bluuebunny/crossref_metadata_2025 huggingface dataset:
Electronic prescribing increases uptake of clinical pharmacologists' recommendations in the hospital setting
Authors: Taegtmeyer Anne B. , Curkovic Ivanka , Rufibach Kaspar , Corti Natascia , Battegay Edouard , Kullak‐Ublick Gerd A.
Published: May 2011

WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT

• Electronic prescribing reduces drug prescription errors and therefore improves patient safety.

• Whether electronic prescribing compared with prescribing on paper facilitates the implementation of clinical pharmacologists' recommendations in the care of patients hospitalized with medical problems is not known.

WHAT THIS STUDY ADDS

• The use of electronic prescriptions when compared with handwritten prescriptions increased the uptake of clinical pharmacologists' recommendations for improving drug safety in hospitalized patients.

AIMS To determine whether electronic prescribing facilitates the uptake of clinical pharmacologists' recommendations for improving drug safety in medical inpatients.

METHODS Electronic case records and prescription charts (either electronic or paper) of 502 patients hospitalized on medical wards in a large Swiss teaching hospital between January 2009 and January 2010 were studied by four junior and four senior clinical pharmacologists. Drug‐related problems were identified and interventions proposed. The implementation and time delays of these proposed interventions were compared between the patients for whom paper drug charts were used and the patients for whom electronic drug charts were used.

RESULTS One hundred and fifty‐eight drug‐related problems in 109 hospital admissions were identified and 145 recommendations were made, of which 51% were implemented. Admissions with an electronic prescription chart (n= 90) were found to have 2.74 times higher odds for implementation of the change than those with a paper prescription chart (n= 53) (95% confidence interval 1.2, 6.3, P= 0.018, adjusted for any dependency introduced by patient, ward or clinical team; follow‐up for two cases missing). The time delay between recommendations being made and their implementation (if any) was minimal (median 1 day) and did not differ between the two groups.

CONCLUSIONS Electronic prescribing in this hospital setting was associated with increased implementation of clinical pharmacologists' recommendations for improving drug safety when compared with handwritten prescribing on paper.
Activin‐A: a novel critical regulator of allergic asthma
Authors: Kariyawasam H. H. , Semitekolou M. , Robinson D. S. , Xanthou G.
Published: June 2011

Activin‐A is a pleiotropic cytokine that belongs to the TGF‐β superfamily and plays an important role in fundamental biological processes, such as development and tissue repair. Growing evidence proposes a crucial role for activin‐A in immune‐mediated responses and associated diseases, with both enhancing and suppressive effects depending on the cell type, the cytokine micromilieu and the context of the response. Several recent studies have demonstrated a striking increase in activin‐A expression in experimental models of asthma, as well as, in the asthmatic airway in humans. Importantly, a strong immunoregulatory role for activin‐A in allergic airway disease, with suppression of T helper (Th) type 2 cell‐driven allergic responses and protection against the development of cardinal features of the asthmatic phenotype was revealed by in vivo functional studies. Activin‐A‐mediated immunosuppression is associated with induction of functional allergen‐specific regulatory T cells. In human asthma, although activin‐A levels are increased in the airway epithelium and submucosal cells, the expression of its signalling components is markedly decreased, pointing to decreased regulation. Nevertheless, a rapid activation of the activin‐A signalling pathway is observed in the airway of individuals with asthma following inhalational allergen challenge, suggestive of an inherent protective mechanism to control disease. In support, in vitro studies using human airway epithelial cells have demonstrated that endogenous activin‐A suppresses the release of inflammatory mediators, while it induces epithelial repair. Collectively, compelling evidence suggests that activin‐A orchestrates the regulation of key events involved in the pathogenesis of allergic asthma. The critical role of activin‐A in allergic airway responses places this cytokine as an exciting new therapeutic target for asthma.

Cite this as: H. H. Kariyawasam, M. Semitekolou, D. S. Robinson and G. Xanthou, Clinical & Experimental Allergy, 2011 (41) 1505–1514.
The effect of sexual self‐concept on sexual health behavioural intentions: a test of moderating mechanisms in early adolescent girls
Authors: Pai Hsiang‐Chu , Lee Sheuan , Yen Wen‐Jiuan
Published: June 2011

pai h.‐c., lee s. & yen w.‐j. (2012) The effect of sexual self‐concept on sexual health behavioural intentions: a test of moderating mechanisms in early adolescent girls. Journal of Advanced Nursing68(1), 47–55.

