bluuebunny/crossref_metadata_2025 huggingface dataset:
The effects of an educational training workshop for community leaders on self‐efficacy of program planning skills and partnerships
Authors: Li I‐Chuan , Chen Yu‐Chi , Hsu Ling‐ling , Lin Chih‐hsuan , Chrisman Noel J
Published: August 2011

li i‐c., chen y‐c., hsu l‐l., lin c‐h. & chrisman n.j. (2012) The effects of an educational training workshop for community leaders on self‐efficacy of program planning skills and partnerships. Journal of Advanced Nursing68(3), 600–613.

Aim.  This aim of this study was to evaluate the effects of a 6‐month educational workshop for community leaders designed to improve their confidence in health promotion programmes and to develop partnerships among the participants.

Background.  It is important for public health nurses to work with community leaders to provide community‐orientated services. However, only a few existing studies have reported the content and effects of training programmes aimed at enhancing the capabilities of community leaders.

Methods.  A participatory action research design with pre‐ and post‐test methods was applied in this study. Fifteen community leaders completed a 6‐month educational workshop that was held in Tamsui, Taipei and Taiwan. It was designed to enable community leaders to improve their confidence in planning health programmes and developing group partnerships. Data were collected from April 2009 to October 2009, and descriptive statistics and Wilcoxon signed‐rank test analyses were carried out.

Results.  Participants demonstrated improvements in their self‐efficacies of planning health programmes by completing a structured questionnaire after attending a 6‐month educational workshop (Z = −2·90, P = 0·004). Their confidence in data collection, needs assessment and diagnosis, programme planning, and programme evaluation were significantly improved (Z = −3·1, P = 0·002; Z = −2·42, P = 0·016, Z = −2·84, P = 0·004, and Z = −2·68, P = 0·007, respectively).

Conclusions.  Providing training workshops for community leaders is a useful strategy for increasing their capabilities and confidence in planning health programmes. Nurses have a responsibility to advocate and provide training programmes for community leaders.
Women’s experiences of undergoing coronary artery bypass graft surgery
Authors: Banner Davina , Miers Margaret , Clarke Brenda , Albarran John
Published: August 2011

banner d., miers m., clarke b. & albarran j. (2011) Women’s experiences of undergoing coronary artery bypass graft surgery. Journal of Advanced Nursing 68(4), 919–930.

Aim.  This paper is a report of a study of women’s experiences of coronary artery bypass graft surgery.

Background.  Worldwide, coronary heart disease is the leading cause of morbidity and mortality. It has traditionally been viewed as primarily affecting men. However, a growing body of literature exploring gender differences in this area is challenging accepted beliefs, particularly in relation to outcomes. Despite this, awareness of how women interpret and respond to the experiences of cardiac surgery remains limited.

Methods.  At regional cardiothoracic centres in England and Wales, during 2003 to 2006, data were collected from 30 women preoperatively and at 6 weeks and 6 months postoperatively using semi‐structured interviews. A constructivist grounded theory approach was adopted and data were analysed using extensive coding and constant comparison techniques.

Results.  A substantive theory of the public–private dialogue of normality emerged demonstrating that participants faced lifestyle disruptions as they attempted to privately normalize and integrates limitations, while minimizing a public display of illness. During the preoperative period, participants experienced difficulties recognizing and acting on symptoms and endured physical and emotional distress while waiting for surgery. Following surgery, women experienced functional limitations which forced them to relinquish normal activities and roles. As recovery progressed, women came to accept their changed health status and renegotiated state of normality.

Conclusion.  The findings increase understanding about the adjustments which women undergoing cardiac surgery make as part of living with a long‐term condition and support the need to develop innovative gender‐sensitive health education and services.
How to make real, constructive, progress in medicine
Authors: Simon Jeremy R.
Published: August 2011

Rationale  One's understanding of medical progress – what it is, how it is pursued and how it is assessed – may be deeply dependent on one's understanding of the metaphysics of medicine, and of diseases in particular.

Aims and Objectives  In this paper I present a new account of the nature of diseases, neither realist nor constructivist, and describe what progress in medicine looks like if we understand diseases in this way.

Conclusions  This new account, Constructive Realism, may provide a better account of medicine than either realism or constructivism.
Statistics‐based research – a pig in a poke?
Authors: Penston James
Published: August 2011

Much of medical research involves large‐scale randomized controlled trials designed to detect small differences in outcome between the study groups. This approach is believed to produce reliable evidence on which the management of patients is based. But can we be sure that the demonstration of a small, albeit statistically significant, difference is sufficient to infer the presence of a causal relationship between the drug and the outcome?

A study is claimed to have internal validity when other explanations for the observed difference – namely, inequalities between the groups, bias in the assessment of the outcome and chance – have been excluded. Despite the various processes that are put into place – including, for example, randomization, allocation concealment, double‐blinding and intention‐to‐treat analysis – it remains doubtful whether the groups are equal in terms of all factors relevant to the outcome and whether bias has been excluded. As for the exclusion of chance, not only may inappropriate statistical tests be used, but also frequentist statistics has been subjected to serious criticisms in recent years that further bring internal validity into question.

