bluuebunny/crossref_metadata_2025 huggingface dataset:
Improving the patient's experience of a bone marrow biopsy – an RCT
Authors: Johnson Helen , Burke Debbie , Plews Caroline , Newell Rob , Parapia Liakat
Published: February 2008

Aims.  To compare nitrous oxide 50%/oxygen 50% (N2O/O2– entonox) plus local anaesthetic (LA) with placebo (oxygen) plus LA in the management of pain experienced by patients undergoing a bone marrow biopsy.

Background.  Bone marrow biopsies are a common procedure for many haematological conditions. Despite the use of a LA, pain during the procedure has frequently been reported by patients. Previous research in pain management of other invasive diagnostic procedures (e.g. sigmoidoscopy) has reported N2O/O2 as an effective alternative to LA.

Design.  Double‐blind randomized controlled trial.

Methods.  Forty‐eight patients requiring a bone marrow biopsy were randomized to receive either N2O/O2 or oxygen in addition to their LA. Participants were asked to complete a pain score and comment on their experience of the procedure.

Results.  Although the overall pain scores were moderate, there was a wide range of scores. N2O/O2 resulted in significantly less pain for men, but not for women. All patients who had had previous biopsies reported significantly more pain, regardless of the gas used. There were no significant adverse effects in either group.

Conclusion.  N2O/O2 is a safe, effective, easy‐to‐use analgesic which merits further investigation in potentially painful diagnostic (and other) interventions.

Relevance to clinical practice.  Relief of pain is an important issue for nurses. Appropriate assessment of pain experience is a key issue. Nurses should reflect on their own area of practice and identify what is known about the effectiveness of pain management from their patient's perspective. Individual differences may be important, and careful instruction regarding appropriate administration of analgesic agents, such as N2O/O2 may enhance their effectiveness.
The two‐step Mini Nutritional Assessment procedure in community resident homes
Authors: Wikby Kerstin , Ek Anna‐Christina , Christensson Lennart
Published: February 2008

Aims and objectivities. The aims were to test internal consistency and interrater reliability of Mini Nutritional Assessment during implementation of Mini Nutritional Assessment in community residential homes and to test sensitivity, specificity and diagnostic predictivity of Mini Nutritional Assessment‐short form vs. Mini Nutritional Assessment.

Background. There is a need in clinical practice to assess nutritional status in older people and to identify those who could benefit from early intervention.

Methods. The two‐step Mini Nutritional Assessment procedure (Mini Nutritional Assessment‐short form and Mini Nutritional Assessment) was used in 127 older people admitted to eight residential homes. In three of those homes (A, B and C), registered nurses simultaneously performed the assessment procedure, after receiving education and training. The intention was to offer the registered nurses a tool for independent practice use.

Results. Internal consistency was 0·68 (Cronbach's alpha) (n = 127). In residential home A, B and C, the registered nurses carried out Mini Nutritional Assessment in 45 residents out of 68. The agreement level between the author's and the registered nurses’ assessments was 62% (kappa 0·41). In residential home A, B and C, the agreement level was 89%, 89% and 44%, respectively. Sensitivity, specificity and diagnostic predictivity of Mini Nutritional Assessment‐short form vs. Mini Nutritional Assessment were 89%, 82% and 92%, respectively.

Conclusions. The two‐step Mini Nutritional Assessment procedure seems to be a useful tool to identify residents in need of nutritional interventions, despite the registered nurses not carrying out Mini Nutritional Assessment in all residents and the low agreement in residential home C. It indicates that to implement and use Mini Nutritional Assessment in nursing care demands the creating necessary staff resources, such as adequate staffing, sufficient education and continual supervision.

Relevance to clinical practice. Because of the high sensitivity of Mini Nutritional Assessment‐short form and Mini Nutritional Assessment, Mini Nutritional Assessment‐short form alone might be sufficient for practice use, as its simplicity might increase its usefulness.
Nurses’ development of professional self – from being a nursing student in a baccalaureate programme to an experienced nurse
Authors: Björkström Monica E , Athlin Elsy E , Johansson Inger S
Published: February 2008

Aims.  To investigate how baccalaureate degree nurses conceive their professional self over time, by following them from being students until some years after graduation.

Background.  Competence and professional development in nursing has been studied and discussed in many research studies. However, how baccalaureate degree nurses judge themselves and their own competencies as professionals over time remains a topic for further research.

Design.  Quantitative and longitudinal.

Methods.  Respondents were students entering the three‐year academic nursing programme 1993–1995 at a Swedish university. The Nurse Self‐Description Form was used at the beginning of the education programme (n = 163), just before graduation (n = 124) and 3–5 years after graduation (n = 82). Data were analysed using parametric and non‐parametric procedures.

Results.  Generally, the respondents rated their professional self highly and rather stably over time on items related to humanistic values, practical, affective and social skills. Six of the 19 items increased significantly during the transition from student to nurse. The rating of the components ‘Knowledge mastery’ and ‘Desire to contribute through research’ decreased over time after graduation. Gender, previous studies in health care and participation in development or research work as nurses, influenced the results in some parts.

