bluuebunny/crossref_metadata_2025 huggingface dataset:
Species differences in the effect of pregnancy on lymphocyte cytokine production between human and rat
Authors: Faas Marijke M , Bouman Annechien , Veenstra van Nieuwenhoven Angelique L , van der Schaaf Gerda , Moes Henk , Heineman Maas Jan , de Vos Paul
Published: July 2005

In the present study, we evaluated whether lymphocyte cytokine production during human and rat pregnancy shifts toward T helper cell type 2 (Th2) cytokine production. Therefore, blood samples were taken during the follicular and luteal phase and during pregnancy in rats and humans. Whole blood was ex vivo-stimulated with phorbol 12-myristate 13-acetate and calcium ionophore and intracellular interferon-γ (IFN-γ) and interleukin (IL)-4 production, and the percentage of cells in the various lymphocyte populations was measured using flow cytometry. Rats and humans adapted their immune responses to pregnancy but have different strategies: During human pregnancy, the percentage of lymphocytes producing IFN-γ was decreased, and the percentage IL-4-producing lymphocytes was not affected. The rat adapts its immune response to pregnancy by decreasing the total number of the various lymphocyte populations, and the percentage of IFN-γ- or IL-4-producing lymphocytes was not affected or increased (% IFN-γ-producing cytotoxic lymphocytes). It is speculated that during rat pregnancy, there is no need to decrease the number of IFN-γ-producing lymphocytes, as in nonpregnant rats, the total number of IFN-γ-producing lymphocytes after stimulation is relatively low, and there is no necessity for a further decrease. In nonpregnant humans, the percentage IFN-γ-producing lymphocytes is much higher and probably dangerous for pregnancy, and therefore, this percentage needs to decrease during pregnancy. In conclusion, although the data from humans concur with the Th1/Th2 paradigm, the data from rats do not concur with this paradigm. The present studies therefore challenge the classical Th1/Th2 paradigm during pregnancy.
Perfusion safety: defining the problem
Authors: Palanzo David A
Published: July 2005

Perfusion safety is not an isolated component of cardiac surgery, but encompasses many facets, including equipment, safety devices, conduct of perfusion, surgical technique, vigilance, and communication within the operating room. Over the last 25 years, several surveys have provided an estimation of the occurrence of perfusion-related incidents and documented the frequency with which they affected patient morbidity and mortality. As the focus of attention turned to correcting these problem areas, each subsequent survey demonstrated changes, but also pointed out new areas needing improvement. As technology and education improved, so did results. With refinements in perfusion equipment and techniques, and increasing use of computer assistance and automation, cardiopulmonary bypass should become even safer. The key ingredient, though, will remain the knowledge and expertise of the perfusionist.
The Great Britain and Ireland perspective: current perfusion safety issues, preparing for the future
Authors: Mulholland J W
Published: July 2005

The Great Britain and Ireland (GBI) recommendations for standards of monitoring and alarms during cardio-pulmonary bypass (CPB) came into force in January 2004. While perfusion departments in Great Britain and Ireland should now have a good baseline level of safety, it is important that department-specific safety is also considered. Patient safety is paramount, but safety within our speciality must also take into account the protection of the perfusionists’ health and the protection of their careers. These different aspects of safety are fundamentally interrelated.

This paper focuses on the importance of careful assessment, implementation and documentation when a new component or technique is being introduced to the CPB circuit, even when the aim is to increase safety.

Knowledge of the civil justice system and the trends in medical negligence claims are an integral part of perfusionist safety. Perfusion in Great Britain and Ireland is rightly striving for professional recognition from the Health Professions Council (HPC). As we raise the profile of perfusion, we educate more people about the importance of our role and level of responsibility within the cardiac operating team. This will increase the potential for medical negligence claims to be directed specifically at our speciality. All these issues are discussed in detail.
Assessment of ovarian failure and osteoporosis in premenopausal breast cancer survivors
Authors: McCune Jeannine S , Games Dona M , Espirito Janet L
Published: July 2005

Premenopausal women who develop ovarian failure after receiving chemotherapy are at a higher risk of rapid bone loss. Pharmacists have successfully implemented osteoporosis screening programmes in the general population and thus, assessment of breast cancer survivors for ovarian failure and osteopenia could represent a novel focus for oncology pharmacists. Therefore, we conducted a retrospective chart review to determine the adequacy of ovarian failure and osteoporosis assessment and management in premenopausal breast cancer survivors.

Methods and results. The charts of 20 women diagnosed with early stage breast cancer treated with cyclophosphamide over a 4.5-year timespan were included. Their median age was 36.7 years (range 29.8-41). The median cyclophosphamide cumulative dose was 9 g/m2 (range 2.4-14.45), with a median duration of follow-up being 4.62 years. The assessment of ovarian failure mainly occurred by documenting menstrual periods, which has been questioned as a reliable method for assessing ovarian failure. Menses stopped while or shortly after receiving chemotherapy in 11 women. Prior to and during cyclophosphamide administration, osteoporosis screening or counselling was not documented for any patient. After completion of chemotherapy administration, eight patients were counselled regarding osteoporosis and seven women were screened for osteoporosis with a dual X-ray absorptimetry (DXA) scan. Five women had DXA scans indicative of osteopenia according to World Health Organization guidelines.