But the problems do not end with the flaws in internal validity. The philosophical basis of large‐scale randomized controlled trials and epidemiological studies is unsound. When examined closely, many obstacles emerge that threaten the inference from a small, statistically significant difference to the presence of a causal relationship between the drug and the outcome.

Given the influence of statistics‐based research on the practice of medicine, it is of the utmost importance that the flaws in this methodology are brought to the fore.
The role of prudent love in the practice of clinical medicine
Authors: Marcum James A.
Published: August 2011

Rationale Virtues are an important component in the practice of clinical medicine. Prudence or wisdom and charity or love are often viewed as crucial for virtuous practice. Generally, the two virtues are discussed separately, with no connection between them; however, a synergy exists between the two virtues as a compound virtue of prudent love in which the properties of the compound virtue transcend those of the individual virtues.

Aims and objectives To examine the nature of prudent love and to discuss its role in the practice of clinical medicine.

Methods Philosophical and conceptual analyses.

Results Prudent love exhibits properties, which are the result of a synergistic interaction between the two individual virtues. Succinctly, prudent love synergism is an outcome of a particular structural relationship between the two virtues in which motivational love prompts the prudent clinician to acquire and utilize clinical competence, which then allows the loving clinician to take care of an individual patient's health care needs. In turn, the virtuous clinician's ability to meet those needs successfully feedbacks onto the motivation to satisfy them initially, thereby encouraging and enhancing the clinician to fulfil them even more prudently and lovingly, not only for the individual patient but also for other patients.

Conclusions The compound virtue of prudent love provides a comprehensive approach to practising medicine that meets not only the needs of patients but also fulfils the physician's sense as healer. Although challenges face teaching virtues in the medical curriculum, strategies are available for incorporating training in virtues into the curriculum.
Robot decisions: on the importance of virtuous judgment in clinical decision making
Authors: Gelhaus Petra
Published: August 2011

Rationale, aims and objectives The aim of this article is to argue for the necessity of emotional professional virtues in the understanding of good clinical practice. This understanding is required for a proper balance of capacities in medical education and further education of physicians. For this reason an ideal physician, incarnating the required virtues, skills and knowledge is compared with a non‐emotional robot that is bound to moral rules. This fictive confrontation is meant to clarify why certain demands on the personality of the physician are justified, in addition to a rule‐ and principle‐based moral orientation and biomedical knowledge and skills.

Methods Philosophical analysis of thought experiments inspired by science fiction literature by Isaac Asimov.

Results Althoughprima faciea rule‐oriented robot seems more reliable and trustworthy, the complexity of clinical judgment is not met by an encompassing and never contradictory set of rules from which one could logically derive decisions. There are different ways how the robot could still work, but at the cost of the predictability of its behaviour and its moral orientation. In comparison, a virtuous human doctor who is also bound to these rules, although less strictly, will more reliably keep at moral objectives, be understandable, be more flexible in case the rules come to their limits, and will be more predictable in these critical situations. Apart from these advantages of the virtuous human doctor referring to her own person, the most problematic deficit of the robot is its lacking deeper understanding of the inner mental events of patients which makes good contact, good communication and good influence impossible.

Conclusion Although an infallibly rule‐oriented robot seems more reliable at first view, in situations that require complex decisions like clinical practice the agency of a moral human person is more trustworthy. Furthermore, the understanding of the patient's emotions must remain insufficient for a non‐emotional, non‐human being. Because these are crucial preconditions for good clinical practice, enough attention should be given to develop these virtues and emotional skills, in addition to the usual attention on knowledge, technical skills and the obedience to moral rules and principles.
Dealing with systems and understanding contexts: what it might mean to be a ‘good health care practitioner’
Authors: Duncan Peter , Stephenson Anne
Published: August 2011

The increasing complexity of contemporary health care policy and practice leads us to ask questions about what might constitute ‘the good health care practitioner’. Yet, attempts through empirical work to address such questions are sparse. This paper reports on a small‐scale qualitative study, which sought to explore questions with a number of health care professionals and academics about the nature of ‘the good practitioner’. Four themes emerged from our exploration and analysis: the difficulty in trying to talk about ‘the good practitioner’, the importance of systems and contexts in understanding this area, the place of consultation and diagnosis in conceptions of ‘good practice’ and ‘the good practitioner’, and the dissembling of the elusive idea of the ‘practitioner who is good’ into a more realistic idea of constituent ‘good practices’. We draw conclusions from our work and suggest a way forward.
Functional anatomy of the Arabidopsis cytokinesis‐specific syntaxin KNOLLE
Authors: Touihri Sonja , Knöll Christian , Stierhof York‐Dieter , Müller Isabel , Mayer Ulrike , Jürgens Gerd
Published: August 2011