Conclusion.  In the transition from novice students to experienced nurses, the participants saw themselves well equipped compared with others regarding traditional components of nursing competence. However, their self‐judgement decreased in components related to the new demands of a professional nurse. The findings illuminate an urgent need to search for further understanding about reasons why nurses decrease in self‐judgement concerning these components.

Relevance to clinical practice.  As the judgement of professional self is of importance to good performance in nursing, this study shows the need for further collaboration between the nursing education and the health care sector, in which nurses practice and also supervise nursing students.
The lived experience of the diabetes nurse specialist regular check‐ups, as narrated by patients with type 2 diabetes
Authors: Edwall Lise‐Lotte , Hellström Anna‐Lena , Öhrn Ingbritt , Danielson Ella
Published: February 2008

Aim.  The aim was to elucidate the lived experience of regular diabetes nurse specialist check‐ups among patients with type 2 diabetes.

Background.  Diabetes care with diabetes nurse‐led clinics in primary care has been established in Sweden since the 1980s. Information about patients’ lived experience of these regular check‐ups is important in the further development of diabetes nursing in primary care.

Methods.  Narrative interviews were conducted with 10 women and 10 men with type 2 diabetes regarding their lived experience in everyday life and the regular check‐ups by the diabetes nurse specialist. A phenomenological‐hermeneutic method inspired by Ricoeur was used in the analysis.

Results.  Patients’– with type 2 diabetes – lived experience of regular check‐ups showed an overall positive influence on the patients’ way of living with the disease by underpinning and developing their understanding and management of daily life. This influence was interpreted as an interlinked chain comprising the following elements; being confirmed, being guided within the disease process, becoming confident and independent and being relieved. Every link contained a positive influence from being dependent‐independent, autonomous and a feeling of freedom in patients striving for an everyday life with a disease under control.

Relevance to clinical practice.  The development of diabetes‐nurse‐led clinics from the perspective of the patient must consider the patient's individual need for support and continuity with the diabetes nurse specialist. Consultations with collaborative partnership and specific expertise that is easy to access implied autonomous disease self‐management in terms of patients’ own control of the disease over time. In view of the increasing number of patients with diabetes, this could positively impact the availability of diabetes nursing care.
State and trait anxiety levels before coronary angiography
Authors: Uzun Senay , Vural Huriye , Uzun Mehmet , Yokusoglu Mehmet
Published: February 2008

Aim.  To investigate the factors that are related to increased anxiety before elective coronary angiography.

Background.  Anxiety before coronary angiography is an important factor for complications. To know the factors for increased anxiety, it is important for nurse to prevent complications.

Design.  A cross‐sectional study design was used. The study included 88 consecutive patients waiting for coronary angiography.

Methods.  A data‐collecting form, which included questions about demographic features, health history and angiography, was completed by the participants on the day of coronary angiography. The level of state and trait anxiety was measured by Spielberger's State‐Trait Anxiety Inventory. Multivariate Analysis was performed to disclose the independency of the relation between state anxiety and factors.

Results.  Both trait and state anxiety levels were found to be moderate (age = 46, SD = 9, 24–67 years and age = 40, SD = 10, 21–65 years, respectively). There was a significant relation between state and trait anxiety levels (r = 0·56, p < 0·001). Among the investigated factors, only the trait anxiety (p < 0·001) and time on waiting list (p = 0·020) were found to be independent. For predicting high level of state anxiety, the cut‐off value of trait anxiety was found to be 48 with a sensitivity of 67% and specificity of 67% and cut‐off value of time on waiting list was found to be seven days with a sensitivity of 83% and specificity of 52%.

Conclusions.  The time on waiting list and trait anxiety levels are the most important factors for state anxiety level. To prevent high level of coronary angiography‐related anxiety, those patients with trait anxiety level >48 and time on waiting list >7 days should be managed specifically. The preventive measures should be specifically focused on the connection between state and trait anxiety.

Relevance to clinical practice.  Nursing planning should be focused on patients especially those on a long‐time waiting list and on patients with high trait anxiety level prior to coronary intervention.
Congenital anomalies: parents’ anxiety and women's concerns before prenatal testing and women's opinions towards the risk factors
Authors: Sahin Nevin Hotun , Gungor Ilkay
Published: February 2008

Aims.  The aims of the study were to determine parents’ anxiety and women's concerns before prenatal testing and women's opinions towards the risk factors for congenital anomalies.

Background.  Undergoing prenatal screening or diagnostic tests cause potential distress and worry for parents. Little attention has been paid to the psychological aspect of such testing in clinical and research areas.

Design.  This descriptive study was conducted in a prenatal diagnosis unit in a university hospital in Istanbul. The convenience sample of the study consisted of 200 women and 104 partners who applied for prenatal screening or diagnosis tests.