Conclusions. Improvements are needed in the documentation and potentially also the management of ovarian failure and osteoporosis in premenopausal breast cancer survivors receiving cyclophosphamide-based regimens. This represents a potential opportunity for pharmacists to manage long-term chemotherapy toxicity.
Alendronate for steroid-induced osteopenia in children with acute lymphoblastic leukaemia or non-Hodgkin’s lymphoma: results of a pilot study
Authors: Wiernikowski JT , Barr RD , Webber C , Guo CY , Wright M , Atkinson SA
Published: July 2005

Background/objectives. Osteopenia is a significant morbidity in children undergoing therapy for acute lymphoblastic leukaemia (ALL) or non-Hodgkin’s lymphoma (NHL). We conducted a pilot study to assess the impact of alendronate on whole body bone mineral content (WB-BMC), lumbar spine bone mineral density (LS-BMD), biochemical measures of bone mineral metabolism, as well as gross motor function and health-related quality of life (HRQL) in children undergoing therapy for ALL or NHL.

Methods. Ten children (nine boys) between the ages of 3.6 and 14.6 years, on identical maintenance chemotherapy for ALL or NHL were treated with oral alendronate once weekly, and daily calcium supplementation, for a period of six months. Outcome measures were WB-BMC and LSBMD; biochemical measures of bone mineral metabolism including plasma osteocalcin, C-terminal telopeptide of type I collagen (CTx), serum calcium, 25-hydroxy-vitamin D (25-OHD), and parathyroid hormone (PTH); as well as assessments of motor function and HRQL.

Results. A gain in Z score was observed in 7/9 evaluable patients for WB-BMC (mean increase of 0.49) and LS-BMD (0.51). Plasma osteocalcin and CTx showed a change in bone turnover favouring formation over resorption. Serum calcium and 25- OHD remained normal throughout treatment. After an initial spike, serum PTH returned to baseline values at week 4. Measures of motor function showed some improvement and there were modest gains in HRQL.

Conclusions. Alendronate therapy was tolerated well. Further study in a larger sample of children with ALL or NHL is warranted, in the context of a randomized clinical trial.
Vinorelbine and venous irritation: optimal parenteral administration
Authors: de Lemos Mário L
Published: July 2005

Vinorelbine is a vesicant associated with extra-vasation hazards and injection site reactions, which can be alleviated by shortening of infusion time and flushing of intravenous fluid. A critical review of the current evidence showed that the optimal administration is to flush ≥75-124 mL of intravenous fluid after vinorelbine infusion. In travenous push administration over 1-2 min does not seem to offer significant improvement over rapid intravenous infusion over 6-10 min.
Are health care providers who work with cancer drugs at an increased risk for toxic events? A systematic review and meta-analysis of the literature
Authors: Dranitsaris George , Johnston Mary , Poirier Susan , Schueller Trudi , Milliken Debbie , Green Esther , Zanke Brent
Published: July 2005

Objective. A systematic review and meta-analysis was conducted to test the hypothesis that oncology health care workers are at an increased risk of cancer, reproductive complications and acute toxic events.

Design. A structured literature search of Index Medicus/MEDLINE, CINAHL, EMBASE, the Cochrane Database of Systematic Reviews and Healthstar was performed from 1966 to December 2004 for human epidemiological studies evaluating the risk of toxic events in health care workers exposed to cytotoxic drugs. Raw data and adjusted odds ratios (OR) reported in eligible studies were combined using a random effects model to calculate point estimates and 95% confidence intervals (CI) for each potential risk outcome.

Main outcome measures. Adjusted OR for congenital malformations, stillbirths and spontaneous abortions among health care workers exposure to cytotoxic agents compared to a non-exposed control group.

Results. The systematic review identified 14 studies evaluating the outcomes of interest, seven of which were suitable for statistical pooling. Due to lack of evidence, we were unable to estimate a pooled OR for the risk of cancer and acute toxic events. However, no significant association was detected between exposure to cytotoxic drugs and; congenital malformations (OR=1.64; 95% CI: 0.91-2.94) and stillbirths (OR=1.16; 95% CI: 0.73-1.82). In contrast, an association was identified between exposure to chemotherapy and spontaneous abortions (OR=1.46; 95% CI: 1.11-1.92).

Conclusions. The results of this systematic review identified a small incremental risk for spontaneous abortions in female staff working with cytotoxic agents. Health policy decision makers should effectively communicate the magnitude of this risk to their staff and implement cost effective interventions for its reduction or elimination.
Pharmaceutical validation as a process of improving the quality of antineoplastic treatment
Authors: Fabiá Amparo Serrano , Rodrigo Elisa Cavero , Marí Asunción Albert , Cubells Daniel Almenar , Jiménez Torres N Victor
Published: July 2005

Objective. To quantify the improvement added by standardization of pharmaceutical validation (PV) of antineoplastic treatment to the processes of prescription and preparation of the pharmacotherapeutic sequence, in terms of prevention and reduction of medication errors (ME).

