galera H. , Añibarro B. , Soler R. , Navarro A. , Jáuregui I. , Peláez A.
Published: January 2012

Background

Sleep is impaired in allergic rhinitis (AR) patients, with subsequent effects on daytime performance and health‐related quality of life (QOL). Sleep quality in AR has rarely been considered through validated tools and consensus classifications.

Objective

To evaluate sleep quality and daytime somnolence in AR patients, and to estimate its relationship to disease severity according to Allergic Rhinitis and Its Impact on Asthma (ARIA) conventional and modified classifications, as well as in terms of QOL and comorbidities.

Methods

Allergic rhinitis adult patients were evaluated through a prospective, observational, multicentre survey in Spain. Symptoms were assessed using the Total Symptoms Score (TSS), specific QOL by the Rhinitis Quality of Life Questionnaire (RQLQ), sleep quality by Pittsburgh scale, and diurnal somnolence by a scale based on Epworth's, all recorded in a unique visit.

Results

A total of 2275 patients were included. According to ARIA criteria, 50.2% had persistent and 49.8% intermittent rhinitis, whereas 87.6% were classified as moderate‐severe and 12.4% as mild; 52.8% had poor sleep quality, with a global median score for Pittsburgh scale of 6 (normal < 5) and 21.1% suffered from excessive diurnal somnolence. Correlation between Pittsburgh scale and RQLQ was moderate (r = 0.54). Among symptoms, nasal obstruction and concomitant asthma mainly, contributed to bad sleep quality. In a logistic regression model, moderate‐severe rhinitis and nasal obstruction were all associated with a worse sleep quality.

Conclusions and clinical relevance

Sleep quality is altered in AR patients. Sleep quality was worse in moderate‐severe, and particularly in severe AR. Nasal obstruction and RQLQ deterioration are associated with a poorer sleep quality. Sleep impairment is common in allergic rhinitis, particularly in more severe forms. Nasal obstruction and concomitant asthma should be considered as contributing factors.

Capsule summary

This is a large epidemiological survey of patients with allergic rhinitis showing a strong relationship between disease severity, as assessed by a consensus classification, and sleep impairment, as measured by a validated sleep quality tool.
Immunohistochemical expression of somatostatin receptor subtypes 2 and 5 in colorectal cancer
Authors: Evangelou Ioulia , Petraki Constantina , Msaouel Pavlos , Scorilas Andreas , Sdrolia Eleni , Padazi Georgia , Koborozos Vassilios , Koutsilieris Michael
Published: January 2012

Eur J Clin Invest 2012; 42 (7): 777–783

Background  To determine the immunohistochemical expression levels of the somatostatin receptor subtypes 2 and 5 (Sst2 and Sst5) in patients with colorectal cancer (CRC) and to investigate the association of Sst2 and Sst5 expression with clinicopathological parameters.

Materials and methods  A retrospective analysis of formalin‐fixed and paraffin‐embedded CRC surgical specimens from 81 patients assessed by immunohistochemistry for Sst2 and Sst5 expression.

Results  Sst2 and Sst5 expression levels showed significant, negative association with CRC invasion and liver metastasis (P values < 0·05) while Sst2 also showed significantly increased expression in lower‐grade tumours as well as in tumours located in the rectum (P values < 0·05). Patients with CRC expressing either Sst2 or Sst5 had significantly longer survival rates (P values < 0·05), although Sst expression was not found to be an independent predictor of survival after controlling for other known prognostic clinicopathological variables (P values > 0·05).

Conclusions  The present data confirm the relationship of Sst2 and Sst5 expression levels with reduced tumour aggressiveness.
River temperature and adult anadromous Atlantic salmon, Salmo salar, and brown trout, Salmo trutta
Authors: MOORE A. , BENDALL B. , BARRY J. , WARING C. , CROOKS N. , CROOKS L.
Published: January 2012

Abstract  In terms of the spawning migration of adult salmon, Salmo salar L., water flow is often considered the primary factor controlling river entry and fluctuations in flow controlling when the fish subsequently migrate upstream. However, water temperature has also been suggested to modify the spawning migration of salmon, particularly their movements within estuaries and the timing of freshwater entry. Freshwater temperature is more likely to impact salmonid biology than flow, particularly in relation to temperature dependant metabolic costs, time of spawning and fecundity. Therefore, temperature may be more of a factor regulating salmonid populations in fresh water than flow itself. This study focuses on two aspects of the impact of temperature on salmonids in fresh water: first, how salmon may modify their behaviour to adapt to changes in temperature and second the potential relationship between temperature, environmental conditions (e.g. water quality) and physiology (e.g. maturation and olfaction) in regulating adult migration.
A review on pathways and drivers of use regarding non‐native freshwater fish introductions in the Mediterranean region
Authors: TRICARICO E.
Published: January 2012