In plant cytokinesis, Golgi/trans‐Golgi network‐derived vesicles are targeted to the plane of cell division where they fuse with one another to form the partitioning membrane (cell plate). This membrane fusion requires a specialised syntaxin (Qa‐SNARE), named KNOLLE in Arabidopsis. KNOLLE is only made during the M‐phase of the cell cycle, targeted to the plane of cell division and degraded in the vacuole at the end of cytokinesis. To identify the parts of KNOLLE required for proper targeting and function in membrane fusion, we generated chimeric syntaxins comprising complementary fragments from KNOLLE and MVB‐localized PEP12 (SYP21). Surprisingly, targeting of the chimeric protein was not specified by the C‐terminal membrane anchor. Rather the N‐terminal region including helix Ha and the adjacent linker to helix Hb appeared to played a critical role. However, deletion of this N‐terminal fragment from KNOLLE (KNΔ1–82) had the same effect as its presence in the chimeric protein (KN1–82‐PEP1264–279), suggesting that targeting to the plane of cell division occurs by default, i.e. when no sorting signal would target the syntaxin to a specific endomembrane compartment. Once the full‐length syntaxin accumulated at the plane of division, phenotypic rescue of the knolle mutant only required the SNARE domain plus the adjacent linker connecting helix Hc to the SNARE domain from KNOLLE. Our results suggest that targeting of syntaxin to the plane of cell division occurs without active sorting, whereas syntaxin‐mediated membrane fusion requires sequence‐specific features.
System responses to long‐term drought and re‐watering of two contrasting alfalfa varieties
Authors: Kang Yun , Han Yuanhong , Torres‐Jerez Ivone , Wang Mingyi , Tang Yuhong , Monteros Maria , Udvardi Michael
Published: August 2011

Systems analysis of two alfalfa varieties, Wisfal (Medicago sativa ssp. falcata var. Wisfal) and Chilean (M. sativa ssp. sativa var. Chilean), with contrasting tolerance/sensitivity to drought revealed common and divergent responses to drought stress. At a qualitative level, molecular, biochemical, and physiological responses to drought stress were similar in the two varieties, indicating that they employ the same strategies to cope with drought. However, quantitative differences in responses at all levels were revealed that may contribute to greater drought tolerance in Wisfal. These included lower stomatal density and conductance in Wisfal; delayed leaf senescence compared with Chilean; greater root growth following a drought episode, and greater accumulation of osmolytes, including raffinose and galactinol, and flavonoid antioxidants in roots and/or shoots of Wisfal. Genes encoding transcription factors and other regulatory proteins, and genes involved in the biosynthesis of osmolytes and (iso)flavonoids were differentially regulated between the two varieties and represent potential targets for improving drought tolerance in alfalfa in the future.
Induction and detoxification of maize 1,4‐benzoxazin‐3‐ones by insect herbivores
Authors: Glauser Gaétan , Marti Guillaume , Villard Neil , Doyen Gwladys A. , Wolfender Jean‐Luc , Turlings Ted C.J. , Erb Matthias
Published: August 2011

In monocotyledonous plants, 1,4‐benzoxazin‐3‐ones, also referred to as benzoxazinoids or hydroxamic acids, are one of the most important chemical barriers against herbivores. However, knowledge about their behavior after attack, mode of action and potential detoxification by specialized insects remains limited. We chose an innovative analytical approach to understand the role of maize 1,4‐benzoxazin‐3‐ones in plant–insect interactions. By combining unbiased metabolomics screening and simultaneous measurements of living and digested plant tissue, we created a quantitative dynamic map of 1,4‐benzoxazin‐3‐ones at the plant–insect interface. Hypotheses derived from this map were tested by specifically developed in vitro assays using purified 1,4‐benzoxazin‐3‐ones and active extracts from mutant plants lacking 1,4‐benzoxazin‐3‐ones. Our data show that maize plants possess a two‐step defensive system that effectively fends off both the generalist Spodoptera littoralis and the specialist Spodoptera frugiperda. In the first step, upon insect attack, large quantities of 2‐β‐d‐glucopyranosyloxy‐4,7‐dimethoxy‐1,4‐benzoxazin‐3‐one (HDMBOA‐Glc) are formed. In the second step, after tissue disruption by the herbivores, highly unstable 2‐hydroxy‐4,7‐dimethoxy‐1,4‐benzoxazin‐3‐one (HDMBOA) is released by plant‐derived β‐glucosidases. HDMBOA acts as a strong deterrent to both S. littoralis and S. frugiperda. Although constitutively produced 1,4‐benzoxazin‐3‐ones such as 2,4‐dihydroxy‐7‐methoxy‐1,4‐benzoxazin‐3‐one (DIMBOA) are detoxified via glycosylation by the insects, no conjugation of HDMBOA in the insect gut was found, which may explain why even the specialist S. frugiperda has not evolved immunity against this plant defense. Taken together, our results show the benefit of using a plant–insect interface approach to elucidate plant defensive processes and unravel a potent resistance mechanism in maize.
Same description, different values. How service users and providers define patient and public involvement in health care
Authors: Rise Marit By , Solbjør Marit , Lara Mariela C. , Westerlund Heidi , Grimstad Hilde , Steinsbekk Aslak
Published: August 2011

Background  Patient and public involvement in health care is important, but the existing definitions of the concept do not integrate the stakeholders’ own perceptions.

Objective  To investigate and compare service users’ and service providers’ own definitions of patient and public involvement and their implications.

Design, setting and participants  Qualitative study with mainly individual in‐depth semi‐structured interviews conducted between June 2007 and June 2009. Data were analysed using a grounded theory approach.