Design. Prospective cohort study during two years (from 2001-2002) for oncohaematologic patients (inpatients and outpatients) that compared the percentage of medication errors detected and resolved and the number of medication errors with potential clinical significance (severity value ≥4) intercepted during PV in both years. Results. During the PV processes, 202 ME were identified and resolved, which is the equivalent of 16.88 ME/1000 patient-days. In 2001 14.08 ME/1000 patient-days were detected and 19.83 ME/1000 patient-days in 2002. This means that the effectiveness of the identification method increased by 41%. The number of ME intercepted with clinical significance (severity value ≥4) increased in a statistically significant manner by 2.18 times in 2002.

Conclusion. This study shows that the standardization of PV is an effective method of improving the quality of antineoplastic treatment use, by increasing the ability to intercept ME.
Surgical Menopause, Estrogen, and Cognitive Function in Women: What Do the Findings Tell Us?
Authors: SHERWIN BARBARA B.
Published: July 2005

Abstract: Randomized, controlled trials of estrogen treatment found protective effects of estrogen therapy (ET) on verbal memory in healthy, 45‐year‐old surgically menopausal women given 17‐β estradiol immediately after surgery. However, no effect was found when conjugated equine estrogens were given to older women years after their surgical menopause. These findings suggest that there is a critical time for the initiation of estrogen following the menopause with regard to its protective effect on memory as well as a specificity of the effect on verbal memory. These factors may explain why no protective effect of ET on cognitive aging was found in the Women's Health Initiative Memory Study.
Estrogen and the Brain: Beyond ER‐α, ER‐β, and 17β‐Estradiol
Authors: TORAN‐ALLERAND C.DOMINIQUE
Published: July 2005

Abstract: The brain of both sexes is a major target of estradiol and a site of estrogen synthesis during development and in the adult. In addition to the classical intranuclear estrogen receptors (ERs) ER‐α and ER‐β, we have recently identified a novel, plasma membrane‐associated ER that is neither ER‐α nor ER‐β in the brain and uterus, which we have designated “ER‐X”. ER‐X is a developmentally regulated estrogen‐binding protein that is present in wild‐type, ER‐α gene‐disrupted (αERKO) and ER‐α‐null mice. ER‐X is re‐expressed after ischemic brain injury and in adult transgenic mice with Alzheimer's disease. Although ER‐X shares some homology with the C‐terminal region of ER‐α, it is not an alternative splicing variant of ER‐α and may be a new gene. ER‐X mediates 17α‐estradiol and 17β‐estradiol activation of MAPK/ERK. In contrast, ER‐αdoes not elicit ERK activation but, surprisingly, is inhibitory. The potential importance of 17α‐estradiol, the preferred ligand of ER‐X, for the brain is underscored by our findings by liquid chromatography/tandem mass spectrometry that the endogenous levels of 17α‐estradiol are significantly elevated in the postnatal day‐7 and adult mouse neocortex and hippocampus, as compared with 17β‐estradiol. That there is so much more 17α‐estradiol than 17β‐estradiol in the brain suggests that this enantiomer would be readily available to the brain. In considering estrogens for postmenopausal treatment, one should consider all the ERs present in the brain, not just ER‐α and ER‐β, but ER‐X as well, and focus on ligands such as 17α‐estradiol that may be more selective for this ER.
The Case for Progesterone
Authors: STEIN DONALD G.
Published: July 2005

Abstract: Recent clinical trials in hormone therapy (HT) for women approaching or past menopause have been disappointing. Most women who have been taking conjugated equine estrogens combined with synthetic progestins have been encouraged to stop these supplements because of increased health risks. The results of the clinical trials may be accurate about the risks associated with the synthetic compounds and combinations, but the data do not reflect what might have been the case if 17β‐estradiol had been tested with natural progesterone instead of synthetic medroxyprogesterone acetate. For the most part, in almost all work on HT, estrogens have been given the primary focus despite the fact that progesterone has important properties that can enhance the repair of neurodegenerative and traumatic injuries to the central nervous system. This article reviews some of those properties and discusses the evidence suggesting that, if HT is to be reconsidered, progesterone should be given more attention as a potent neurotrophic agent that may play an important role in reducing or preventing motor, cognitive, and sensory impairments that can accompany senescence in both males and females.
Role of Nonfeminizing Estrogens in Brain Protection from Cerebral Ischemia: An Animal Model of Alzheimer's Disease Neuropathology
Authors: SIMPKINS JAMES W. , WEN YI , PEREZ EVELYN , YANG SHAOHUA , WANG XIAOFEI
Published: July 2005

Abstract: Estrogens are potent and efficacious neuroprotectants both in vitro and in vivo in a variety of models of neurotoxicity. We determined the structural requirements for neuroprotection in in vitro assays using a library of more than 70 novel estratrienes, synthesized to reduce or eliminate estrogen receptor (ER) binding. We observed that neuroprotection could be enhanced by as much as 200‐fold through modifications that positioned a large, bulky group at the C2 and/or C4 position of the phenolic A ring of the estratriene. Further, substitutions on the B, C, or D rings either reduced or did not markedly change neuroprotection. For this library of compounds, there was a negative correlation between ER binding and neuroprotection, as the more potent compounds showed weaker or no ER binding. In an in vivo model for neuroprotection, transient cerebral ischemia, efficacious compounds were active in protection of brain tissue from this pro‐oxidant insult. Finally, estradiol protected brains from insult‐induced Alzheimer's disease (AD) neuropathology, including activation of apoptosis, stimulation of Aβ production, hyperphosphorylation of tau, activation of cyclin‐dependent kinases, and activation of catastrophic attempts at neuronal mitosis. Collectively, these results demonstrate that nonfeminizing estrogens are neuroprotective and protect the brain from the induction of AD‐like neuropathology in an animal model. These features of nonfeminizing estrogens make them attractive compounds for assessment of efficacy in AD and stroke, because they are not expected to show the side effects of chronic estrogen therapy that are ER mediated in the liver, uterus, and breast.
Pediatric Melanoma: Risk Factor and Survival Analysis of the Surveillance, Epidemiology and End Results Database
Authors: Strouse John J. , Fears Thomas R. , Tucker Margaret A. , Wayne Alan S.
Published: July 2005