Aim.  The purpose of this study was to examine whether normative beliefs would act as a moderator of the main relationship between sexual self‐concept and sexual heath behavioural intentions.

Background.  Sexual self‐concept has been defined as an individual’s evaluation of his or her own sexual feelings and actions. Research has shown that sexually related behaviours are associated with sexual self‐concept and perceived parental/peer approval of sexual behaviour.

Methods.  We conducted cross‐sectional research, using face‐to‐face interviews, to assess sexual self‐concept, normative beliefs and sexual health behavioural intention. This study was conducted with 534 adolescent female participants, aged 12–15 years, in Taiwan. Data was collected between September and December 2009. We conducted structural equation modelling to examine the proposed conceptual model.

Findings.  We found that individuals with a high score on sexual self‐concept (i.e. who had stronger erotic feelings) were less likely to believe that they would behave in ways that would protect their sexual health (i.e. low behavioural intention, β = −0·44, t = −8·43, P < 0·001). The hypothesized moderating role of normative beliefs was also supported. Those with a greater tendency to believe that their parents/peers approved of sex (i.e. normative beliefs) were more likely to have a positive sexual self‐concept (β = 0·57, P < 0·001), and were less likely to protect their sexual health (β = −0·19, P < 0·01). The findings showed that, together, normative beliefs and sexual self‐concept accounted for 24·9% of the variance in girls’ sexual health behavioural intentions.

Conclusions.  We recommend that interventions that target sexual health behavioural intentions for this population would be more effective if such interventions targeted normative beliefs and helped adolescent females to clarify their sexual self‐concept.
Electronic prescribing reduces prescribing error in public hospitals
Authors: Shawahna Ramzi , Rahman Nisar‐Ur , Ahmad Mahmood , Debray Marcel , Yliperttula Marjo , Declèves Xavier
Published: June 2011

Aims and objectives.  To examine the incidence of prescribing errors in a main public hospital in Pakistan and to assess the impact of introducing electronic prescribing system on the reduction of their incidence.

Background.  Medication errors are persistent in today’s healthcare system. The impact of electronic prescribing on reducing errors has not been tested in developing world.

Design.  Prospective review of medication and discharge medication charts before and after the introduction of an electronic inpatient record and prescribing system.

Methods.  Inpatient records (n = 3300) and 1100 discharge medication sheets were reviewed for prescribing errors before and after the installation of electronic prescribing system in 11 wards.

Results.  Medications (13,328 and 14,064) were prescribed for inpatients, among which 3008 and 1147 prescribing errors were identified, giving an overall error rate of 22·6% and 8·2% throughout paper‐based and electronic prescribing, respectively. Medications (2480 and 2790) were prescribed for discharge patients, among which 418 and 123 errors were detected, giving an overall error rate of 16·9% and 4·4% during paper‐based and electronic prescribing, respectively.

Conclusion.  Electronic prescribing has a significant effect on the reduction of prescribing errors.

Relevance to clinical practice.  Prescribing errors are commonplace in Pakistan public hospitals. The study evaluated the impact of introducing electronic inpatient records and electronic prescribing in the reduction of prescribing errors in a public hospital in Pakistan.
The dilemma of diabetic patients living with hypoglycaemia
Authors: Wu Fei‐Ling , Juang Jyuhn‐Huarng , Yeh Mei Chang
Published: June 2011

Aims.  To examine the impact of the threat of hypoglycaemic episodes on people with diabetes in Taiwan.

Background.  Intensive diabetes treatment in people with diabetes helps them to achieve better glycaemic control. However, it also causes more frequent hypoglycaemic episodes and has an impact on their overall quality of life. Hypoglycaemia is accompanied by various distressing symptoms which may cause excessive fear, affecting decision making in hypoglycaemic management.

Design.  Purposive sampling and in‐depth, face‐to‐face interviews were used to collect data.

Methods.  Semi‐structured interviews were conducted from July 2008–January 2009 with 17 individuals treated with insulin who had previous hypoglycaemic episodes. Data were analysed using qualitative content analysis.

Results.  Four themes were generated from the analysis, ‘inability to control fluctuations in health’, ‘challenges to interpersonal relationships’, ‘facing the disease alone’ and ‘finding a balance between competing symptoms’.

Conclusions.  Hypoglycaemia is a major health issue for many people with diabetes. Understanding individuals’ experiences with hypoglycaemic episodes should help practitioners become more fully involved in promoting self‐management. We identified key areas that health care providers should address, including concerns about patient education and professional support for people with diabetes experiencing hypoglycaemia, to enhance problem solving skills for them and their families.