Methods.  Women were interviewed by the researcher before they underwent prenatal screening or diagnostic procedures. Data were gathered through interviews using an interview form that addressed women's evaluations for causes of fear and their opinions towards the risk factors for congenital anomalies. Spielberger State Anxiety Inventory was used to assess parents’ anxiety before prenatal testing.

Results.  Anxiety scores of women and their partners were higher in invasive tests group and suspicious findings group. The possibility of a malformation detected and of it being missed were major concerns of women. Receiving insufficient information about the procedure, undergoing this test for the first time, smoking and lower education was associated with increased anxiety scores in women. Although women knew about some certain risk factors for congenital anomalies like drug use, smoking and malnutrition, their knowledge about other risks were not sufficient.

Conclusion.  Prenatal tests, both routine screening and prenatal diagnosis, cause anxiety for parents. Understanding women's concerns and awareness of risk factors are important for providing care and counselling.

Relevance to clinical practice.  Nurses can provide appropriate information and support at each step in the screening and diagnosis process so that parents’ psychological stress is minimised.
Embedding nursing and therapy consultantship: the case of stroke consultants
Authors: Burton Christopher R , Bennett Bev , Gibbon Bernard
Published: February 2008

Aims and objectives.  As the basis for the design of career development opportunities for current and aspiring nursing and therapy consultants, we aimed to explore the factors that shape how these roles have embedded in UK stroke services.

Background.  The non‐medical consultant role has been introduced into UK health care services to provide opportunities for experienced practitioners to progress their careers in clinical practice. Whilst there have been evaluations of the impact of the role on service delivery, little attention has been paid to the pathways towards consultantship.

Design.  An exploratory design, incorporating focus group discussions, was used to address the research questions. Participating consultants, both nurses and allied health professionals, worked in stroke services, although it is anticipated that the results will have wider application.

Methods.  Two focus groups were held with non‐medical consultants in stroke from across the UK. Participants had the opportunity to comment on an interim paper prior to publication of the results. Thirteen consultants took part in the study.

Results.  A lack of consensus about the nature of clinical expertise and a diverse range of pathways towards consultantship were identified. Health care policy had presented the opportunity for consultants to be entrepreneurial in the development of stroke services, although this had limited the scope for the development of professional knowledge. Inflexible programmes to support aspiring consultants may limit the opportunities to develop these entrepreneurial skills.

Conclusions.  This study challenges health care organizations and the education and research departments that support them to think creatively in the way that the non‐medical consultant role is embedded, and that this should draw on the commitment of existing consultants to support succession planning.

Relevance to clinical practice.  The identification of those aspects of career pathways that current consultants have found to be helpful will be useful in designing opportunities for aspiring consultants.
Norton, Waterlow and Braden scores: a review of the literature and a comparison between the scores and clinical judgement
Authors: Anthony Denis , Parboteeah Sam , Saleh Mohammad , Papanikolaou Panos
Published: February 2008

Aims and objectives.  To consider the validity and reliability of risk assessment scales for pressure ulcers.

Background.  Pressure ulcers are a major problem worldwide. They cause morbidity and lead to mortality. Risk assessment scales have been available for nearly 50 years, but there is insufficient evidence to state with any certainty that they are useful.

Design.  A literature review and commentary.

Methods.  Bibliographic databases were searched for relevant papers, a critical review was completed on relevant papers.

Results.  There is contradictory evidence concerning the validity of risk assesment scales. The interaction of education, clinical judgement and use of risk assessment sakes has not been fully explored. It is not known which of these is most important, nor whether combining them results in better patient care.

Conclusions.  There is a need for further work. A study exploring the complex interaction of risk assessment scales, clinical judgement and education and training is introduced.

Relevance to clinical practice.  Nurses may be wasting their time conducting risk assessment scoring if clinical judgement and/or education are sufficient to assess pressure ulcers risk.
Mental health: patients’ experiences of patient education during inpatient care
Authors: Hätönen Heli , Kuosmanen Lauri , Malkavaara Heikki , Välimäki Maritta
Published: February 2008

Aims and objectives.  This study aimed to explore psychiatric patients’ experiences of patient education on psychiatric inpatient wards.

Background.  Patient education seems to be an effective way to support psychiatric patients’ capacity for independent living, compliance and insight. Despite the development of various patient education interventions there is still a lack of coherent information on how to improve patient education in the field of psychiatric care, especially from patients’ own perspectives.

Design and method.  Data were collected through interviews with 51 inpatients during their discharge process. This exploratory study employs a mixed methods design in data collection and analysis. The structured questions were analysed using descriptive statistics (percentages, frequencies, Mann–Whitney U‐test, t‐test). Open‐ended questions were analysed using inductive content analysis.

Results.  Patients perceived different informational areas to be important for them, although some variation was found. However, patient education was not realized in these same areas. Problems related to patient education described by patients were lack of information, problems in patient–staff interaction and a lack of prerequisite knowledge among patients and staff. Patients’ suggestions for future development of patient education were more innovative methods in patient education, paying attention to patient–staff interaction and personnel's professional knowledge. A majority of patients wanted to receive information through discussions with staff. However, other patient education methods were also suggested.