Abstract  The Mediterranean region is considered one of the six global invasion hotspots, with non‐native freshwater fishes representing more than a quarter of all fish species in drainage basins. Existing literature is reviewed to identify the main pathways and drivers of non‐native fish introductions. In the Mediterranean region, non‐native fishes were introduced through aquaculture and stocking activities for commercial and angling purposes. Introductions doubled from the 1950s, involving mostly Perciformes and Cypriniformes, with species coming from other parts of Europe, Asia and North America. Some differences between the northern and the south‐eastern areas of the Mediterranean region were found, although data from the latter area were scanty. Greater effort should be exerted to improve controls on aquaculture and stocking activities, as well as public awareness of the risks posed by non‐native species introductions.
An in vivo investigation of salivary properties, enamel hypomineralisation, and carious lesion severity in a group of Iraqi schoolchildren
Authors: GHANIM AGHAREED , MARIÑO RODRIGO , MORGAN MICHAEL , BAILEY DENISE , MANTON DAVID
Published: January 2012

International Journal of Paediatric Dentistry 2013; 23: 2–12

Background.  Hypomineralised enamel is a prevalent, congenital defect vulnerable to deteriorate post‐eruptively particularly in the presence of an unfavourable oral environment.

Aims.  To assess the influence of salivary characteristics on the clinical presentation of hypomineralisation lesions diagnosed in first permanent and second primary molars and to evaluate caries severity in relation to the defect’s clinical presentation.

Design.  Recruitment consisted of 445 seven‐ to nine‐year‐old participants, of whom 152 were diagnosed as having molar hypomineralisation (MH); the remaining unaffected subjects (N = 293) were considered their controls for saliva analysis. Dental caries status was assessed in 300 subjects of saliva sub‐sample, equally divided as MH‐affected and non‐affected children. The International Caries Detection and Assessment System was used for caries detection. Salivary flow rates, viscosity, pH, and buffering capacity were determined.

Results.  Molar hypomineralisation‐affected children have significantly higher mean caries scores compared to the non‐affected group. Dentinal carious lesions were ten times more frequent in teeth with post‐eruptive breakdown (PEB) than with teeth with opacities only. Low salivary flow rates (LSFR), moderately viscous saliva, and low pH were significantly more common in the affected group. LSFR and moderate and highly acidic saliva were more likely associated with PEB.

Conclusion.  Demarcated hypomineralised enamel is a dynamic defect highly influenced by individual characteristics of the oral environment.
A controlled, longitudinal study of home visits compared to telephone contacts to prevent early childhood caries
Authors: PLONKA KATHRYN A. , PUKALLUS MARGARET L. , BARNETT ADRIAN , HOLCOMBE TREVOR F. , WALSH LAURENCE J. , SEOW W. KIM
Published: January 2012

International Journal of Paediatric Dentistry 2013; 23: 23–31

Background.  Home visits (HV) provide excellent opportunities for health promotion.

Aim.  This longitudinal study compared the effects of HV and telephone contacts (TC) in preventing early childhood caries (ECC) and colonisation of mutans streptococci (MS) and lactobacilli (LB) from 0 to 24 months.

Design.  A total of 325 children were recruited from community health centres at mean age of 42 days, and randomly assigned to receive either HV or TC. A total of 188 children completed three, 6 monthly HV, and another 58 had three, 6 monthly TC. An additional 40 age‐matched children from childcare facilities served as reference controls (RC). At 24 months, all groups were examined at a community dental clinic.

Results.  At 24 months, three HV children of 188 (1.5%) had caries, compared to four TC of 58 (6.8%) and nine RC of 40 (22.5%) (P < 0.001 for HV versus RC; P = 0.05 for HV versus TC and P = 0.03 for TC versus RC). There were also more children with MS in the TC (47%) and RC (35%) compared to HV (28%) group (P = 0.01 and P = 0.02).

Conclusions.  Home visits and telephone contacts conducted 6 monthly from birth are effective in reducing ECC prevalence by 24 months.
Spatially structured populations with a low level of cryptic diversity in European marine Gastrotricha
Authors: KIENEKE ALEXANDER , MARTÍNEZ ARBIZU PEDRO M. , FONTANETO DIEGO
Published: January 2012