Relevance to clinical practice.  We recommend that health care providers make proper use of support groups for family caregivers or other important individuals in the lives of people with diabetes to provide education, clarification, support and guidance. In addition, health care providers also need to provide clients with hypoglycaemia‐related emotional support, while enhancing diabetes self‐management and problem‐solving skills.
Non‐invasive, dynamic imaging of murine intestinal motility
Authors: Kwon S. , Sevick‐Muraca E. M.
Published: May 2011

Background  After intravenous (i.v.) administration, indocyanine green (ICG) is known to be secreted into bile from the liver via the biliary tracts, enabling fluorescent delineation of the intestine. In addition, ICG is a near‐infrared (NIR) excitable fluorophore, capable of providing exogenous contrast for rapid NIR fluorescence imaging. We sought to quantify the intestinal motility using dynamic NIR fluorescence imaging after injection of ICG.

Methods  C57BL6 mice were dynamically imaged immediately before and up to 24 h after i.v. and intradermal (i.d.) injection of 50 and 10 μL of ICG, respectively. Necropsy was also performed 1 h postinjection and the entire gastrointestinal tract was isolated and exposed for ex vivo fluorescence imaging.

Key Results  The secretion of ICG‐laden fluorescent bile into the duodenum was observed in vivo and confirmed in situ. Different patterns of the intestinal motility, such as peristaltic and segmental motions, were dynamically imaged in vivo. Our imaging data showed that the frequency of contractions ranged from 27 to 35 cycles min−1 and the propagation velocity of peristaltic waves ranged from 0.82 ± 0.5 to 2.04 ± 1.12 cm s−1.

Conclusions & Inferences  Dynamic NIR fluorescence imaging with injection of ICG can provide a method for diagnostic motility testing for intestinal motility disorders or dysfunction and for potential evaluation of therapeutic agents.
Day length is a key regulator of transcriptomic responses to both CO2 and H2O2 in Arabidopsis
Authors: QUEVAL GUILLAUME , NEUKERMANS JENNY , VANDERAUWERA SANDY , VAN BREUSEGEM FRANK , NOCTOR GRAHAM
Published: June 2011

Growth day length, CO2 levels and H2O2 all impact plant function, but interactions between them remain unclear. Using a whole‐genome transcriptomics approach, we identified gene expression patterns responding to these three factors in Arabidopsis Col‐0 and the conditional catalase‐deficient mutant, cat2. Plants grown for 5 weeks at high CO2 in short days (hCO2) were transferred to air in short days (SD air) or long days (LD air), and microarray data produced were subjected to three independent studies. The first two analysed genotype‐independent responses. They identified 1549 genes differentially expressed after transfer from hCO2 to SD air. Almost half of these, including genes modulated by sugars or associated with redox, stress or abscisic acid (ABA) functions, as well as light signalling and clock genes, were no longer significant after transfer to air in LD. In a third study, day length‐dependent H2O2‐responsive genes were identified by comparing the two genotypes. Two clearly independent responses were observed in cat2 transferred to air in SD and LD. Most H2O2‐responsive genes were up‐regulated more strongly in SD air. Overall, the analysis shows that both CO2 and H2O2 interact with day length and photoreceptor pathways, indicating close networking between carbon status, light and redox state in environmental responses.
Maize seed and stem roots differ in response to neighbouring weeds
Authors: AFIFI M , SWANTON C
Published: May 2011

Afifi M & Swanton C (2011). Maize seed and stem roots differ in response to neighbouring weeds. Weed Research51, 442–450.

Light signals such as the red to far‐red ratio (R/FR) reflected from stem and leaf surfaces of neighbouring weeds can trigger a shade avoidance response in maize seedlings, resulting in a reduction in root biomass. In this experiment, we tested the hypothesis that maize roots originating from seed or stem tissue differed in their response to the R/FR ratio reflected from neighbouring weeds. Laboratory experiments were conducted under conditions of non‐limiting resources using perennial ryegrass as a model weed species. The above‐ground reduction in the R/FR ratio reflected from neighbouring weeds delayed the emergence of the root radicle and reduced the root relative growth rate from emergence until the fourth leaf tip stage of maize. At this leaf stage, no effect was observed on root length or surface area of the root radicle or seminal roots. In contrast, crown root length, diameter, surface area and number were all reduced, compared with crown roots grown under weed‐free conditions. These changes accounted for the observed reduction in total root biomass and volume. This is the first study to report that maize roots originating from seed or stem tissue differ in their response to the proximity of neighbouring weeds.
Signalling by the global regulatory molecule ppGpp in bacteria and chloroplasts of land plants
Authors: Tozawa Y. , Nomura Y.
Published: May 2011