Purpose

To evaluate risk factors for the development of and factors influencing survival in pediatric melanoma.

Patients and Methods

We evaluated 1,255 children (age < 20 years) and 2,673 young adults (age 20 to 24 years) with melanoma in the 2001 National Cancer Institute (NCI) Surveillance, Epidemiology and End Results (SEER) database. We estimated exposure to UV radiation based on Environmental Protection Agency (EPA) measurements.

Results

The incidence of pediatric melanoma increased 46% (95% CI, 40 to 52) per year of age and 2.9% (95% CI, 2.1 to 3.6) per year from 1973 to 2001. Incidence rates were lower in black patients (−95%; 95% CI, −98 to −90) compared with white patients and in male patients (−39%; 95% CI −46 to −31) compared with females. Increased ambient UV radiation was associated with elevated risk (19% per kJ; 95% CI, 9 to 30). Children with melanoma had a 5-year melanoma-specific survival of 93.6% (95% CI, 91.9 to 94.9), which improved from 1973 to 2001. The hazard ratio of death from melanoma increased with male sex; older age; advanced disease; location of the primary other than extremities or torso; earlier year of diagnosis; and previous cancer.

Conclusion

The incidence of melanoma in the United States is increasing rapidly in children. Risk factors for pediatric melanoma include being white, being female, increasing age, and environmental UV radiation. Survival is decreased for children and adolescents with unfavorable prognostic factors (male sex, unfavorable site, and/or second primary or regional or distant metastasis). More effective therapeutic strategies are needed for these groups.
Immunoglobulin M Monoclonal Gammopathies of Undetermined Significance and Indolent Waldenström's Macroglobulinemia Recognize the Same Determinants of Evolution Into Symptomatic Lymphoid Disorders: Proposal for a Common Prognostic Scoring System
Authors: Baldini Luca , Goldaniga Maria , Guffanti Andrea , Broglia Chiara , Cortelazzo Sergio , Rossi Andrea , Morra Enrica , Colombi Mariangela , Callea Vincenzo , Pogliani Enrico , Ilariucci Fiorella , Luminari Stefano , Morel Pierre , Merlini Giampaolo , Gobbi Paolo
Published: July 2005

Purpose

To evaluate the clinicohematologic variables at diagnosis that are prognostically related to neoplastic progression in patients with immunoglobulin M (IgM) monoclonal gammopathies of undetermined significance (MGUS), and indolent Waldenström's macroglobulinemia (IWM), and propose a scoring system to identify subsets of patients at different risk.

Patients and Methods

We evaluated 217 patients with IgM MGUS and 201 with IWM (male-female ratio, 131:86 and 117:84; mean age, 63.7 and 63.6 years, respectively) diagnosed on the basis of serum monoclonal component (MC) levels and bone marrow lymphoplasmacytic infiltration degree. The variables selected by univariate analyses were multivariately investigated; on the basis of their individual relative hazards, a scoring system was devised to identify subsets of patients at different risk of evolution.

Results

After a median follow-up of 56.1 and 60.2 months, 15 of 217 MGUS and 45 of 201 IWM patients, respectively, required chemotherapy for symptomatic WM (13 and 36), non-Hodgkin's lymphoma (2 and 6) and amyloidosis (0 and 3). The median time to evolution (TTE) was not reached for MGUS and was 141.5 months for IWM. The variables adversely related to evolution were qualitatively the same in both groups: MC levels, Hb concentrations and sex. A scoring system based on these parameters identified three risk groups with highly significant differences in TTE in both groups (P < .0001).

Conclusion

MGUS and IWM identify disease entities with different propensities for symptomatic neoplastic evolution. As both have the same prognostic determinants of progression, we propose a practical scoring system that, identifying different risks of malignant evolution, may allow an individualized clinical approach.
Treatment of Refractory Hodgkin's Lymphoma Patients With an Iodine-131–Labeled Murine Anti-CD30 Monoclonal Antibody
Authors: Schnell Roland , Dietlein Markus , Staak Jan Oliver , Borchmann Peter , Schomaecker Klaus , Fischer Thomas , Eschner Wolfgang , Hansen Hinrich , Morschhauser Franck , Schicha Harald , Diehl Volker , Raubitschek Andrew , Engert Andreas
Published: July 2005

Purpose

Hodgkin's lymphoma (HL) has been demonstrated to be a good target for immunotherapy since lymphocyte activation markers such as CD30 are expressed in high numbers on the malignant cells. Thus, we developed a new radioimmunoconjugate consisting of the murine anti-CD30 monoclonal antibody (MAb) Ki-4 labeled with iodine-131 (131I).