Results  A total of 20 patients, 13 public representatives and 44 health service providers/managers in both somatic and mental health care were interviewed. A common definition of patient and public involvement emerged: It is founded on mutual respect, carried out through dialogue aiming at achieving shared decision making. Nevertheless, users and providers assigned different values to the core aspects: Respect was imperative for service users and implied for providers, dialogue was a way to gain respect for service users and to achieve good outcome for providers, and both worried that the other party wanted to make sole decisions.

Conclusions  Users and providers need to consider that although they have a common definition of involvement in health care, they assign different values to its aspects. Increasing and improving patient and public involvement therefore requires knowledge on and dialogue between the parties about these differences.
‘Seamless care? Just a list would have helped!’ Older people and their carer’s experiences of support with medication on discharge home from hospital
Authors: Knight Denise A , Thompson Diane , Mathie Elspeth , Dickinson Angela
Published: August 2011

Background  Many older people use one or more prescribed medicines on a daily basis. Effective medicines management at hospital discharge can support appropriate use of medicines following discharge and help avoid unnecessary hospital re‐admission. Many people, however, feel they receive insufficient information about medicines on discharge from hospital.

Objectives  To explore older people and their family carers’ experience of hospital discharge in relationship to the organization and management of medicines.

Design  Qualitative interviews with older people over 75 years old, taking four or more medicines, and their carers, following discharge from hospital in the United Kingdom (UK). Participants completed medication diaries prior to the interview.

Setting  Interviews took place in the participant’s home.

Results  Nineteen interviews were conducted involving 12 carers and seven older people. Participants were generally not satisfied with the discharge process, particularly concerning perceived delays in discharge. Inadequate explanations about medicines at discharge were commonly reported and led to omission of medicines, incorrect dosage, anxiety and confusion. Poor communication between the hospital and general practitioners or community pharmacists was also evident.

Conclusions  Despite significant policy recommendations and research in this area, many problems with the management of medicines during hospital discharge were shown, and a lack of partnership was evident between hospital staff and patients/family carers regarding the use of medicines post‐discharge. Improved medicines management during hospital discharge is required to ensure older people take their medications as prescribed and to protect them from the adverse effects of medicines not being taken correctly.
Prescription medicines: decision‐making preferences of patients who receive different levels of public subsidy
Authors: Robertson Jane , Doran Evan , Henry David A. , Salkeld Glenn
Published: August 2011

Objective  To compare the relative importance of medicine attributes and decision‐making preferences of patients with higher or lower levels of insurance coverage in a publicly funded health care system.

Design and setting  Cross‐sectional telephone survey of randomly selected regular medicine users aged ≥18 years in the Hunter Valley, NSW, Australia.

Main variables studied  Questions about 27 medicine attributes and active involvement in decisions to start a new medicine.

Results  After adjustment, there were few differences between the 408 concession card holders (high insurance) and 410 general beneficiaries (low insurance) in their assessment of the importance of medicine attributes. For both groups, the explanation of treatment options, establishing the need for the medicine, and medicine efficacy and safety were the most important considerations. Medicine costs, the treatment burden and medicine familiarity were less important; the views of family and friends ranked lowest. There was a statistically significantly greater influence of the regular doctor for the concession card holders than general beneficiaries (93.6 vs. 84%, adjusted OR 2.80, 95% CI 1.31, 5.99). Concession card holders were more likely to favour doctors having more say in the decision‐making process (crude OR 1.69, 95% CI 1.28, 2.24), and more likely to report the most recent treatment decision being made by the doctor alone, compared with general beneficiaries (61.2 vs. 40.3%).

Conclusion  Medicine need, efficacy and safety are viewed as paramount for most patients, irrespective of insurance status. While patients report the importance of participation in treatment decisions, delegation of decision making to the doctor was common in practice.
Physicians’ attitudes about communicating and managing scientific uncertainty differ by perceived ambiguity aversion of their patients
Authors: Portnoy David B. , Han Paul K. J. , Ferrer Rebecca A. , Klein William M. P. , Clauser Steven B.
Published: August 2011

Background  Medical interventions are often characterized by substantial scientific uncertainty regarding their benefits and harms. Physicians must communicate to their patients as part of the process of shared decision making, yet they may not always communicate scientific uncertainty for several reasons. One suggested by past research is individual differences in physicians’ tolerance of uncertainty. Relatedly, an unexplored explanation is physicians’ beliefs about their patients’ tolerance of uncertainty.

Design  To test this possibility, we surveyed a sample of primary care physicians (N = 1500) and examined the association between their attitudes about communicating and managing scientific uncertainty and their perceptions of negative reactions to uncertainty by their patients. Physician perceptions were measured by their propensity towards pessimistic appraisals of risk information and avoidance of decision making when risk information is ambiguous – of uncertain reliability, credibility or adequacy, known as ‘ambiguity aversion’.

Results  Confirming past studies, physician demographics (e.g. medical specialty) predicted attitudes toward communicating scientific uncertainty. Additionally, physicians’ beliefs about their patients’ ambiguity aversion significantly predicted these preferences. Physicians who thought that more of their patients would have negative reactions to ambiguous information were more likely to think that they should decide what is best for their patients (β = 0.065, P = 0.013), and to withhold an intervention that had uncertainty associated with it (β = 0.170, P < 0.001).