The hyperphosphorylated guanine ribonucleotide ppGpp mediates the stringent response in bacteria. Biochemical and genetic studies of this response in Escherichia coli have shown that the biosynthesis of ppGpp is catalysed by two homologous enzymes, RelA and SpoT. RelA is activated in response to amino acid starvation, and SpoT responds to abiotic physical stress beside nutritional stress. All free‐living bacteria, including Gram‐positive firmicutes, contain RelA‐SpoT homologues (RSH). Further, novel ppGpp biosynthetic enzymes, designated small alarmone synthetases (SASs), were recently identified in a subset of bacteria, including the Gram‐positive organism Bacillus subtilis, and were shown to consist only of a ppGpp synthetase domain. Studies suggest that these SAS proteins contribute to ppGpp signalling in response to stressful conditions in a manner distinct from that of RelA‐SpoT enzymes. SAS proteins currently appear to always occur in addition to RSH enzymes in various combinations but never alone. RSHs have also been identified in chloroplasts, organelles of photosynthetic eukaryotes that originated from endosymbiotic photosynthetic bacteria. These chloroplast RSHs are exclusively encoded in nuclear DNA and targeted into chloroplasts. The findings suggest that ppGpp may regulate chloroplast functions similar to those regulated in bacteria, including transcription and translation. In addition, a novel ppGpp synthetase that is regulated by Ca2+ as a result of the presence of two EF‐hand motifs at its COOH terminus was recently identified in chloroplasts of land plants. This finding indicates the existence of a direct connection between eukaryotic Ca2+ signalling and prokaryotic ppGpp signalling in chloroplasts. The new observations with regard to ppGpp signalling in land plants suggest that such signalling contributes to the regulation of a wider range of cellular functions than previously anticipated.
Debunking the manual handling myth: An investigation of manual handling knowledge and practices in the Australian private health sector
Authors: Kay Kate , Glass Nel
Published: May 2011

Kay K, Glass N. International Journal of Nursing Practice 2011; 17: 231–237

Debunking the manual handling myth: An investigation of manual handling knowledge and practices in the Australian private health sector

Nursing care involves complex patient handling tasks. Strategies to address associated manual handling issues commonly include training programmes, despite conflicting evidence regarding training efficacy for manual handling injury reduction. Resultant knowledge acquisition and skills transfer from training programmes are prerequisites for subsequent practice changes in the clinical setting. This paper draws upon the findings from a questionnaire completed by 100 nurses in an Australian private hospital in 2008. A substantial knowledge deficit was identified, despite previous training undertaken by participants. A striking finding was that although 82% (n = 82) of nurses surveyed believed they used safe manual handling practices, only 18% (n = 15) of these nurses correctly answered items assessing manual handling knowledge. The study suggests prudence in the assumption of skills and knowledge acquisition during manual handling training. It informs the development of future implementation strategies, and provides a contributory explanation for the limited application of recommended practices after training completion.
A novel educational programme to improve knowledge regarding health care‐associated infection and hand hygiene
Authors: Fitzpatrick Maureen , Everett‐Thomas Ruth , Nevo Igal , Shekhter Ilya , Rosen Lisa F , Scheinman Stephen R , Arheart Kristopher L , Birnbach David J
Published: May 2011

Fitzpatrick M, Everett‐Thomas R, Nevo I, Shekhter I, Rosen LF, Scheinman SR, Arheart KL, Birnbach DJ. International Journal of Nursing Practice 2011; 17: 269–274

A novel educational programme to improve knowledge regarding health care‐associated infection and hand hygiene

Lack of hand hygiene by health‐care workers is the most significant cause of health care‐associated infection. This programme was designed to make health‐care workers want to wash their hands, to change their knowledge regarding hand hygiene and health care‐associated infection, and influence practice. Improvement between pre‐ and post‐test scores was statistically significant. Compliance is a multifactorial problem that involves knowledge and behaviour. Educational awareness and frequent reminders are critical to maintain high rates of hand hygiene compliance.
Impact of hand injury on patients: Psychosocially oriented nurse care
Authors: Tocco Ilaria , Salini Elena , Bassetto Franco
Published: May 2011

Tocco I, Salini E, Bassetto F. International Journal of Nursing Practice 2011; 17: 275–279