Patients and Methods

The biodistribution of131I–Ki-4 was assessed via dosimetry after preinfusion of 5 mg native Ki-4 followed by 250 to 300 MBq131I-labeled Ki-4. Whole-body scintigraphy was performed 1 hour, 24 hours, 48 hours, 72 hours, and 6 days after the infusion. Dosimetry was calculated using the programs NucliDose ICON-IDL (version 5.0.2; Siemens, Erlanger, Germany) and MIRDOSE (version 3.1; Oak Ridge National Laboratories; Oak Ridge, TN). The therapeutic dose was given on day 8 after preinfusion of unlabeled Ki-4.

Results

We treated 22 patients with relapsed or refractory CD30-positive HL. Preinfusion of 5 mg native Ki-4 was sufficient to bind the soluble CD30. Imaging demonstrated localization of involved areas measuring 5 cm in diameter or more in four patients and 2.5 cm in one patient. Patients received total body doses of 0.035 Gy to 0.99 Gy. Acute toxicity was mild with grade 1 fatigue in 19 of 22 assessable patients. Seven patients experienced grade 4 degrees hematotoxicity 4 to 8 weeks after treatment. Response included one complete remission, five partial remissions, and three minor responses.

Conclusion

Treatment with131I–Ki-4 is effective but can be associated with severe hematotoxicity.
Neonatal Leptin Treatment Reverses Developmental Programming
Authors: Vickers M. H. , Gluckman P. D. , Coveny A. H. , Hofman P. L. , Cutfield W. S. , Gertler A. , Breier B. H. , Harris M.
Published: July 2005

An adverse prenatal environment may induce long-term metabolic consequences, in particular obesity and insulin resistance. Although the mechanisms are unclear, this programming has generally been considered an irreversible change in developmental trajectory. Adult offspring of rats subjected to undernutrition during pregnancy develop obesity, hyperinsulinemia, and hyperleptinemia, especially in the presence of a high-fat diet. Reduced locomotor activity and hyperphagia contribute to the increased fat mass. Using this model of maternal undernutrition, we investigated the effects of neonatal leptin treatment on the metabolic phenotype of adult female offspring. Leptin treatment (rec-rat leptin, 2.5 μg/g·d, sc) from postnatal d 3–13 resulted in a transient slowing of neonatal weight gain, particularly in programmed offspring, and normalized caloric intake, locomotor activity, body weight, fat mass, and fasting plasma glucose, insulin, and leptin concentrations in programmed offspring in adult life in contrast to saline-treated offspring of undernourished mothers who developed all these features on a high-fat diet. Neonatal leptin had no demonstrable effects on the adult offspring of normally fed mothers. This study suggests that developmental metabolic programming is potentially reversible by an intervention late in the phase of developmental plasticity. The complete normalization of the programmed phenotype by neonatal leptin treatment implies that leptin has effects that reverse the prenatal adaptations resulting from relative fetal undernutrition.
Estrogen Mediates Phosphorylation of Histone H3 in Ovarian Follicle and Mammary Epithelial Tumor Cells via the Mitotic Kinase, Aurora B
Authors: Ruiz-Cortés Z. Tatiana , Kimmins Sarah , Monaco Lucia , Burns Kathleen H. , Sassone-Corsi Paolo , Murphy Bruce D.
Published: July 2005

Cells of the ovarian follicle undergo extensive proliferation and differentiation from the time that the follicle escapes from the primordial state to its acquisition of ovulatory capacity. We examined the dynamic modification of the phosphorylation state of the histone H3 N-terminal tail in granulosa cells during follicular development. In rodent follicles, the granulosa cell H3 phosphorylation on Ser10 peaks during proestrus. This epigenetic mark is induced by both FSH and 17β-estradiol (E2), acting independently. E2-induced H3 phosphorylation fails to occur in mice with inactivated α-isoform of the nuclear estrogen receptor. E2 induction of histone phosphorylation is attenuated by cell cycle inhibition. Further, E2 induces the activity of the mitotic kinase, Aurora B, in a mammary tumor cell model where mitosis is estrogen receptor-α dependent. These results provide evidence for mitotic regulation in follicle development by estrogen and demonstrate a previously undiscovered mechanism for induction of cell proliferation in ovarian and mammary gland cells.
Characteristics of subepithelial fibroblasts as a mechano-sensor in the intestine: cell-shape-dependent ATP release and P2Y1 signaling
Authors: Furuya Kishio , Sokabe Masahiro , Furuya Sonoko
Published: July 2005