Conclusions.  Patient education in psychiatric hospitals is an important area to be developed, therefore, more innovative methods should be developed and their effectiveness should be tested.

Relevance to clinical practice.  Development of patient education can be implemented through tailoring patient education to patients’ individual needs and provide patient education using more innovative methods.
Adherence to pressure ulcer prevention guidelines in home care: a survey of current practice
Authors: Paquay Louis , Wouters Renild , Defloor Tom , Buntinx Frank , Debaillie Roseline , Geys Ludo
Published: February 2008

Aims and objectives.  To investigate the pressure ulcer prevalence in home nursing patients and to evaluate guideline adherence of measures for the prevention of pressure ulcers and the participation of informal carers in pressure ulcer prevention.

Background.  Since 2002, the Belgian Guideline for the Prevention of Pressure Ulcers was published on the Internet, but no information was available on guideline adherence in home care.

Methods.  A cross‐sectional survey of pressure ulcer prevalence and guideline adherence was performed in a cluster randomized sample of 2779 clients of nine regional nursing departments in Flanders, Belgium. The Belgian Guideline for the Prevention of Pressure Ulcers was the reference standard for the evaluation of the guideline adherence.

Results.  There were 744 subjects at risk for developing pressure ulcers. The overall prevalence of pressure ulcers for the total sample population was 6·8%. The age‐, sex‐ and risk‐standardized prevalence per regional department varied between 4·9% and 9·1%. Of the 744 subjects at risk, 33 (4·4%) received preventive measures, which were in adherence to the Belgian Guideline for Prevention of Pressure Ulcers, 482 persons (64·8%) were administered measures, which did not adhere to the Belgian Guideline for Prevention of Pressure Ulcers and in 229 subjects (30·8%) at risk for developing pressure ulcers, prevention was lacking. For subjects with at least one pressure ulcer, the proportions were: 4·8% adherence, 76·6% no adherence and 18·6% no prevention. A proportion of 22·2% of the patients at risk and their informal carers were informed and motivated by the home care nurse to participate in the pressure ulcer prevention and their actual participation in the prevention was 21·4% of all risk cases.

Conclusions.  The adherence of nurses and clients to the guideline for pressure ulcer prevention was low.

Relevance to the clinical practice.  The study demonstrates a detailed evaluation of guideline adherence to pressure ulcer prevention in an individual patient situation, with special attention for materials and measures, which are not adequate and not recommended by the Belgian Guideline for the Prevention of Pressure Ulcers.
Patients’ lived experiences of excisional breast biopsy: a phenomenological study1
Authors: Demir Fatma , Donmez Yelda Candan , Ozsaker Esma , Diramali Alev
Published: February 2008

Aims.  The purpose of this study was to explore the lived experience of patients undergoing an excisional breast biopsy.

Background.  It has been determined that women who feel a lump or a lesion in their breast delay seeking medical treatment because it could be cancer and they might need a mastectomy and/or the cancer may not be treatable. After women go to a health‐care facility and are told that they need to have a biopsy to make a clear diagnosis they want to have the biopsy performed as soon as possible.

Method.  A phenomenological approach from a Heideggerian hermeneutical perspective was used. Participants were 20 patients who had an excisional breast biopsy in the day surgery of a university research and training hospital general surgery division under general anaesthesia between the dates of 1 December 2004–30 June 2005 and who returned one week later for monitoring, who were over 18 years old and who volunteered to participate in the research. Data were collected using in‐depth interviewing and analysed using the principles of Heideggerian hermeneutics.

Results.  Three themes were identified: need for information, fear, spiritual needs.

Conclusion.  It was determined that patients undergoing excisional breast biopsy had significant information and spiritual needs and experienced a fear of having cancer, losing their breasts and dying in surgery.

Relevance to clinical practice.  Although there are many studies about breast cancer and day surgery patients’ experiences in the literature, no studies were found about patients’ experiences with day surgery excisional breast biopsy procedures. The results provide a possible framework for patient care.
Facilitating transitions. Nursing support for parents during the transfer of preterm infants between neonatal nurseries
Authors: Rowe Jennifer , Jones Liz
Published: February 2008

Aims and objectives.  Transfers between neonatal units are significant transitional experiences for parents of preterm infants. The study aimed to investigate practices that nurses identify as supportive to parents during preterm infants’ transfers. It explored the influence of organisational context on practice and what strategies nurses perceive would help them to provide supportive care.

Background.  Parents’ experiences of neonatal nurseries, their stressors and needs have been well documented. The powerful position of nurses in influencing parenting experience is also recognised. However, nurses’ understanding of the transfer process, their roles in supporting parents through this and the organisational context influencing practice have not been explored.

Design and methods.  A focus group design was used composed of registered nurses from two neonatal units who met for a series of group interviews. Eleven registered nurses participated. They explored and critiqued their current practices and then established aims and strategies for practice development. A qualitative content analysis was conducted.