Impact of hand injury on patients: Psychosocially oriented nurse care

Psychological and social post‐traumatic adjustments consequent to hand injury deeply affect patients' needs. Nurses are the professional figures who, within the surgery, work more closely in terms of frequency and time with patients: a targeted nurse training must be implemented. A systematic review was conducted to assess hand‐injured patients nurse care. In total, 335 articles were identified, of which 20 met inclusion criteria. Issues identified included psychological response to hand injury, social implications, nurse's recognition and assessment of psychosocial needs, appropriate intervention. The results show how important it is to train nurses who are well prepared to deal with the psychological status when caring for hand‐injured patients, in order to set the most correct psychosocial assistance.
Pandemic response lessons from influenza H1N1 2009 in Asia
Authors: FISHER DALE , HUI DAVID S. , GAO ZHANCHENG , LEE CHRISTOPHER , OH MYOUNG‐DON , CAO BIN , HIEN TRAN TINH , PATLOVICH KRISTA , FARRAR JEREMY
Published: May 2011

During April 2009, a novel H1N1 influenza A virus strain was identified in Mexico and the USA. Within weeks the virus had spread globally and the first pandemic of the 21st Century had been declared. It is unlikely to be the last and it is crucial that real lessons are learned from the experience. Asia is considered a hot spot for the emergence of new pathogens including past influenza pandemics. On this occasion while preparing for an avian, highly virulent influenza virus (H5N1 like) originating in Asia in fact the pandemic originated from swine, and was less virulent. This discrepancy between what was planned for and what emerged created its own challenges. The H1N1 pandemic has tested national health‐care infrastructures and exposed shortcomings in our preparedness as a region. Key health challenges include communication throughout the region, surge capacity, access to reliable information and access to quality care, health‐care worker skills, quality, density and distribution, access to essential medicines and lack of organizational infrastructure for emergency response. Despite years of preparation the public health and clinical research community were not ready to respond and opportunities for an immediate research response were missed. Despite warm words and pledges efforts to engage the international community to ensure equitable sharing of limited resources such as antivirals and vaccines fell short and stockpiles in the main remained in the rich world. This manuscript with authors from across the region describes some of the major challenges faced by Asia in response to the pandemic and draws lessons for the future.
Management of heart conditions in older rural and urban Australian women
Authors: Jordan S. , Wilson A. , Dobson A.
Published: June 2011

Background:  Cardiovascular disease death rates are higher among Australians from regional and remote areas than those from major cities.

Aims:  To investigate the causes of excess mortality from heart disease in rural compared to urban Australian women aged over 75 years.

Methods:  In 2004, 944 older urban and rural participants in the Australian Longitudinal Study on Women's Health aged 77–83 years with self‐reported ischaemic heart disease (IHD), heart failure or atrial fibrillation took part in a nested cross‐sectional substudy. We used clinical guidelines to determine key management issues for these conditions. Using logistic regression we calculated odds ratios (OR) and 95% confidence intervals (CI) to assess the relationship between management and area of residence.

Results:  These older Australian women often did not receive recommended management for their heart conditions. Only 30% reported having had an echocardiogram. Reported use of statins and beta‐blockers was low among women with IHD (58% and 41% respectively) and only 32% of women reporting heart failure were taking angiotensin‐converting enzyme inhibitors. Women from regional/remote areas had greater odds of reporting never having seen a cardiologist (OR = 3.88, 95% CI 1.72–8.72) and never having had an echocardiogram than women from major cities (OR = 2.86, 95% CI 1.42–5.75). Medication use was similar for rural and urban women.

Conclusions:  Our results suggest that best‐practice treatments for heart conditions are suboptimally provided to older women. In addition, they suggest differential use of some health services, which might help explain higher cardiovascular mortality among rural compared with urban women.
Identifying patient‐specific beliefs and behaviours for conversations about adherence in asthma
Authors: Foster J. M. , Smith L. , Bosnic‐Anticevich S. Z. , Usherwood T. , Sawyer S. M. , Rand C. S. , Reddel H. K.
Published: June 2011

Background:  Asthma guidelines advise addressing adherence at every visit, but no simple tools exist to assist clinicians in identifying key adherence‐related beliefs or behaviours for individual patients.

Aims:  To identify potentially modifiable beliefs and behaviours that predict electronically recorded adherence with controller therapy.

Methods:  Patients aged ≥14 years with doctor‐diagnosed asthma who were prescribed inhaled corticosteroid/long‐acting β2‐agonist (ICS/LABA) completed questionnaires on medication beliefs/behaviours, side‐effects, Morisky adherence behaviour score and Asthma Control Test (ACT), and recorded spirometry. Adherence with ICS/LABA was measured electronically over 8 weeks. Predictors of adherence were identified by univariate and multivariate analyses.