Subepithelial fibroblasts form a cellular network just under the epithelium of the gastrointestinal tract. Using primary cultured cells isolated from rat duodenal villi, we previously found that subepithelial fibroblasts reversibly changed cell morphology between flat and stellate-shape depending on intracellular cAMP levels. In this paper, we examined cell-cell communication via released ATP and Ca2+ signaling in the cellular network. Subepithelial fibroblasts were sensitive to mechanical stress such as `touching' a cell with a fine glass rod and `stretching' cells cultured on elastic silicone chamber. Mechanical stimulations evoked Ca2+-increase in the cells and ATP-release from the cells. The released ATP activated P2Y receptors on the surrounding cells and propagated Ca2+-waves through the network. Concomitant with Ca2+-waves, a transient contraction of the network was observed. Histochemical, RT-PCR, western blotting and Ca2+ response analyses indicated P2Y1 is a dominant functional subtype. ATP-release and Ca2+ signaling were cell-shape dependent, i.e. they were abolished in stellate-shaped cells treated with dBcAMP, and recovered or further enhanced in re-flattened cells treated with endothelin. The response to ATP also decreased in stellate-shaped cells. These findings indicate cAMP-mediated intracellular signaling causes cell-shape change, which accompanies the changes in mechano- and ATP sensitivities. Using a co-culture system of neuronal cells (NG108-15) with subepithelial fibroblasts, we confirmed that mechanically induced Ca2+-waves propagated to neurons. From these findings we propose that subepithelial fibroblasts work as a mechanosensor in the intestine. Uptake of food, water and nutrients may cause mechanical stress on subepithelial fibroblasts in the villi. The ATP released by mechanical stimulation elicits Ca2+-wave propagation through the network via P2Y1 activation and also activates P2X on terminals of mucosal sensory neurons to regulate peristaltic motility.
Clinical trials and evaluation of a mobile, robotic tele-ultrasound system
Authors: Courreges Fabien , Vieyres Pierre , Istepanian Robert S H , Arbeille Philippe , Bru Conxita
Published: July 2005

We have developed a robotic tele-ultrasound system (OTELO) that allows an expert to examine a distant patient by ultrasound. At the expert station, a sonographer controls a virtual probe. Movements are reproduced at the patient station, which may be several kilometres away, on a real probe held by a lightweight robot, which is positioned on the patient by a paramedic. Two medical teams tested the tele-ultrasound system at two different hospitals on a total of 52 patients. Except for some difficulties caused by particular conditions, the diagnosis obtained with the remote scanning system agreed in at least 80% of the cases with the diagnosis made by conventional scanning. The results demonstrate the feasibility and efficiency of the device.
Developing e-learning for interprofessional education
Authors: Varga-Atkins Tunde , Cooper Helen
Published: July 2005

An evidence-based, interprofessional educational course involving first-year undergraduate students studying medicine, nursing, physiotherapy and occupational therapy has been piloted at the University of Liverpool. Part of the content was developed in an online format. To capture the development process and the e-learning writing experience, a focus group was arranged for the content writers. The session was audio-recorded and tapes were transcribed. All the data were subjected to thematic analysis. Twenty-three sub-themes were identified in the 72 comments. These were grouped under six themes, corresponding to the developmental stages of e-learning. The highest number of comments fell under the theme of preparation, followed by content development, evaluation, general design and structure, and finally delivery. Team working contributed to the success of the writing process, reflecting the theme of working interprofessionally.
Unattended home sleep studies for the evaluation of suspected obstructive sleep apnoea syndrome in children
Authors: Patel Amit , Watson Mando , Habibi Parviz
Published: July 2005

Children suspected of obstructive sleep apnoea syndrome (OSAS) are traditionally investigated in hospital with overnight sleep studies, and single-channel pulse oximetry is the commonest form of initial study. A prospective study was conducted comparing unsupervised sleep studies, using a Nellcor N-395 pulse oximeter, performed in hospital and at home. Two hundred and eleven patient studies were completed in 18 months, 158 in hospital and 53 at home. The median age of patients was four years in both groups. The mean study duration was 9 h 5 min in hospital and 9 h 12 min at home (P = 0.75). The mean time in pulse search was 0.4% (SD = 0.7) in hospital and 0.2% (SD = 0.4) at home (P = 0.008). The number of failed studies was 96 of 254 (38%) in hospital and three of 56 (5%) at home (P<0.001). Overall, 149 hospital bed days were saved (at £690 per bed day), representing £68,540 saved annually. The results show that unattended home sleep studies in the form of overnight pulse oximetry can be performed to a standard better than hospital studies, where local community nursing facilities exist.
Teleradiology and picture archiving and communications systems: Changed pattern of communication between clinicians and radiologists
Authors: Aas I H Monrad , Geitung Jonn Terje
Published: July 2005

In a few years all radiology departments in Norwegian hospitals will have a picture archiving and communications system (PACS). This depends on telecommunications with great capacity for transmitting radiology images. The new technology questions the need for daily meetings between radiologists and clinicians, ‘clinico-radiological conferences’. Qualitative interviews were performed with 23 resource persons experienced with problems related to PACS and teleradiology. The response rate was 91 %. In all, 29% answered that the clinico-radiological conferences could be abolished, 52% replied no and 19% replied both yes and no. The clinico-radiological conferences could be abolished for some clinical departments, but only after consultation between radiology and clinical departments. If the conferences are abolished, clinicians and radiologists may spend more time on treatment and interpretation, with a probable productivity gain.
A critical analysis of the literature on the Internet and consumer health information
Authors: Powell J A , Lowe P , Griffiths F E , Thorogood M
Published: July 2005