Results.  Participants identified validation, empowerment and communication as critical to effective practice. They identified a range of organisational dynamics, from logistical issues to nursing authority and scope of practice, as these influenced practice. They presented strategies for practice development, including staff education and the development of nurse practitioner roles.

Relevance to clinical practice.  This study explores nurses’ understanding and insights into transitions for parents of preterm infants. It shows a congruence between nurses’ perceptions of parents’ experiences and needs and those reported by parents in previous studies. It articulates the way nurses practice in response to these perceptions, and the manner in which organisational dynamics influence their ability to facilitate transitions. The need to invest in transitions and invest in nurses to facilitate transitions is proposed, ultimately by increasing their clinical authority and autonomy.
The coping experiences of carers who live with someone who has schizophrenia
Authors: Huang Xuan‐Yi , Sun Fan‐Ko , Yen Wen‐Jiuan , Fu Chou‐Mei
Published: February 2008

Aims and objectives.  The purpose of this study was to understand the coping experiences of carers living with a schizophrenic family member. Our research may be a valuable reference for mental health professionals seeking to improve the quality of care for people with schizophrenia and their carers.

Design.  We employed a qualitative descriptive phenomenological research methodology to understand the coping experiences of carers living with a schizophrenic family member.

Methods.  Purposive sampling and in‐depth, face‐to‐face interviews were used to collect data. When data saturation was reached, the sample size comprised 10 carers (five men and five women). The interview focused on the carer's coping experience. During the process of data collection and data analyis we established epoches (bracketing) and returned to the reality of the carers’ experience to keep the data objective. Narratives were analysed according to Colaizzi's seven steps method.

Results.  The two most commonly used coping mechanisms that emerged from this study were psychological coping strategies (cognitive, behavioural and emotional) and social coping strategies (religious, social and professional support). Furthermore, three factors were found in the study, including low social status, traditional help‐seeking behaviours and feelings of shame.

Conclusion.  Findings from this study demonstrate the importance of understanding the coping experiences of carers who have a family member with schizophrenia. Further research is needed to identify more important detailed factors that affect the coping strategies of carers.

Relevance to clinical practice.  Community mental health care professionals need to improve the quality of care for helping carers living with a family member who has schizophrenia. It is important to develop effective coping intervention strategies that help carers cope with the stress and strain of caring for a family member with schizophrenia.
Comparative pharmacokinetics of amikacin in Greyhound and Beagle dogs
Authors: KUKANICH B. , COETZEE J. F.
Published: February 2008

The purpose of the study was to compare the pharmacokinetics of amikacin administered i.v., to Greyhound and Beagle dogs and determine amikacin pharmacokinetics administered subcutaneously to Greyhounds. Amikacin was administered i.v. at 10 mg/kg to six healthy Greyhounds and six healthy Beagles. The Greyhounds also received amikacin, 10 mg/kg s.c. Plasma was sampled at predetermined time points and amikacin concentrations determined by a fluorescence polarization immunoassay (FPIA).

The volume of distribution was significantly smaller in Greyhounds (mean = 176.5 mL/kg) compared to Beagles (234.0 mL/kg). The C0 and AUC were significantly larger in Greyhounds (86.03 μg/mL and 79.97 h·μg/mL) compared to Beagles (69.97 μg/mL and 50.04 h·μg/mL). The plasma clearance was significantly lower in Greyhounds (2.08 mL/min/kg) compared to Beagles (3.33 mL/min/kg). The fraction of the dose absorbed after s.c. administration to Greyhounds was 0.91, the mean absorption time was 0.87 h, and the mean maximum plasma concentration was 27.40 μg/mL at 0.64 h.

Significant differences in the pharmacokinetics of amikacin in Greyhounds indicate it should be administered at a lower dose compared to Beagles. The dose in Greyhounds to achieve a Cmax:AUC ≥ 8 for bacteria (with an MIC ≤ 4 μg/mL) is 12 mg/kg q24 h compared to 22 mg/kg q24 in Beagles.
Modelling the kinetics of hepatitis C virus RNA decline over 4 weeks of treatment with pegylated interferon α‐2b
Authors: Shudo E. , Ribeiro R. M. , Perelson A. S.
Published: February 2008

Summary.  Viral kinetic models for hepatitis C virus (HCV) have generally assumed that the effectiveness of therapy in blocking virion production, ε, is constant. However, with pegylated interferon α‐2b (PEG‐IFN) given weekly, there are significant changes in drug concentration between doses that may lead to changes in drug effectiveness and viral rebounds towards the end of the dosing interval. Here we investigate the effects of using a model that assumes a constant effectiveness for studies involving PEG‐IFN. We simulated PEG‐IFN treatment in a population of 294 computer simulated ‘patients’, each characterized by a different set of pharmacokinetic and pharmacodynamic parameters. We then sampled the simulated treatment data over 4 weeks with a schedule similar to that used in viral kinetic studies, and fitted a viral kinetic model assuming constant drug effectiveness, the CE model, to that data. Although the CE model was able to fit to the data well in most cases, the parameter estimates obtained scattered widely both above and below the true values. Thus, this model is less useful to analyse HCV RNA data during therapy with PEG‐IFN than with standard IFN given daily. With PEG‐IFN accurate estimation of viral dynamic parameters necessitates concomitant measurements of serum viral load and drug concentration.
Evolutionary Origin of the Immune System: A Dialogue with Rod Langman
Authors: Nagy Z. A.
Published: February 2008