Results:  99/100 patients completed the study (57 female; forced expiratory volume in 1 s mean ± standard deviation 83 ± 23% predicted; ACT 19.9 ± 3.8). Mean electronically recorded adherence (n= 85) was 75% ± 25, and mean self‐reported adherence was 85% ± 26%. Factor analysis of questionnaire items significantly associated with poor adherence identified seven themes: perceived necessity, safety concerns, acceptance of asthma chronicity/medication effectiveness, advice from friends/family, motivation/routine, ease of use and satisfaction with asthma management. Morisky score was moderately associated with actual adherence (r=−0.45, P < 0.0001). In regression analysis, 10 items independently predicted adherence (adjusted R2= 0.67; P < 0.001). Opinions of friends/family about the patient's medication use were strongly associated with poor adherence. Global concerns about ICS/LABA therapy were more predictive of poor adherence than were specific side‐effects; the one‐third of patients who reported experiencing side‐effects from their steroid inhaler had lower adherence than others (mean 62% vs 81%; P= 0.015).

Conclusions:  This study identified several specific beliefs and behaviours which clinicians could use for initiating patient‐centred conversations about medication adherence in asthma.
Effect of stress parameters on ratcheting deformation stages of polycrystalline OFHC copper
Authors: DAS D. , CHAKRABORTI P. C.
Published: May 2011

Engineering stress‐controlled ratcheting tests under different sets of stress amplitudes and mean stresses show that ratcheting deformation in polycrystalline OFHC copper occurs in three different stages. A plateau region with almost no accumulation of inelastic strain follows general ratcheting deformation during initial loading cycles. With breakdown of the plateau region inelastic ratcheting deformation occurs at an increasingly rapid rate. The effect of the stress amplitude on the ratcheting process is found to be more than mean stress effect. Reconstruction of the ratcheting curves clearly separates the conditions for stress‐controlled low cycle fatigue with zero mean stress and ratcheting with tensile mean stress.
Laparoscopic total colectomy and ileorectal anastomosis (IRA), supported by an enhanced recovery programme in cases of familial adenomatous polyposis
Authors: McNicol F. J. , Kennedy R. H. , Phillips R. K. S. , Clark S. K.
Published: May 2011

Aim  Familial adenomatous polyposis (FAP) is associated with an almost 100% chance of colorectal cancer by the age of 50 years. Surgery is the only prophylaxis. The study compared the outcome of prophylactic laparoscopic colectomy and ileorectal anastomosis (IRA) with conventional open surgery.

Method  A case–control study was carried out including all cases of proven FAP undergoing prophylactic laparoscopic colectomy with IRA between 1 April 2006 and 31 March 2008 using a standardized technique within an enhanced recovery programme (ERAS). All data were collected prospectively. Controls were identified retrospectively from patients who underwent open prophylactic IRA before 31 March 2008 and were matched for age, gender, BMI and ASA. Outcomes included duration of surgery, complications, length of stay, readmission and mortality.

Results  During the study period 25 patients underwent laparoscopic IRA. The median operating time was longer in the laparoscopic group (235 vs 180 mins, P < 0.0001) but the median hospital stay was shorter (6 vs 9 days, P = 0.002). Overall there were fewer complications in the laparoscopic group (20%vs 40%, P = 0.3).

Conclusion  Laparoscopic prophylactic colectomy with IRA in FAP is safe and feasible, and combined with ERAS leads to accelerated recovery and possibly fewer complications than open surgery. FAP patients undergoing prophylactic IRA should be offered laparoscopic surgery.
Experience of hypoglycaemia is associated with changes in beliefs about diabetes in patients with Type 2 diabetes
Authors: Malanda U. L. , Bot S. D. , French D. P. , Kostense P. J. , Wade A. N. , Dekker J. M. , Nijpels G. , Farmer A. J.
Published: May 2011

Diabet. Med. 28, 1395–1400 (2011)

Aim   Hypoglycaemia may have a detrimental impact on quality of life for patients with Type 2 diabetes. There are few clinical studies exploring the impact of experiencing hypoglycaemia on beliefs about diabetes and health status. The aim of this study was to explore associations between experience of hypoglycaemia and changes in diabetes beliefs and self‐reported health status in patients with non‐insulin‐treated Type 2 diabetes using a blood glucose meter.