A critical review of the published literature investigating the Internet and consumer health information was undertaken in order to inform further research and policy. A qualitative, narrative method was used, consisting of a three-stage process of identification and collation, thematic coding, and critical analysis. This analysis identified five main themes in the research in this area: (1) the quality of online health information for consumers; (2) consumer use of the Internet for health information; (3) the effect of e-health on the practitioner-patient relationship; (4) virtual communities and online social support and (5) the electronic delivery of information-based interventions. Analysis of these themes revealed more about the concerns of health professionals than about the effect of the Internet on users. Much of the existing work has concentrated on quantifying characteristics of the Internet: for example, measuring the quality of online information, or describing the numbers of users in different health-care settings. There is a lack of qualitative research that explores how citizens are actually using the Internet for health care.
Measurements of the clinical competence of doctors and nurses to process telemedicine referrals for burns patients
Authors: Jones Owen
Published: July 2005

Simulated telemedicine referrals were used to test the ability of groups of clinicians to manage telemedicine referrals of patients with burn injuries. Sixty-one participants recorded burn depth from digital images using a four-point scale. The definitive (‘gold standard’) diagnoses were based on a review by an experienced consultant burns surgeon. Sixty clinical cases that reflected the routine referrals to a specialist burns service were used for the study. The mean kappa scores for the participants ranged from 0.33 to 0.58, indicating poor to good agreement. The scores for the groups all had a similar pattern, with more experienced staff scoring higher than junior staff. The doctors and nurses specializing in burns had higher scores than the general surgical nurses.
Telecare: Perspectives on the changing role of patients and citizens
Authors: Finch Tracy , Mort Maggie , May Carl , Mair Frances
Published: July 2005

We conducted a qualitative study in the UK to examine perspectives about telemedicine, telecare and e-health for the changing roles of patients and citizens. We believe there are important differences between these applications, but for simplicity, the term ‘telecare’ is used broadly here to include all three. In-depth, semistructured interviews were conducted between September 2002 and May 2004. Participants were 38 key informants from the UK, known to have involvement or interest in telecare: policy-makers, clinicians, technologists, health service managers, researchers and patient advocates. Interviews were conducted either in person or over the telephone, and were audio-recorded with participants’ consent. The most frequently cited priorities for patients included accessibility to services, locations of care and quality of care, with some respondents emphasizing the importance of choice for the patient (in terms of appointments and ways of accessing services). However, telecare has implications for patients that go beyond issues of access. A major problem is that ‘priorities’ are assumed rather than based on an empirical understanding; moreover, for individual patients, preferences for particular forms of service delivery are likely to represent trade-offs between multiple priorities. The findings of the present study confirm that concepts of the patient's rights and responsibilities are changing with the increasing use of new technologies to deliver health care.
Daily usage and efficiency of remote home monitoring in hypertensive patients over a one-year period
Authors: Port Kristjan , Palm Kairit , Viigimaa Margus
Published: July 2005

We evaluated daily self-monitored blood pressure (BP) data collected over one year using remote home monitoring. Fifty treated, moderately hypertensive subjects (26 males, mean age 50 years; 17 females, mean age 54 years; seven exclusions) were recruited for the study in which semi-automatic arm-cuff BP measurement devices were used. The daily self-monitoring regimen had two phases of usage: one of initial enthusiasm (the first one to two months) followed by a phase of lower usage (89% versus 64%, P<0.01). Monitoring was missed more often (P<0.01) during weekends (7.3 instances per patient) compared with workdays (5.0). Lack of motivation was not considered to be a major barrier. Approximately half of the study population was willing to continue the trial at the end of the one-year study. The occurrence of extreme BP values dropped significantly after the initial study month (P=0.02). In conclusion, routine remote BP monitoring is capable of collecting consistent and accurate data, with sufficient sensitivity to reveal trends.
An online survey of nurses’ perceptions, knowledge and expectations of the National Health Service modernization programme
Authors: Bryson Maria , Tidy Natalie , Smith Michael , Levy Sharon
Published: July 2005

We conducted an online survey to investigate nurses’ perceptions, knowledge and expectations of the National Health Service (NHS) modernization programme in the UK. The questionnaire was available for 28 days via the Website of the Royal College of Nursing. The questionnaire was completed by 2020 nurses, midwives and health visitors working in all sectors of the health service in a wide range of specialties and environments of care. Less than one-quarter of respondents felt that they had adequate information about NHS information technology (IT) developments. In all, 528 (26%) said this was the first they had heard of the initiatives. Only 383 respondents (19%) felt adequately informed about the development of electronic health records; 470 (23%) felt inadequately informed and 456 (23%) had only heard something about it. The findings of this survey suggest that nursing staff are not widely aware of current IT plans and programmes in the NHS. They suggest that nurses also lack confidence in using advanced IT, which is compounded by lack of training.
Telecardiology: One-lead electrocardiogram monitoring and nurse triage in chronic heart failure
Authors: Scalvini S , Martinelli G , Baratti D , Domenighini D , Benigno M , Paletta L , Zanelli E , Giordano A
Published: July 2005