Species of the marine meiofauna such as Gastrotricha are known to lack dispersal stages and are thus assumed to have low dispersal ability and low levels of gene flow between populations. Yet, most species are widely distributed, and this creates a paradox. To shed light on this apparent paradox, we test (i) whether such wide distribution may be due to misidentification and lumping of cryptic species with restricted distributions and (ii) whether spatial structures exist for the phylogeography of gastrotrichs. As a model, we used the genus Turbanella in NW Europe. DNA taxonomy using a mitochondrial and a nuclear marker supports distinctness of four traditional species (Turbanella ambronensis, T. bocqueti, T. mustela and T. cornuta) and provides evidence for two cryptic species within T. hyalina. An effect of geography on the within‐species genetic structure is indeed present, with the potential for understanding colonization processes and for performing phylogeographic inference from microscopic animals. On the other hand, the occurrence of widely distributed haplotypes indicates long‐distance dispersal as well, despite the assumed low dispersal ability of gastrotrichs.
Islands and streams: clusters and gene flow in wild barley populations from the Levant
Authors: HÜBNER SARIEL , GÜNTHER TORSTEN , FLAVELL ANDREW , FRIDMAN EYAL , GRANER ANDREAS , KOROL ABRAHAM , SCHMID KARL J.
Published: January 2012

The domestication of plants frequently results in a high level of genetic differentiation between domesticated plants and their wild progenitors. This process is counteracted by gene flow between wild and domesticated plants because they are usually able to inter‐mate and to exchange genes. We investigated the extent of gene flow between wild barley Hordeum spontaneum and cultivated barley Hordeum vulgare, and its effect on population structure in wild barley by analysing a collection of 896 wild barley accessions (Barley1K) from Israel and all available Israeli H. vulgare accessions from the Israeli gene bank. We compared the performance of simple sequence repeats (SSR) and single nucleotide polymorphisms (SNP) marker data genotyped over a core collection in estimating population parameters. Estimates of gene flow rates with SSR markers indicated a high level of introgression from cultivated barley into wild barley. After removing accessions from the wild barley sample that were recently admixed with cultivated barley, the inference of population structure improved significantly. Both SSR and SNP markers showed that the genetic population structure of wild barley in Israel corresponds to the three major ecogeographic regions: the coast, the Mediterranean north and the deserts in the Jordan valley and the South. Gene flow rates were estimated to be higher from north to south than in the opposite direction. As has been observed in other crop species, there is a significant exchange of alleles between the wild species and domesticated varieties that needs to be accounted for in the population genetic analysis of domestication.
“It was just an unconditional gift.” Self reflections of non‐directed living kidney donors
Authors: Tong Allison , Craig Jonathan C. , Wong Germaine , Morton John , Armstrong Sarah , Schollum John , Cross Nick
Published: January 2012

Tong A, Craig JC, Wong G, Morton J, Armstrong S, Schollum J, Cross N. “It was just an unconditional gift.” Self reflections of non‐directed living kidney donors.

Abstract:  Non‐directed living kidney donation is an important emerging type of donation, but there are concerns about ulterior motives and irrational decision‐making. This study aimed to elicit the motivations and experiences of non‐directed living kidney donors. Qualitative interviews were conducted with all 18 people who donated a kidney in the transplant unit of the South Island, New Zealand. Six major themes were identified: offering the chance of life (opportunity for normalcy in the recipient, good samaritanism), determination (resolute personal decision, rooted in stability, urgency, opportuneness), minimizing perceived risks (live with one kidney, trust in the medical system, physical and genetic resilience, taking chances, mental preparation, mild inconvenience), preserving anonymity (protecting donor anonymity, respecting recipient choice, receiving appreciation, knowing recipient outcomes, developing relationships), donor support (psychologic preparation, efficient coordination, reimbursement of expenses), and gaining benefits (improved fitness, empowerment and satisfaction, connectedness). Non‐directed living kidney donors want to offer someone a chance of normal life; a decision driven by resoluteness and a sense of urgency. Kidney donation is perceived to offer improved fitness, and a sense of empowerment, satisfaction, and connectedness. Reluctance to consider non‐directed donation programs solely on concerns of unrealistic or ill‐motivations and potential feelings of donor regret appear unwarranted.
HLA‐E polymorphisms in hematopoietic stem cell transplantation
Authors: Fürst D. , Bindja J. , Arnold R. , Herr W. , Schwerdtfeger R. , Müller C. H. , Recker K. , Schrezenmeier H. , Mytilineos J.
Published: January 2012

Human leukocyte antigen (HLA)‐E is an inhibitory ligand of natural killer cells and γ/δ T‐cells. Differential expression of HLA‐E alleles on the cell surface has been reported to influence outcome of hematopoietic stem cell transplantation (HSCT). We performed HLA‐E genotyping in 116 HSCT patients and their HLA‐matched unrelated donors. The impact of HLA‐E genotypes on patient's overall survival (OS), disease free survival (DFS), cumulative incidences for relapse, transplant‐related mortality (TRM) and acute graft vs host disease (aGvHD) was assessed. Neither univariate nor multivariate analysis showed any influence of HLA‐E polymorphisms on the investigated endpoints of HSCT in our cohort. We could not confirm any of the previous observations in our cohort and consider it unlikely that HLA‐E polymorphisms affect outcome of HSCT.
Immunocytochemical Localization of Cytoplasmic and Nuclear Intermediate Filaments in the Bovine Ovary during Folliculogenesis
Authors: Wendl J. , Ebach K. , Rodler D. , Kenngott R. A.‐M.
Published: January 2012