Discussion  When faced with the task of communicating scientific uncertainty about medical tests and treatments, physicians’ perce‐ptions of their patients’ ambiguity aversion may be related to their attitudes towards communicating uncertainty.
Juvenile polyposis and other intestinal polyposis syndromes with microdeletions of chromosome 10q22–23
Authors: Dahdaleh FS , Carr JC , Calva D , Howe JR
Published: August 2011

Dahdaleh FS, Carr JC, Calva D, Howe JR. Juvenile polyposis and other intestinal polyposis syndromes with microdeletions of chromosome 10q22–23.

Juvenile polyposis (JP) is an autosomal dominant hamartomatous polyposis syndrome that carries a significant risk for the development of colorectal cancer. Microdeletions of one of the two predisposing genes to JP, BMPR1A, have been associated with a severe form of JP called juvenile polyposis of infancy. Many of these deletions have also been found to contiguously include PTEN, which is the gene responsible for the development of Cowden syndrome. The advent of molecular techniques that localize genomic copy number variations and others that target specific genes such as multiplex‐ligation probe analysis has allowed researchers to explore this area further for deletions. Here, we review the literature for microdeletions described on chromosome 10q22–23 in patients with JP and other intestinal polyposis syndromes.
Functional genomics of a living fossil tree, Ginkgo, based on next‐generation sequencing technology
Authors: Lin Xiaohan , Zhang Jin , Li Ying , Luo Hongmei , Wu Qiong , Sun Chao , Song Jingyuan , Li Xiwen , Wei Jianhe , Lu Aiping , Qian Zhongzhi , Khan Ikhlas A. , Chen Shilin
Published: August 2011

Ginkgo biloba is monotypic species native to China and has old, dioecious, medicinally important characteristics. The functional genes related to these characteristics have not been effectively explored due to a limited number of expressed sequence tags (ESTs) from Ginkgo. To discover novel functional genes efficiently and to understand the development of a living fossil tree, Ginkgo, we used massive parallel pyrosequencing on the Roche 454 GS FLX Titanium platform to generate 64 057 ESTs. The ESTs combined with the 21 590 Ginkgo ESTs in genbank were assembled into 22 304 unique putative transcripts, in which 13 922 novel unique putative transcripts were identified by 454 sequencing. After being assigned to putative functions with Gene Ontology terms, a detailed view of the Ginkgo biological systems was displayed, including characterization of unique putative transcripts with homology to known key enzymes and transcription factors involved in ginkgolide/bilobalide and flavonoid biosynthetic pathways, as well as unique putative transcripts related to development, response to disease and defence. The fact that three full‐length Ginkgo genes encoding key enzymes were found and cloned, suggests that high‐throughput sequencing technology is superior to traditional gene‐by‐gene approach in discovery of genes. Additionally, a total of 204 simple sequence repeat motifs were detected. Our study not only lays the foundations for transcriptome‐led studies in biosynthetic mechanisms, but also contributes significantly to the understanding of functional genomics and development in non‐model plants.
Effects of Soil Salinity and Plant Density on Yield and Leaf Senescence of Field‐Grown Cotton
Authors: Zhang H. J. , Dong H. Z. , Li W. J. , Zhang D. M.
Published: August 2011

The response of cotton to constant salinity has been well documented under controlled conditions, but its response to changing salinity under field conditions is poorly understood. Using a split‐plot design, we conducted a 2‐year field experiment to determine the effects of soil salinity and plant density on plant biomass, boll load, harvest index and leaf senescence in relation to cotton yield in three fields with similar fertility but varying salinity. The main plots were assigned to weak (electrical conductivity of soil saturated paste extract, ECe = 5.5 dS m−1), moderate (ECe = 10.1 dS m−1) and strong (ECe = 15.0 dS m−1) soil salinity levels, while plant density (3.0, 4.5 and 7.5 plants m−2) was assigned to the subplots. Soil salinity had a negative effect on seedcotton yield, but the negative effect was compensated for by increased plant density under strong‐salinity conditions. Seedcotton yield under weak salinity changed little with varying plant density, but the medium plant density yielded better than the low or high plant density under moderate salinity. Plants accumulated 49 and 112 % more Na+ in leaves under moderate and strong salinity than under weak salinity. Strong salinity also led to higher boll load and early leaf senescence. Plant density had no effect on Na+ accumulation in leaves, but greatly reduced boll load and delayed leaf senescence. Plant biomass, maximum leaf area index and harvest index were greatly affected by salinity, plant density and their interaction. Accelerated leaf senescence under strong salinity was attributed to the high boll load and increased accumulation of toxic ions like Na+ in leaves, while delayed leaf senescence with increased plant density was attributed to the reduced boll load. Optimal yield can only be obtained with proper coordination of total biomass and harvest index by modification of plant density based on salinity levels.
Tripterygium wilfordii bioactive compounds as anticancer and anti‐inflammatory agents
Authors: Wong Kwong‐Fai , Yuan Yi , Luk John M
Published: August 2011

1. Bioactive compounds from medicinal plants with anticancer and anti‐inflammatory effects have become key resources in drug discovery fields for the treatment of various malignancies and immunological disorders.