Methods  One‐year prospective cohort analysis of 226 patients recruited to a randomized trial evaluating the impact of self‐monitoring of blood glucose. Self‐reported hypoglycaemia over 1 year was categorized into three groups: (1) no experience of hypoglycaemia; (2) blood glucose measurements < 4 mmol/l with no associated symptoms of hypoglycaemia (grade 1); and (3) symptomatic hypoglycaemia (grade 2 and 3). Measures of beliefs about diabetes (Revised Illness Perception Questionnaire) and health status (EuroQol‐5D) were assessed at baseline and 1 year. Differences in mean changes over 1 year were explored with analyses of covariance.

Results  There was a significant increase in mean score in beliefs about personal control (1.14; 95% CI 0.14–2.14) among those experiencing grade 1 hypoglycaemia compared with those not experiencing hypoglycaemia. There were no significant differences in changes in health status between groups, with small overall changes that were inconsistent between groups.

Conclusions  This study does not provide support for a long‐term adverse impact on beliefs about diabetes or health status from the experience of mild symptomatic hypoglycaemia, in well‐controlled, non‐insulin‐treated patients with Type 2 diabetes using self‐monitoring of blood glucose.
Preventing corruption in humanitarian assistance: perceptions, gaps and challenges
Authors: Maxwell Daniel , Bailey Sarah , Harvey Paul , Walker Peter , Sharbatke‐Church Cheyanne , Savage Kevin
Published: May 2011

Corruption is a threat to the purpose of humanitarian assistance. Until fairly recently, humanitarian assistance has not been considered an important arena in broader efforts aimed at curbing corruption, and corruption has not always been considered a particularly important concern for humanitarian assistance despite the obviously challenging nature of the context of humanitarian emergencies. Corruption, though, is a threat to humanitarian action because it can prevent assistance from getting to the people who most need it, and because it can potentially undermine public support for such assistance. This paper examines perceptions of corruption and its affects, documents best practices, and outlines gaps in understanding. It suggests recommendations for improving the capacity of humanitarian agencies to prevent and manage the risk of corruption. Agencies have taken steps to combat corruption and improve accountability—downwards and upwards—but scope remains for improvement and for greater sharing of learning and good practice.
Multi‐variate stochastic volatility modelling using Wishart autoregressive processes
Authors: Triantafyllopoulos K.
Published: May 2011

A new multi‐variate stochastic volatility estimation procedure for financial time series is proposed. A Wishart autoregressive process is considered for the volatility precision covariance matrix, for the estimation of which a two step procedure is adopted. The first step is the conditional inference on the autoregressive parameters and the second step is the unconditional inference, based on a Newton‐Raphson iterative algorithm. The proposed methodology, which is mostly Bayesian, is suitable for medium dimensional data and it bridges the gap between closed‐form estimation and simulation‐based estimation algorithms. An example, consisting of foreign exchange rates data, illustrates the proposed methodology.
Miller Fisher syndrome: brief overview and update with a focus on electrophysiological findings
Authors: Arányi Z. , Kovács T. , Sipos I. , Bereczki D.
Published: June 2011

Miller Fisher syndrome (MFS), a variant of the Guillain–Barré syndrome (GBS), is characterized by ophthalmoplegia, ataxia, and areflexia. The annual incidence is around one patient per one million population. The antiganglioside anti‐GQ1b IgG antibody has a role in the pathogenesis of the syndrome, especially of ophthalmoplegia. The presence of this antibody in the serum can be identified in over 80% of the patients, peaking in the first week, whereas albuminocytological dissociation in the cerebrospinal fluid (CSF) appears later. The most consistent electrophysiological findings in MFS are reduced sensory nerve action potentials and absent H reflexes. More variability is seen with F waves and various investigations involving cranial structures. Although there are usually no abnormalities in MFS by routine neuroimaging, in a few cases, contrast enhancement of nerve roots and signs of central nervous system involvement were described supporting the hypothesis of an anti‐GQ1b‐syndrome, a continuum involving GBS, MFS, and Bickerstaff’s brainstem encephalitis. Owing to the lack of randomized trials, treatments used for GBS (intravenous immunoglobulin and plasmapheresis) are usually applied, although from retrospective analyses, the outcome was similar between treated and untreated subjects. The outcome of MFS is usually good with case fatality of < 5%. In the few autopsy cases, macroscopic abnormalities were generally not seen in the nervous system. Microscopic examination of the peripheral nervous system (including cranial nerves) showed segmental demyelination with minimal perivascular infiltration with normal spinal cord and brain stem.
Preventing melasma recurrence: prescribing a maintenance regimen with an effective triple combination cream based on long‐standing clinical severity
Authors: Arellano I. , Cestari T. , Ocampo‐Candiani J. , Azulay‐Abulafia L. , Bezerra Trindade Neto P. , Hexsel D. , Machado‐Pinto J. , Muñoz H. , Rivitti‐Machado M.C. , Sittart J.A. , Trindade de Almeida A.R. , Rego V. , Paliargues F. , Marques‐Hassun K.
Published: May 2011

Background  The relapsing nature of melasma emphasizes the need to maintain efficacy achieved after acute treatment.