The need of a specific defence mechanism against intracellular pathogens is proposed to have arisen very early in evolution, perhaps already in protozoa, e.g. amoebae. The phagocytic machinery of amoebae lends itself as a possible starting point for the evolution of such a mechanism. The hypothetical evolutionary pathway described here has been constructed to demonstrate the feasibility of developing a defence system against pathogens in the amoeba, which bears resemblances to contemporary cell‐mediated immunity, and can thus be considered as its ancestor.
Structural study on immunoglobulin G solution after pasteurization with and without stabilizer
Authors: Aghaie A. , Pourfathollah A. A. , Bathaie S. Z. , Moazzeni S. M. , Khorsand Mohammad Pour H. , Banazadeh S.
Published: February 2008

summary Pasteurization was investigated as a method of inactivating virus during the preparation of immunoglobulin for intravenous use. The effect of pH, protein concentration and the presence of protein stabilizers on the structure of immunoglobulin G (IgG) molecules during pasteurization was investigated using an immunoglobulin solution derived from a Cohn’s fraction II preparation. Changes in the secondary and tertiary structure of IgG molecules as well as the degree of polymerization of protein were investigated using spectrophotometry, circular dichroism and size exclusion chromatography. Only slight changes in secondary and tertiary structure were observed after pasteurization in a 10 g L−1 immunoglobulin solution at pH 4·5 and 5·5 in the absence of stabilizer and in a 50 g L−1 immunoglobulin solution at pH 5·5 in the presence of glycine and sucrose or sorbitol. Concentrations of immunoglobulin solution below 20 g L−1 were not denatured when pasteurized at pH 4·5 in the absence of stabilizers. High concentrations of immunoglobulin solution required stabilizers such as glycine and sorbitol or sucrose to prevent or reduce denaturation during pasteurization.
Estimating the risk of blood donation associated with HIV risk behaviours
Authors: Musto J. A. , Seed C. R. , Law M. , Keller A. J. , Kaldor J. M.
Published: February 2008

summary A blood donor questionnaire and declaration, with deferral of potential donors at a higher risk of blood‐borne infections, was introduced in Australia in the mid‐1980s to reduce the risk of donation of HIV‐infected blood. However, the absolute risk of HIV transmission through blood donation from high‐HIV‐risk donors has not been estimated. This study presents a new method of assessing the risk posed to the blood supply by selected HIV risk behaviours. A model was developed to estimate the probability of blood donation during the window period for HIV infection. Five scenarios for blood donors were considered: (1) men who have sex with men (MSM), (2) men who have sex with women in Australia, (3) women who have sex with partners from countries with a high HIV prevalence, (4) men who have sex with commercial sex workers in Australia and (5) people injecting drugs used once in a year. Those estimated to be at highest risk of becoming infected and donating in the window period were MSM. Women who have sex with men from countries of high HIV prevalence are at greater risk than men who have sex with female sex workers from Australia. These three groups under current Australian guidelines are deferred from donating blood for 12 months. In Australia, a single episode of injecting drug use is associated with very low risk of HIV transmission. The model presented in this study can be used to assess the impact of selected individual risk behaviours on the safety of the blood supply.
Human embryonic stem cells: origins, characteristics and potential for regenerative therapy
Authors: Mountford J. C.
Published: February 2008

summary Stem cells and their use in regenerative therapies are currently hot topics in both biology and medicine. For transfusion scientists the concept of cell therapy is not a new idea but rather a fundamental practice in this field. Bone marrow transplantation was pioneered in the 1960s and relies on the capacity of haemopoietic stem cells in the donated bone marrow to completely reconstitute the blood system of the recipient. Although this capacity of adult (or somatic) stem cells to regenerate the tissue from which they arise is extremely important, the isolation and cultivation of human embryonic stem cells (hESCs) have opened up the possibility to generate any cell or tissue of the body. This characteristic of hESC offers the hope of cell replacement and regenerative therapy for a whole array of diseases, many of which are currently untreatable. However, in order to understand the potential advantages and disadvantages of using stem cells in regenerative medicine, it is necessary to fully understand their origin, characteristics and potential. This review will concentrate particularly on hESCs and their derivation, characterization and capacity to differentiate into clinically useful tissue including haemopoietic lineages.
Modulation of neurotrophin and neurotrophin receptor expression in nasal mucosa after nasal allergen provocation in allergic rhinitis
Authors: Raap U. , Fokkens W. , Bruder M. , Hoogsteden H. , Kapp A. , Braunstahl G.‐J.
Published: February 2008

Background:  Patients with allergic rhinitis (AR) feature both allergic airway inflammation and a hyperresponsiveness to nonspecific stimuli which is partly neuronally controlled. Still, it is unclear whether or not neurotrophins are involved in airway pathophysiology of AR and in nasobronchial interaction.