2. Tripterygium wilfordii (TW) is a medicinal plant that exhibits profound immunosuppressive effects and has been used in herbal regimens for the treatment of immunological diseases for thousand years in China.

3. Procedures for the isolation and characterization of TW bioactive compounds have been well established. Over the past three decades, more than 46 diterpenoids, 20 new triterpenoids, 26 alkaloids and other small molecules have been identified from TW.

4. Triptolide, celastrol and tripchlorolide are among the bioactive compounds conferring the immunosuppressive and anticancer activities of TW. Accumulated evidence suggests that the TW bioactive compounds exert their pharmacological actions by modulating the transcriptional activity of nuclear factor‐κB signalling molecule.

5. Triptolide derivatives with improved water solubility have emerged as promising drug candidates. Clinical trials are being conducted on the derivatives to provide encyclopaedic knowledge on triptolide pharmacokinetics in patients.
Factors predicting continence recovery 1 month after radical prostatectomy: Results of a multicenter survey
Authors: Gacci Mauro , Carini Marco , Simonato Alchiede , Imbimbo Ciro , Gontero Paolo , Briganti Alberto , De Cobelli Ottavio , Fulcoli Vittorio , Martorana Giuseppe , Nicita Giulio , Mirone Vincenzo , Carmignani Giorgio
Published: August 2011

Objectives:  To assess the factors associated with continence recovery 1 month after radical prostatectomy (RP) and to identify the correlation between these factors.

Methods:  In total, 2408 men treated with RP for prostate cancer (PCa) were enrolled in the present multicenter prospective study. Clinical (age, body mass index) and urological (catheterization or transurethral resection of the prostate) records, quality of life (QOL) scores determined using various instruments (including the International Index of Erectile Function [IIEF] and University of California Los Angeles, Prostate Cancer Index [UCLA‐PCI]), PCa characteristics (clinical stage [cT], prostate‐specific antigen, biopsy Gleason score), surgical features (surgical approach, nerve and bladder neck sparing, catheterization), and pathologic outcomes (pT, pN+, Gleason score, positive surgical margins) were recorded. Continence status prior to surgery and at 1 month after RP was assessed and classified as followed: (i) full continence; (ii) 0–1 pads/day; or (iii) >1 pad/day. Only patients determined to have full continence prior to surgery were included in the analysis. Data were evaluated using Spearman's correlation analysis and multivariate logistic regression.

Results:  Data from 1972 patients with full continence preoperatively and complete postoperative data were analyzed. At 1 month after RP, 644 patients (32.7%) were fully continent, 810 (41.1%) were using 0–1 pads/day, and 518 (26.3%) were using >1 pad/day. Univariate analysis indicated that clinical and urological data, QOL, PCa characteristics, surgical features, and pathologic outcomes were determinants for continence recovery. Multivariate analysis indicated that preoperative sexual activity (UCLA‐PCI Sexual Function P = 0.005; IIEF P = 0.040), bladder neck sparing (P = 0.003), catheterization time (P = 0.007), and catheter diameter (P = 0.046) were associated with 1 month continence recovery.

Conclusions:  Age and nerve sparing are not significant predictors of continence recovery 1 month after RP. Preoperative erectile function can predict post‐prostatectomy incontinence. Bladder neck preservation has a significant effect on early continence recovery after RP.
Insertion of laryngeal mask airway does not increase the intraocular pressure in children with glaucoma
Authors: Bhardwaj Neerja , Yaddanapudi Sandhya , Singh Swati , Pandav Surinder S.
Published: August 2011

Objectives:  It is hypothesized that in children with glaucoma, the insertion of laryngeal mask airway (LMA) will cause lesser rise in intraocular pressure (IOP) than tracheal tube (TT).

Aim:  To compare the IOP response to LMA and TT insertion in children with glaucoma.

Methods/Materials:  A prospective, randomized, single‐blind study was conducted in 30 glaucomatous ASA‐1 children, aged 1–10 years scheduled to undergo trabeculectomy. Anesthesia was induced with halothane and maintained for 5 min with 1 MAC of halothane after administering atracurium 0.5 mg·kg−1 following which LMA or TT was introduced. IOP was measured in both the eyes before and after insertion of airway device for 5 min.

Results:  The IOP increased significantly from 27.3 ± 5.2 to 31.2 ± 5.4 mmHg (P < 0.001) after tracheal intubation but returned to baseline within 5 min. The IOP did not change from the baseline after insertion of LMA. The IOP was significantly higher in group TT compared to group LMA at 2 min (P = 0.004) and 5 min (P = 0.01) after the device insertion. The heart rate (HR) increased significantly after tracheal intubation and returned to baseline 4 min after intubation. The HR increase was significantly more in TT group compared to LMA group at all times of observation. Both systolic blood pressure (SBP; P = 0.01) and diastolic blood pressure (DBP; P = 0.02) showed an increase at 1 min in children in group TT.