The cellular cytoskeleton is composed of three fibrillar systems, namely actin microfilaments, microtubules and intermediate filaments (IFs). It not only is a structural system, which mediates functional compartmentalization, but also contributes to many cellular processes such as transport, mitosis, secretion, formation of cell extensions, intercellular communication and apoptosis. In this study, we have examined the distribution of four groups of IFs [cytokeratins (CKs), vimentin, desmin and lamins] in the somatic and germinal cells of the bovine ovary using RT‐PCR and immunohistochemical techniques. Using RT‐PCR, specific transcripts for all intermediate proteins studied (CK8, CK18, desmin, vimentin, lamin A/C and lamin B1) were detected. A characteristic immunohistochemical staining pattern was observed for the different IFs within the ovary. In this study, we used antibodies against type I CK (acidic CKs: CK14, CK18 and CK19) and type II CK (basic CKs: CK5 and CK8). Among these, only antibodies against CK18 gave a characteristic pattern of immunostaining in the ovary, which included the surface epithelium, the follicle cells, the endothelium of blood vessels and rete ovarii. Antibodies against all other CKs resulted in a weak staining of a limited number of cellular structures (CK5 and CK19) or were completely negative (CK8 and CK14, apart from the surface epithelium). Vimentin antibodies resulted occasionally in a weak staining of the granulosa cells of primary and secondary follicles. In late secondary follicles, the basal and the most apical follicle cells contacting the zona pellucida usually showed a marked immunostaining for vimentin. In antral follicles, three different immunostaining patterns for vimentin were observed. Desmin immunostaining was confined to the smooth muscle cells of blood vessels. Although mRNA for lamin A/C and lamin B1 could be demonstrated using RT‐PCR, no immunostaining was found for lamins, neither in the follicle cells nor in the oocytes.
Polymelous Layer Chick Displaying Additional Malformations of the Hind Gut: Case Report and In‐Depth Review of Related Literature
Authors: Hirschberg R. M. , Saleh M. , Kaiser S. , Lierz M. , Hafez H. M. , Bragulla H. H.
Published: January 2012

A case report of a male 6‐day‐old male layer chick featuring incomplete polymelia of the hind limbs and hindgut malformations is presented. The chick was submitted to computed tomography (CT) examination and subsequent anatomical dissection. Apart from the two supernumerary hind limbs, the anatomical dissection revealed additional hindgut alterations: three uniform‐sized caeca flanked the ileum, and the rectum branched into paired cloacae. The supernumerary hind limbs were localized caudal to the normal hind limbs in an inverted position and were attached to pelvic girdle elements and to a curtate pygostyle. They featured a prominent unpaired femur besides paired tibiotarsi, tarsometatarsi and species‐specific phalanges of the toes. Additionally, two separate bones attached to the caudoventral aspect of the regular hip bones were developed. The supernumerary limbs were in part mobile and received nerve and vascular supply. Digital 3D‐reconstruction based on the CT datasets revealed the osseous components of the malformed body parts. The possible morphogenesis including an in‐depth literature review and the clinical implications of the reported malformations are discussed.
Nursing students' perceptions about nursing care plans: A Turkish perspective
Authors: Can Gulbeyaz , Erol Ozgul
Published: January 2012

Can G, Erol O. International Journal of Nursing Practice 2012; 18: 12–19

Nursing students' perceptions about nursing care plans: A Turkish perspective

This descriptive study was planned in order to assess self‐perceived sufficiency levels of nursing students at preparing nursing care plans and also determine the effect of these plans on students' occupational development. Sample of the study was consisted of 55 nursing students who were taking oncological training. Data were collected by using Personal Information Form and Student Care Plan Evaluation Form. Non‐parametric tests were used in data analysis. Students perceived themselves ‘insufficient’ although assessing reproductive neurological and cardiovascular systems, respectively, and also interpreting results of hemogram and urine tests. No significant difference was found between the initial and last nursing care plans prepared by the students during clinical training. Sixty % of students reported that preparing and implementing nursing care plans had favourable effects on their occupational development. Results suggest that students should be well prepared before clinical training programmes and also nursing care plans should be revised and used in more proper and practical ways in order to enhance students' occupational development.
Rapid intervention and treatment zone: Redesigning nursing services to meet increasing emergency department demand
Authors: Considine Julie , Lucas Elspeth , Martin Roslyn , Stergiou Helen E , Kropman Matthew , Chiu Herman
Published: January 2012