Methods:  Nine AR patients with mono‐allergy to grass pollen and nine healthy controls underwent nasal allergen provocation (NP). Serum samples, nasal and bronchial biopsies were taken before (T0) and 24 h after (T24) NP. Pan‐neurotrophin receptor p75NTR, tyrosine kinase A (trkA), trkB, nerve growth factor (NGF), and brain‐derived neurotrophic factor (BDNF) were assessed with immunohistochemistry, and NGF and BDNF levels with ELISA.

Results:  At T24, BDNF and NGF were upregulated in nasal mucosa (P < 0.05) and increased in the peripheral blood of AR compared with T0. The increase in nasal BDNF expression correlated positively with the maximum increase in total nasal symptom score in AR (P = 0.02). p75NTR was expressed on peripheral nerves and epithelial layer, trkA on endothelial cells, and trkB on mast cells. trkB + mast cells significantly decreased after NP in AR (P < 0.01). NP did not modulate p75NTR and trkA expression in nasal mucosa and had no effect on the expression of neurotrophins and receptors in bronchial mucosa.

Conclusion:  This study shows that neurotrophins and their receptors are expressed in human airways. Allergic rhinitis was characterized by a modulation of BDNF, NGF, and trkB in nasal mucosa after NP and a correlation of nasal BDNF with the maximal increase of total nasal symptom score. Therefore, our data suggest that neurotrophins participate in upper‐airway pathophysiology in AR, whereas their role in nasobronchial interaction remains unclear.
The importance of early complementary feeding in the development of oral tolerance: Concerns and controversies
Authors: Prescott Susan L. , Smith Peter , Tang Mimi , Palmer Debra J. , Sinn John , Huntley Sophie J. , Cormack Barbara , Heine Ralf G. , Gibson Robert A. , Makrides Maria
Published: February 2008

Rising rates of food allergies in early childhood reflect increasing failure of early immune tolerance mechanisms. There is mounting concern that the current recommended practice of delaying complementary foods until 6 months of age may increase, rather than decrease, the risk of immune disorders. Tolerance to food allergens appears to be driven by regular, early exposure to these proteins during a ‘critical early window’ of development. Although the timing of this window is not clear in humans, current evidence suggests that this is most likely to be between 4 and 6 months of life and that delayed exposure beyond this period may increase the risk of food allergy, coeliac disease and islet cell autoimmunity. There is also evidence that other factors such as favourable colonization and continued breastfeeding promote tolerance and have protective effects during this period when complementary feeding is initiated. This discussion paper explores the basis for concern over the current recommendation to delay complementary foods as an approach to preventing allergic disease. It will also examine the growing case for introducing complementary foods from around 4 months of age and maintaining breastfeeding during this early feeding period, for at least 6 months if possible.
Changing landscape of invasive aspergillosis in allogeneic stem cell transplant recipients
Authors: Jantunen E. , Nihtinen A. , Anttila V.‐J.
Published: February 2008

Abstract: Invasive aspergillosis (IA) is an important infectious complication in allogeneic stem cell transplant (SCT) recipients. Diagnosis of IA has been difficult and often delayed and treatment outcome has been poor, with mortality rates up to 80%. This review summarizes recent developments in this field. There are indications that the incidence of IA may be decreasing due to multiple factors including better understanding of pathogenesis of IA, earlier diagnosis, and various prophylactic and preventive strategies. Recently posaconazole has shown to be effective in reducing the risk of IA in patients treated for graft‐versus‐host disease (GVHD). Early use of high‐resolution thoracic computed tomography assisted with complimentary methods including bronchoalveolar lavage and serum galactomannan determinations are useful in early diagnosis. Our treatment armamentarium against IA has broadened significantly during the last years and there are some indications of improved outcome more recently. On the other hand, increasing use of blood progenitor grafts instead of marrow with higher risk of chronic GVHD, increasing age of SCT recipients, and wide use of donor lymphocyte infusions for treatment of minimal residual disease or relapse may affect to the opposite direction. Despite some promises and improvements, IA will continue to remain a challenge in the upcoming years.
Relation of ferritin levels with symptom ratings and cognitive performance in children with attention deficit–hyperactivity disorder
Authors: Oner Ozgur , Alkar Ozden Yalcinkaya , Oner Pinar
Published: February 2008

Background: The aim of the present paper was to investigate the relationship between behavioral symptoms and attentional and executive functions and hematological variables related to iron deficiency and anemia, ferritin, hemoglobin, mean corpuscular volume (MCV), and red cell distribution width (RDW) in children and adolescents with attention deficit–hyperactivity disorder (ADHD).