Conclusion:  Insertion of LMA in glaucomatous children is not associated with an increased IOP response or cardiovascular changes.
Role of biopsies in patients with residual rectal cancer following neoadjuvant chemoradiation after downsizing: can they rule out persisting cancer?
Authors: Perez R. O. , Habr‐Gama A. , Pereira G. V. , Lynn P. B. , Alves P. A. , Proscurshim I. , Rawet V. , Gama‐Rodrigues J.
Published: August 2011

Aim  The study aimed to determine the value of postchemoradiation biopsies, performed after significant tumour downsizing following neoadjuvant therapy, in predicting complete tumour regression in patients with distal rectal cancer.

Method  A retrospective comparative study was performed in patients with rectal cancer who achieved an incomplete clinical response after neoadjuvant chemoradiotherapy. Patients with significant tumour downsizing (> 30% of the initial tumour size) were compared with controls (< 30% reduction of the initial tumour size). During flexible proctoscopy carried out postchemoradiation, biopsies were performed using 3‐mm biopsy forceps. The biopsy results were compared with the histopathological findings of the resected specimen. UICC (Union for International Cancer Control) ypTNM classification, tumour differentiation and regression grade were evaluated. The main outcome measures were sensitivity and specificity, negative and positive predictive values, and accuracy of a simple forceps biopsy for predicting pathological response after neoadjuvant chemoradiotherapy.

Results  Of the 172 patients, 112 were considered to have had an incomplete clinical response and were included in the study. Thirty‐nine patients achieved significant tumour downsizing and underwent postchemoradiation biopsies. Overall, 53 biopsies were carried out. Of the 39 patients who achieved significant tumour downsizing, the biopsy result was positive in 25 and negative in 14. Only three of the patients with a negative biopsy result were found to have had a complete pathological response (giving a negative predictive value of 21%). Considering all biopsies performed, only three of 28 negative biopsies were true negatives, giving a negative predictive value of 11%.

Conclusion  In patients with distal rectal cancer undergoing neoadjuvant chemoradiation, post‐treatment biopsies are of limited clinical value in ruling out persisting cancer. A negative biopsy result after a near‐complete clinical response should not be considered sufficient for avoiding a radical resection.
The incidence and outcome of brain metastases after liver resection for colorectal cancer metastases
Authors: Byrne B. E. , Geddes T. , Welsh F. K. S. , John T. G. , Chandrakumaran K. , Rees M.
Published: August 2011

Aim  Brain metastases from colorectal cancer are rare, with an incidence of 0.6–4%. The risk and outcome of brain metastases after hepatic and pulmonary metastasectomy have not been previously described. This study aimed to determine the incidence, predictive factors, treatment and survival of patients developing colorectal brain metastases, who had previously undergone resection of hepatic metastases.

Method  A retrospective review was carried out of a prospectively maintained database of patients undergoing liver resection for colorectal metastases.

Results  Fifty‐two (4.0%) of 1304 patients were diagnosed with brain metastases. The annual incidence rate was 1.03% per person‐year. In the majority of cases brain metastases were found as part of multifocal disease. Median survival was 3.2 months (95% CI: 2.3–4.1), but was best for six patients treated with potentially curative resection [median survival = 13.2 (range, 4.9–32.1) months]. Multivariate analysis showed that a lymph node‐positive primary tumour [hazard ratio (HR) = 2.7, 95% CI: 1.8–6.19; P = 0.019], large liver metastases (> 6 cm) [HR = 2.23, 95% CI: 1.19–2.33; P = 0.012] and recurrent intrahepatic and extrahepatic disease [HR = 2.11, 95% CI: 1.2–4.62; P = 0.013] were independent predictors for the development of brain metastases.

Conclusion  The annual risk of developing brain metastases following liver resection for colorectal metastases is low, but highest for patients presenting with a Dukes’ C primary tumour, large liver metastases or who subsequently develop disseminated disease. The overall survival from colorectal brain metastases is poor, but resection with curative intent offers patients their best chance of medium‐term survival.
Measurement of insulin action: a tribute to Sir Harold Himsworth
Authors: Kim S. H.
Published: August 2011

Diabet. Med. 28, 1487–1493 (2011)

Sir Harold Himsworth was a renowned clinician and researcher. Among his myriad of accomplishments, he was the first to differentiate diabetes mellitus into ‘insulin‐sensitive’ and ‘insulin‐insensitive’ forms. To help distinguish these two types, he developed the first test to measure insulin sensitivity, the insulin–glucose test. This article reviews Himsworth’s pioneer methods and subsequent advances in the measurement of insulin action. The advantages and limitations of commonly used methods to assess insulin sensitivity are also examined.
The current status of diabetes professional educational standards and competencies in the UK—a Position Statement from the Diabetes UK Healthcare Professional Education Competency Framework Task and Finish Group
Authors: Walsh N. , George S. , Priest L. , Deakin T. , Vanterpool G. , Karet B. , Simmons D.
Published: August 2011

Diabet. Med. 28, 1501–1507 (2011)

Diabetes is a significant health concern, both in the UK and globally. Management can be complex, often requiring high levels of knowledge and skills in order to provide high‐quality and safe care. The provision of good, safe, quality care lies within the foundations of healthcare education, continuing professional development and evidence‐based practice, which are inseparable and part of a continuum during the career of any health professional. Sound education provides the launch pad for effective clinical management and positive patient experiences.