Considine J, Lucas E, Martin R, Stergiou HE, Kropman M, Chiu H. International Journal of Nursing Practice 2012; 18: 60–67

Rapid intervention and treatment zone: Redesigning nursing services to meet increasing emergency department demand

The impact of emergency nursing roles in demand management systems is poorly understood. The aim of this study was to evaluate emergency nurses' role in a specific emergency department (ED) demand management system: rapid intervention and treatment zone (RITZ). A descriptive exploratory approach was used. Data were collected from audit of 193 randomly selected patient records and 12 h of clinical practice observation. The median age of participants was 31 years, 51.8% were males and 99.5% were discharged home. Nurse qualifications or seniority had no significant effect on waiting time or length of stay (LOS). There were disparities between documented and observed nursing practice. Thedesignation and qualifications of RITZ nurses made little difference to waiting times and ED LOS. Specific documentation and communication systems for areas of the ED that manage large numbers of low complexity patients warrant further research.
Critical discourse analysis: Understanding change in maternity services
Authors: McIntyre Meredith , Francis Karen , Chapman Ysanne
Published: January 2012

McIntyre M, Francis K, Chapman Y. International Journal of Nursing Practice 2012; 18: 36–43

Critical discourse analysis: Understanding change in maternity services

This paper provides an example of the use of critical discourse analysis (CDA) in the area of maternity care policy and describes the process of CDA as an effective research method for understanding the influences of change in the context of Australian maternity services. CDA is a methodological approach that examines how discourse is formed and given power, as a result of how power is used, who uses it and the context within which this usage takes place. The application of CDA is described in this study for the purpose of examining key‐stakeholder use of knowledge and power for the purpose of influencing the direction of the maternity services reform. The CDA theoretical framework guided discourse identification and analysis of the purpose behind the discourse through examination of power relationships between key stakeholders. The use of a theoretical lens in the form of neoliberalism to supplement the theoretical framework facilitated the exposure of forces intrinsic to the maternity care context driving change.
Nurses' protective measures during chemotherapy preparation and administration in Turkey*
Authors: Rizalar Selda , Tural Esra , Altay Birsen
Published: January 2012

Selda R, Tural E, Altay B. International Journal of Nursing Practice 2012; 18: 91–98

Nurses' protective measures during chemotherapy preparation and administration in Turkey

Chemotherapeutic agents are known to be carcinogenic, teratogenic and mutagenic to humans. Occupational exposure to chemotherapeutic agents is a potential risk. The aim of this study was to determine the safety measures on personal and environmental protection taken by nurses during chemotherapy preparation and administration. Current study was conducted between 1 April and 30 June 2007 in the chemotherapy administration units of all hospitals in Samsun, North of the Turkey. Seventy‐three nurses were included in the study group. Data were obtained via questionnaire form. Findings for nurses' safety behaviour and usage of recommended health safety measures showed that, notwithstanding the rules and regulations pertaining to chemotherapeutics, nurses did not comply with them fully. The study expanded that health providers and clinical environment are under threat for contamination of chemotherapeutics. The results clearly point the importance of need for regular education programme. This study also revealed the necessity for improvement of the working environment.
Self‐care strategies to facilitate sleep in patients with heart disease—A qualitative study
Authors: Johansson Anna , Karlsson Johan , Brödje Karin , Edell‐Gustafsson Ulla
Published: January 2012

Johansson A, Karlsson J, Brödje K, Edell‐Gustafsson U. International Journal of Nursing Practice 2012; 18: 44–51

Self‐care strategies to facilitate sleep in patients with heart disease—A qualitative study

This study aimed at exploring and describing the self‐care management strategies used by patients with coronary artery disease to facilitate sleep. Qualitative interviews in a dialogue manner, in a phenomenographic reference frame analyzed according to manifest and latent principles of qualitative content analysis, were performed. A purposeful sampling technique was used including 11 patients with coronary heart disease in a Heart Medical Unit in a general hospital setting. Two main themes were identified: ‘sleep‐rhythm’ and ‘sleep‐hygiene’ including four descriptive categories. The categories reveal five basic responses including emotions, cognition, physical symptoms (reactions), behaviours and/or the sleep environment, which were related to perceived or actual presence of sleep‐wake problems and health that were the underlying reason for the self‐care management strategies. Basically, intervention studies that address these five responses for choice of non‐pharmacological methods based on cognitive behavioural therapy provided by nurses are needed.
Public services for children with special needs: Discrimination by diagnosis?
Authors: McDowell Michael , O'Keeffe Mick
Published: January 2012