We investigated a home-based intervention based on telecardiology in patients with chronic heart failure (CHF). Two hundred and thirty CHF patients, aged 59 years (SD 9), in stable condition and with optimized therapy were enrolled. The programme consisted of trans-telephonic follow-up and electrocardiogram (ECG) monitoring followed by visits from a paramedical and medical team. The patient could call the centre when required (tele-assistance), while the team could call the patient at pre-scheduled times (telemonitoring). During the first 12 months, there were 3767 calls (873 ad hoc and 2894 scheduled calls). There were 648 events, including 126 episodes of asymptomatic hypotension and 168 episodes which were not due to cardiological symptoms. No actions were taken by the nurse after 2417 calls (64%). A change in therapy was suggested after 418 calls, hospital admission in 62 patients, further investigations for 243 patients and a consultation with the general practitioner in 41 patients. A total of 2303 one-lead ECG recordings were received (10 per patient); 126 recordings (6%) were diagnosed as pathological in comparison with the baseline one. The one-lead ECG recording was used for titration of beta-blockers in 79 patients (mean dosage 38 mg vs 42 mg, P<0.01). Home telenursing could be an important application of telemedicine and single-lead ECG recording seems to offer additional benefit in comparison with telephone follow-up alone.
Experience-based guidelines for the implementation of telemedicine services
Authors: Brebner J A , Brebner E M , Ruddick-Bracken H
Published: July 2005

Many telemedicine projects fail to survive beyond the funded research phase. A review of seven Scottish telemedicine services was conducted to identify successes and failures. Qualitative interviews were conducted with key individuals in each project. All projects were partly successful. The main reasons associated with partial failure were: the service was not needs-driven; there was no commitment to provide the service; there was no suitable exit strategy after research funding expired; there was poor communication; there was a lack of training; there were technical problems; work practices were not updated; the protocols for use were poor or non-existent. Based on this, guidelines that might improve the chances of success in future projects were drawn up.
Introducing assistive technology into the existing homes of older people: Feasibility, acceptability, costs and outcomes
Authors: Tinker Anthea , Lansley Peter
Published: July 2005

We examined how far, and at what cost, the housing stock could be modified to accommodate the assistive technology (AT) necessary to enable older people to remain in their own homes. A multidisciplinary team devised seven hypothetical user profiles for 10 case study areas, with five local authorities and five housing associations in England and Wales. Each profile was considered at two times, five years apart, with the users’ functional abilities deteriorating in between. In addition, in-depth interviews were carried out with a sample of 67 older people in the case study areas about their use and experience of a wide range of AT. The interviews showed the need to listen to older people and that they welcomed AT when it addressed a perceived need. The results showed that the extent of adaptation required of buildings to accommodate a user's needs varied greatly. It was also found that there was confusion about the terminology of AT, including the idea of the ‘smart house’. The study shows that the adaptability of the housing depends on a range of factors and costs.
Role flexibility among telemedicine service providers in the north-west and west of Ireland
Authors: Macfarlane A , Clerkin P , Murphy A W
Published: July 2005

A recent review of telemedicine services in the north-west and west of Ireland identified 11 telemedicine services, most of which were in the early stages of implementation. A qualitative approach was used to review them. Semistructured interviews were conducted with a multidisciplinary group of primary- and secondary-care providers (n = 21) who were involved with either synchronous or asynchronous telemedicine services. Data were analysed according to the principles of framework analysis. Participants described the ways in which they were flexible about their workload, professional identities and roles to facilitate the organization and delivery of telemedicine services, and to ensure that services ran smoothly. While the positive effect of product champions and members of a wider supportive network or alliance on the conception and development of telemedicine services must be acknowledged, questions remain about associated long-term implementation and sustainability.
Videoconferences for rural physicians’ continuing health education
Authors: Klein Doug , Davis Paul , Hickey Lynn
Published: July 2005

The University of Alberta uses videoconferencing to link physicians in interactive continuing health education. We examined evaluations of 29 videoconferences for rural practitioners during the programme year September 2003–May 2004. The evaluation form, completed by participants following the presentation, used both quantitative and qualitative methods of data collection. The average attendance for the videoconference sessions was 40 people. A total of 593 evaluations were collected (response rate 51%). The audience were very satisfied with the programme and felt that the sessions were relevant to their practice. The interactive discussion component was rated very highly. Most respondents stated that they would change their practice based on the information discussed. It is clear from our survey that videoconferencing is useful in overcoming the barriers of distance and that small physician numbers create a positive environment for adult learning.
MPEG-21 as an access control tool for the National Health Service Care Records Service
Authors: Brox Georg A
Published: July 2005

Since the launch of the National Health Service (NHS) Care Records Service with plans to share patient information across England, there has been an emphasis on the need for manageable access control methods. MPEG-21 is a structured file format which includes an Intellectual Property Management and Protection (IPMP) function using XML to present all digitally stored items in the patient record. Using DICreator software, patient records consisting of written text, audio-recordings, non-X-ray digital imaging and video sequences were linked up successfully. Audio records were created using Talk-Back 2002 to standardize and optimize recording quality. The recorded reports were then linked and archived using iTunes. A key was used each time the file was displayed to secure access to confidential patient data. The building of the correct file structure could be monitored during the entire creation of the file. The results demonstrated the ability to ensure secure access of the MPEG-21 file by both health-care professionals and patients by use of different keys and a specific MPEG-21 browser. The study also showed that the enabling of IPMP will provide accurate audit trails to authenticate appropriate access to medical information.