This position paper reviews and discusses work undertaken by a Working Group under the auspices of Diabetes UK with the remit of considering all health professional educational issues for people delivering care to people with diabetes. This work has scoped the availability of education for those within the healthcare system who may directly or indirectly encounter people with diabetes and reviews alignment to existing competency frameworks within the UK’s National Health Service.
Outcome of patients with diabetes with negative percutaneous bone biopsy performed for suspicion of osteomyelitis of the foot
Authors: Senneville E. , Gaworowska D. , Topolinski H. , Devemy F. , Nguyen S. , Singer B. , Beltrand E. , Legout L. , Caillaux M. , Descamps D. , Canonne J. P. , Yazdanpanah Y.
Published: August 2011

Diabet. Med. 29, 56–61 (2012)

Aims  To assess the outcome of patients with diabetes with suspicion of osteomyelitis of the foot who had undergone a percutaneous bone biopsy that yielded negative microbiological results, with focus on the occurrence of osteomyelitis at the biopsied site.

Methods  Medical charts of adult patients with diabetes with a negative percutaneous bone biopsy were reviewed. Patients’ outcome was evaluated at least 2 years after the initial bone biopsy according to wound healing, the results of a new bone biopsy and bone imaging evaluation when applicable.

Results  From January 2001 to January 2008, 41 patients with diabetes (30 men/11 women; mean age 58.1 ± 9.6 years; mean diabetes duration 15.8 ± 6.7 years) met study criteria. Osteomyelitis was suspected based on combined clinical and imaging diagnostic criteria. On follow‐up at a mean duration of 41.2 ± 22.5 months post‐bone biopsy, 16 patients had complete wound healing (39.0%). Of the 25 other patients, 15 had a new bone biopsy performed, six of which yielded positive microbiological results, and among the 10 patients who neither healed nor underwent bone biopsy, comparative radiography of the foot showed a stable aspect of the biopsied site in six of them, for whom the data were available. Finally, osteomyelitis of the foot at the site where the initial bone biopsy had been performed was confirmed during follow‐up in six patients (14.6%) and was suspected in four additional patients (9.7%).

Conclusions  The results of the present study suggest that, of patients with diabetes with the suspicion of osteomylelitis and a negative percutaneous bone biopsy, only one out of four will develop osteomyelitis within 2 years of the biopsy.
The impact of hypoglycaemia on quality of life and related patient‐reported outcomes in Type 2 diabetes: a narrative review
Authors: Barendse S. , Singh H. , Frier B. M. , Speight J.
Published: August 2011

Diabet. Med. 29, 293–302 (2012)

As a common side effect of insulin treatment for diabetes, hypoglycaemia is a constant threat and can have far‐reaching and potentially devastating consequences, including immediate physical injury as well as more pervasive cognitive, behavioural and emotional effects. Moreover, as a significant limiting factor in achieving optimal glycaemic control, exposure to hypoglycaemia can influence diabetes self‐management.

Although hypoglycaemia is known to occur in Type 2 diabetes, its morbidity and impact on the individual are not well recognized. The aim of the current review is to examine published evidence to achieve a synthesis of the scope and significance of the potential detriment caused by hypoglycaemia to individuals with Type 2 diabetes. The implications of these observations for treatment and research have also been considered.

A narrative review was performed of empirical papers published in English since 1966, reporting the effect of hypoglycaemia on quality of life and related outcomes (including generic and diabetes‐specific quality of life, emotional well‐being and health utilities) in Type 2 diabetes.

Research demonstrates the potential impact of hypoglycaemia on the lives of people with Type 2 diabetes, from an association with depressive symptoms and heightened anxiety, to impairment of the ability to drive, work and function in ways that are important for quality of life. Few studies consider hypoglycaemia as an explanatory variable in combination with quality of life or related primary endpoints. As a consequence, there is a pressing need for high‐quality research into the overall impact of hypoglycaemia on the lives of people with Type 2 diabetes.
Implementing Key Competences in Basic Education: reflections on curriculum design and development in Spain
Authors: Tiana Alejandro , Moya José , Luengo Florencio
Published: August 2011

The concept of competence is a recent introduction into the curricula of the Spanish education system, and applies to vocational training and university, but also to basic education. In both cases, the meaning and use of the term have differed, sometimes giving rise to confusion. There can be no doubt, however, that this incorporation has been of significant impact. On the one hand, it has generated considerable debate between those who consider the concept to respond to economistic arguments, removed from educational realities, and those who believe it to have a transformation potential that cannot be ignored. On the other, incorporation of the concept is leading to a series of modifications in school practices and in teaching and learning with whose consequences we are not yet acquainted. This article analyses the situation created by the introduction of key competences in Spanish compulsory education and seeks to gauge the potential this offers for improving opportunities for success at school. The authors believe that key competences are a reformulation of educational intentions, whose consequences for schools and teaching practices largely depend on the new interpretation of learning in the light of different approaches and research traditions.