In July 2011, the Australian federal government announced expansion of early intervention funding. Children diagnosed with cerebral palsy, Down syndrome, Fragile X syndrome and hearing and vision impairments are now eligible in addition to the existing funding for children diagnosed with autistic disorders. By deciding who gets the funding according to a set of accepted diagnoses, many children with equivalent if not greater levels of early intervention special need are excluded. In this viewpoint, we consider the fairness of this approach, and argue that while it may make sense from a political point of view, it is hard to justify, and possibly even discriminatory, from clinical, ethical and legal perspectives.
Macrophage infiltration and renal damage are independent of matrix metalloproteinase 12 in the obstructed kidney
Authors: ABRAHAM ABU P , MA FRANK Y , MULLEY WILLIAM R , OZOLS ELYCE , NIKOLIC‐PATERSON DAVID J
Published: January 2012

Aim:  To determine whether matrix metalloproteinase‐12 (MMP‐12) plays a functional role in renal interstitial macrophage accumulation, interstitial fibrosis or tubular apoptosis in the unilateral ureteric obstruction (UUO) model.

Background:  MMP‐12 is an enzyme that can cleave a number of extracellular matrix proteins and plays a role in macrophage‐mediated injury in experimental models of emphysema and antibody‐dependent glomerular disease. Macrophages are thought to promote renal fibrosis and tubular damage in the obstructed kidney. Furthermore, upregulation of MMP‐12 expression by infiltrating macrophages in the obstructed kidney has been described, but the potential role of MMP‐12 in renal injury induced by this non‐immune insult is unknown.

Methods:  Groups of eight MMP‐12 gene deficient (MMP‐12−/−) and wild type (WT) C57BL/6J mice were killed 3, 7 or 14 days after UUO.

Results:  Analysis of three different lineage markers found no difference in the degree of interstitial macrophage accumulation between MMP‐12−/− and WT UUO groups at any time point. Examination of renal fibrosis by total collagen staining, α‐SMA + myofibroblast accumulation, and TGF‐β1, PAI‐1 and collagen IV mRNA levels showed no difference between MMP‐12−/− and WT UUO groups. Finally, tubular damage (KIM‐1 levels) and tubular apoptosis (cleaved caspase‐3) in the obstructed kidney was not affected by MMP‐12 gene deletion.

Conclusion:  In contrast to lung injury and antibody‐dependent glomerular injury, MMP‐12 is not required for renal interstitial macrophage accumulation, interstitial fibrosis or tubular damage in the obstructed kidney.
Naturalistic exploration of the effect of osmotic release oral system‐methylphenidate on remission rate and functional improvement in Taiwanese children with attention‐deficit–hyperactivity disorder
Authors: Tzang Ruu‐Fen , Wang Ya‐Ching , Yeh Chin‐Bin , Hsu Cheng‐Dien , Liang Hsin‐Yi , Yang Pin‐Chen , Liu Hung‐Jen , Huang Yu‐Shu , Cheng Helen , Hsu Ya‐Chen , Liu Shen‐Ing , Pan Chia‐Ho , Huang Ya‐Fen , Huang Chi‐Fen , Wu Yu‐Yu , Huang Yu‐Hsin , Liu Hui‐Ching , Chang Hsueh‐Ling
Published: January 2012

Aim:  To determine the differences in the remission rate, recovery rate, functional improvement, and treatment adherence related to treatment with short‐acting immediate‐release methylphenidate (IR‐MPH) and long‐acting osmotic‐release oral system‐methylphenidate (OROS‐MPH) in a naturalistic setting among Taiwanese children with attention‐deficit–hyperactivity disorder (ADHD).

Methods:  A total of 757 children with ADHD, aged 6–18 years, was evaluated using the following in order determine functional improvement and treatment adherence: the Chinese version of the Swanson, Nolan, and Pelham, version IV scale (SNAP‐IV‐C), Clinical Global Impression‐ADHD‐Severity (CGI‐S) to measure remission and recovery rates, the Chinese version of the Social Adjustment Inventory for Children and Adolescents (CSAICA), and caregiver's satisfaction rate, treatment adherence, and frequency of adverse effects.

Results:  According to the SNAP‐IV‐C scores, the remission rate was 30.72%, and the recovery rate was 16.38%. Compared to short‐acting IR‐MPH, OROS‐MPH was associated with greater functional improvement and treatment adherence among children with ADHD.

Conclusion:  OROS‐MPH treatment at the adequate dosage can achieve higher remission and recovery rates, produce greater functional improvement, and result in better treatment adherence than IR‐MPH treatment.
Multi‐channel near‐infrared spectroscopy shows reduced activation in the prefrontal cortex during facial expression processing in pervasive developmental disorder
Authors: Nakadoi Yoshihiro , Sumitani Satsuki , Watanabe Yukina , Akiyama Mai , Yamashita Naomi , Ohmori Tetsuro
Published: January 2012

Aim:  The purpose of the present study was to investigate whether individuals with pervasive developmental disorders (PDD) show differential activation during an emotional activation task compared with age‐ and sex‐matched controls, by measuring changes in the concentration of oxygenated (oxyHb) and deoxygenated (deoxyHb) hemoglobin, using near‐infrared spectroscopy (NIRS).