Methods: The sample consisted of 52 ADHD children (42 boys, 10 girls; age 7–13 years; mean ± SD, 9.9 ± 2.1 years). Conners Parent and Teacher Rating Scales were obtained. The neuropsychological test battery included Wisconsin Card‐Sorting Test (WCST), Stroop, Continuous Performance Test, Digit Symbol and Digit Span subtests of the Wechsler Intelligence Scale for Children Revised (WISC‐R), and Trail Making Test A and B, which taps abstraction–flexilibity (WCST), sustained attention (CPT), mental tracking and complex attention (WISC‐R Digit Span, Digit Symbol, Trail Making A and B) and interference control (Stroop). Multiple linear regression was used to evaluate the relation of ferritin, hemoglobin, MCV, RDW, age, gender, and presence of comorbidity.

Results: While seven children had iron deficiency, none of them was anemic. Lower ferritin levels were associated with higher hyperactivity scores in parental ratings. While performance increased with age for most of the neuropsychological tests utilized, ferritin, hemoglobin, MCV and RDW and gender were not significantly related with cognitive performance in this sample.

Conclusions: At least for the present clinical sample, ferritin levels might be related with behavioral but not cognitive measures in ADHD cases.
Kinetics of serum S100B in newborns with intracranial lesions
Authors: Murabayashi Masao , Minato Michiyoshi , Okuhata Yoshitaka , Makimoto Masami , Hosono Shigeharu , Masaoka Naoki , Okada Tomoo , Yamamoto Tatsuo , Mugishima Hideo , Takahashi Shigeru , Harada Kensuke
Published: February 2008

Background: The purpose of the present study was to evaluate the usefulness of serum S100B as a clinical marker of intracranial lesions in newborns.

Methods: The study involved 22 normal and 40 diseased newborns. Serum S100B level was measured on days 1 and 6 in normal newborns. Diseased newborns were classified into four groups: birth asphyxia with hypoxic–ischemic encephalopathy (HIE); birth asphyxia without HIE; intracranial hemorrhage (mainly subarachnoid); and brain malformation. In each group the serum S100B level was measured on days 1, 2 and 6. Development was also assessed to investigate the relation between serum S100B level and prognosis at 18 months after birth.

Results: In normal newborns, serum S100B level was significantly higher in those with liquor to meconium stain than in those without. In diseased newborns, serum S100B level on day 1 was significantly higher in the HIE group than in all other groups (P < 0.05). There was no significant difference in serum S100B level between control and intracranial hemorrhage, or brain malformation. In newborns with birth asphyxia, serum S100B level was significantly higher in severe birth asphyxia than in mild or moderate birth asphyxia; two newborns with serum S100B level ≥10 μg/L on days 1 and 2 developed cerebral palsy, others with no increase of S100B were all developing normally.

Conclusions: Serum S100B level is a useful marker of acute perinatal brain damage, and is particularly valuable for fetal distress. In newborns with birth asphyxia, serum S100B levels serve as a biochemical marker of HIE.
Asthma, lung function and sensitization in school children with a history of bronchiolitis
Authors: Cassimos Dimitrios C. , Tsalkidis Aggelos , Tripsianis Gregorios A. , Stogiannidou Anastasia , Anthracopoulos Michael , Ktenidou‐Kartali Sofia , Aivazis Victor , Gardikis Stefanos , Chatzimichael Athanasios
Published: February 2008

Background: The purpose of the present retrospective study was to investigate the association of school‐age asthma with acute‐bronchiolitis and examine the influence of potential risk factors.

Methods: One hundred and eighty‐nine children aged 7.5 ± 2.2 years consecutively hospitalized for respiratory syncytial virus (RSV)‐positive acute bronchiolitis during infancy were evaluated by clinical examination and measurement of peak expiratory flow (PEFR), spirometry, IgE and skin‐prick testing. Their pulmonary function was compared with that of 60 non‐asthmatic matched controls.

Results: Of the entire cohort 57.1% were diagnosed as asthmatic. PEFR, the 1‐second forced expiratory volume and forced expiratory flow of 50% vital capacity of children with a history of acute bronchiolitis were statistically significantly lower than in the control group (all P < 0.001). All the aforementioned measurements of children with/without asthma were also significantly lower than controls, while values of asthmatics were significantly lower than those of non‐asthmatics. The incidence of asthma in childhood was independently associated with breast‐feeding <3 months (adjusted odds ratio [aOR], 8.4; 95% confidence interval [CI]: 3.1–22.4), at least one positive skin prick test (aOR, 7.1; 95%CI: 2.8–18.1), male gender (aOR, 5.0; 95%CI: 2.2–11.5), evidence of moisture in the home environment (aOR, 2.9; 95%CI: 1.3–6.3) and presence of more than one house‐resident smoking indoors (aOR, 4.9; 95%CI: 1.8–9.2).

Conclusion: Children with a history of RSV‐bronchiolitis during infancy have an increased risk for developing asthma in childhood, which was independently associated with male gender, breast‐feeding <3 months, living in a home environment with moisture damage and/or tobacco smoke by two or more residents and sensitization to at least one aeroallergen. Children with a history of RSV bronchiolitis in infancy had lower spirometry in comparison to matched control group. The difference was more marked for asthmatic ones but remained significant even for non‐asthmatic children.