Methods:  Fourteen patients with PDD and 14 age‐ and sex‐matched healthy controls participated in the study. The relative changes of concentrations of oxyHb and deoxyHb were measured on NIRS during an implicit processing task of fearful expression using Japanese standard faces.

Results:  PDD patients had significantly reduced oxyHb changes in the prefrontal cortex (PFC) compared to healthy controls.

Conclusion:  PFC dysfunction may exist in PDD.
Prevalence and relation of dementia to various factors in Parkinson's disease
Authors: Rana Abdul Qayyum , Yousuf Muhammad Saad , Naz Sughra , Qa'aty Nour
Published: January 2012

Aims:  Parkinson's disease is a chronic neurodegenerative disorder characterized by bradykinesia, rigidity, and resting tremor. Dementia, among its non‐motor symptoms, is a debilitating complication affecting intellectual functioning. The aim of the present study was to determine the prevalence of dementia in Parkinson's disease and its relation to age, gender and stage of the disease.

Methods:  A retrospective chart analysis was performed on Parkinson's disease patients seen in a community‐based Parkinson's disease and movement disorder clinic between 2005 and 2010.

Results:  A total of 310 patients were included in this survey, among whom 61 patients (19.7%) with Parkinson's disease met the criteria for dementia. Age was found to be a significant factor in developing dementia, with 90% of patients with dementia aged ≥70. Gender, however, was not correlated with dementia in Parkinson's disease. On analysis of stage at which dementia developed, progression of the disease was positively correlated with prevalence of dementia.

Conclusions:  As age increases, the chances of developing dementia increase. Dementia, contrarily, is not selective between genders. The likelihood of developing dementia increases as the stage of disease advances. Further research is required in order to understand underlying mechanisms of dementia in Parkinson's disease.
Meta‐analysis of robot‐assisted versus conventional laparoscopic Nissen fundoplication for gastro‐oesophageal reflux disease
Authors: Wang Zhanhui , Zheng Qi , Jin Zhiming
Published: January 2012

Background:  Conventional laparoscopic Nissen fundoplication (CLF) is generally considered the surgical approach of choice for gastro‐oesophageal reflux disease. Robotic‐assisted laparoscopic fundoplication (RALF) has recently been introduced into laparoscopic clinical practice with the aim of improving surgical performance by eliminating tremors and fatigue. A meta‐analysis of randomized clinical trials (RCTs) was performed to compare RALF and CLF.

Methods:  Medline, Embase, ISI Web of Knowledge CPCI‐S and The Cochrane Library were searched and the methodological quality of included trials was evaluated. Outcomes evaluated were intraoperative, dysphagia, flatulence, antisecretory medication, satisfaction with intervention, operation time, hospital stay and total cost. Results were pooled in meta‐analyses as risk ratios and weighted mean differences (WMD).

Results:  Of 221 patients in six RCTs, 111 were allocated to CLF and 110 to RALF. RALF prolonged total time necessary to carry out fundoplication (WMD 3.17 (95% confidence interval. 2.33–4.00) min; P < 0.00001, χ2P = 0.25, I2 = 24%). Operation complication, antisecretory medication, satisfaction with intervention, the time needed for hiatal dissection, the time from incision to completion of sutures, the total operation time and total cost were similar in both groups.

Conclusion:  Clinical outcomes from RALF were comparable to CLF approach, but RALF prolonged the operation time. Currently, CLF should be routinely used as costs are lower.
Impact of F18‐fluorodeoxyglycose positron emission tomography/computed tomography on the management of resectable pancreatic tumours
Authors: Yao Jinna , Gan Gary , Farlow David , Laurence Jerome M. , Hollands Michael , Richardson Arthur , Pleass Henry C. C. , Lam Vincent W. T.
Published: January 2012

Background:  Positron emission tomography/computed tomography (PET/CT) using F18‐fluorodeoxyglucose has been shown to be valuable in the management of malignant disease. The aim of this study is to investigate the impact of this technique on the management of patients with resectable pancreatic tumours.

Methods:  Thirty‐six patients with 37 potentially resectable pancreatic tumours on diagnostic CT imaging underwent PET/CT scans. Operative findings, histological reports and/or clinical follow‐up served as standard of reference. The impact of PET/CT on patient management was estimated by calculating the percentage of patients whose treatment plan was altered due to PET/CT.

Results:  Pancreatic adenocarcinoma was diagnosed in 30 patients, neuroendocrine tumours in 3, mass‐forming pancreatitis in 3 and serous cystadenoma in 1. The median standard uptake (max) value was 5.0 (range 2.2–12.0). Sensitivity and specificity of detecting extrapancreatic metastatic disease were 73% and 100%, respectively. Three occult liver metastases were detected at laparotomy following negative PET/CT. PET/CT findings influenced the management of 8 (22%) patients – 3 with liver metastases, 3 with bone metastases, 1 with lymph node metastases and 1 by identifying the benign appearance of the pancreatic tumour.

Conclusion:  PET/CT achieves a significant diagnostic impact in detecting extrapancreatic metastatic disease. F18‐fluorodeoxyglucose PET/CT appears to be useful in assessing suspicious pancreatic masses.
Laparoscopic radical prostatectomy: introduction of training during our first 50 cases
Authors: Louie‐Johnsun Mark , Ouyang Rupert , Indrajit Bala , Haque Mohammad
Published: January 2012

Background:  The study aims to assess the initial experience of laparoscopic radical prostatectomy (LRP) in a regional centre in Australia which includes Fellowship training during our first 50 cases.

Methods:  Data were collected prospectively from our first 50 consecutive patients who underwent LRP for localized prostate cancer between September 2009 and October 2010. All cases were performed or supervised by the primary surgeon. Patient details, operative details, complications, early oncological and functional outcomes were analysed.

Results:  The median age was 65 (45–76) years and median preoperative prostate‐specific antigen was 7.5 (2.5–23) ng/mL, with palpable disease present in 48%. Using D'Amico's risk stratification, 14%, 74% and 12% were in low, intermediate and high‐risk categories, respectively. Forty percent of cases were training cases with a median of 5 (2–8) of 10 operative steps performed by the Fellow. There was one open conversion and no rectal injuries. Mean operative time was 288 (175–440) min and with blood transfusion rate of 6%. Mean length of stay was 2.5 (1–6) days. Positive surgical margin rates for pT2 and pT3 disease were 14% and 52%, respectively, although for the last 25 cases they were 7% and 30%, respectively. Continence rate was 86% at 6 months, and 45% and 33% of preoperatively potent patients were potent after bilateral and unilateral nerve preservation at 6 months.

Conclusion:  LRP has been safely introduced in a regional centre with establishment of a Fellowship training programme, with early results comparable with other open, laparoscopic and robotic series.
Appropriate working hours for surgical training according to Australasian trainees
Authors: O'Grady Gregory , Harper Simon , Loveday Benjamin , Adams Brandon , Civil Ian D. , Peters Matthew
Published: January 2012

Background:  The demands of surgical training, learning and service delivery compete with the need to minimize fatigue and maintain an acceptable lifestyle. The optimal balance of working hours is uncertain. This study aimed to define the appropriate hours to meet these requirements according to trainees.

Methods:  All Australian and New Zealand surgical trainees were surveyed. Roster structures, weekly working hours and weekly ‘sleep loss hours’ (<8 per night) because of 24‐h calls were defined. These work practices were then correlated with sufficiency of training time, time for study, fatigue and its impacts, and work–life balance preferences. Multivariate and univariate analyses were performed.

Results:  The response rate was 55.3% with responders representative of the total trainee body. Trainees who worked median 60 h/week (interquartile range: 55–65) considered their work hours to be appropriate for ‘technical’ and ‘non‐technical’ training needs compared with 55 h/week (interquartile range: 50–60) regarded as appropriate for study/research needs. Working ≥65 h/week, or accruing ≥5.5 weekly ‘sleep loss hours’, was associated with increased fatigue, reduced ability to study, more frequent dozing while driving and impaired concentration at work. Trainees who considered they had an appropriate work–life balance worked median 55 h/week.

Conclusions:  Approximately, 60 h/week proved an appropriate balance of working hours for surgical training, although study and lifestyle demands are better met at around 55 h/week. Sleep loss is an important determinant of fatigue and its impacts, and work hours should not be considered in isolation.
Understanding and planning ecological restoration of plant–pollinator networks
Authors: Devoto Mariano , Bailey Sallie , Craze Paul , Memmott Jane
Published: January 2012

Ecology Letters (2012) 15: 319–328

Theory developed from studying changes in the structure and function of communities during natural or managed succession can guide the restoration of particular communities. We constructed 30 quantitative plant–flower visitor networks along a managed successional gradient to identify the main drivers of change in network structure. We then applied two alternative restoration strategies in silico (restoring for functional complementarity or redundancy) to data from our early successional plots to examine whether different strategies affected the restoration trajectories. Changes in network structure were explained by a combination of age, tree density and variation in tree diameter, even when variance explained by undergrowth structure was accounted for first. A combination of field data, a network approach and numerical simulations helped to identify which species should be given restoration priority in the context of different restoration targets. This combined approach provides a powerful tool for directing management decisions, particularly when management seeks to restore or conserve ecosystem function.