Objective  To compare clinical efficacy and safety of two 6‐month Triple Combination (TC; containing fluocinolone acetonide, hydroquinone and tretinoin) maintenance regimens in subjects with moderate to severe melasma, after daily treatment up to 8 weeks.

Methods  This randomized, investigator‐blinded, controlled study had a maintenance phase of 6 months. Sixteen centres in Brazil and Mexico enrolled 242 subjects 18 years or older attaining no or mild melasma after 8 weeks of daily TC applications. Subjects were randomized to receive TC in a twice weekly or tapering regimen [3/week (1st month), 2/week (2nd month), 1/week (4th month)].

Efficacy and safety measurements included median time to relapse and relapse‐free rate, Global Severity Score, Melasma Area and Severity Index score (MASI), subject’s assessment, quality of life questionnaire (MelasQol), and adverse events.

Results  The majority (78.8%) had no or mild melasma (GSS ≤ 1) at week 8 and entered maintenance phase. After 6 months, 53% of patients remained relapse‐free with improved quality of life, and time to relapse was similar between groups (about 190 days). Melasma severity at study entry, not maintenance baseline, influenced relapse rate. The twice weekly regimen tended to show better effectiveness in postponing relapse in severe melasma. Both regimens were safe.

Conclusions  After resolution of melasma with TC, maintenance therapy over 6 months was successful in preventing relapse in over half of the patients who entered maintenance phase. Prescribing medicines should be adapted to patients based on melasma severity.
The effects of product scarcity and consumers' need for uniqueness on purchase intention
Authors: Wu Wann‐Yih , Lu Hsiao‐Yun , Wu Ying‐Yin , Fu Chen‐Su
Published: May 2011

Scarcity strategies are employed by marketers to influence consumer decision making. Many famous brands have been designed and produced for the purpose of as being marketed as limited‐edition products to intensify consumer desire and intention to purchase them. However, very few studies have simultaneously integrated relevant constructs to explain the phenomenon of scarcity purchasing. To fill this void, this study develops a comprehensive research model in order to fully understand how scarcity affects consumer value perception and purchase intention. Simultaneously, two competing models are developed to compare the explanation power of Lynn's Scarcity–Expensiveness–Desirability (S‐E‐D) model and Synde and Fromkin's desire for uniqueness model. The results suggest that the effects of scarcity on purchase intention through perceived uniqueness, perceived sacrifice and perceived value are stronger than the scarcity effects through assumed expensiveness, perceived quality, perceived sacrifice and perceived value.
Incidence of cervical intraepithelial neoplasia grade 2 or worse in colposcopy‐negative/human papillomavirus‐positive women with low‐grade cytological abnormalities
Authors: Kelly RS , Walker P , Kitchener H , Moss SM
Published: May 2011

Please cite this paper as: Kelly R, Walker P, Kitchener H, Moss S. Incidence of cervical intraepithelial neoplasia grade 2 or worse in colposcopy‐negative/human papillomavirus‐positive women with low‐grade cytological abnormalities. BJOG 2012;119:20–25.

Objective  To determine the risk of incident high‐grade cervical intraepithelial neoplasia (CIN) in human papillomavirus (HPV) ‐positive women with low‐grade cytological abnormalities who had a satisfactory normal colposcopy.

Design  A retrospective follow‐up study within the NHS HPV/LBC pilot studies.

Setting  The NHS Cervical Screening Programme in England.

Population  A total of 1063 HPV‐positive women with borderline or mild dyskaryosis who were negative at colposcopy from three sites within the NHS HPV/liquid‐based cytology (LBC) pilot studies.

Methods  HPV triage took place in 2001/02. In 2009 all information on additional management on HPV‐positive/colposcopy‐negative women was requested. The rate of disease following a negative colposcopy was calculated, and survival analysis was used to determine whether the grade of referral cytology impacted on risk of subsequent disease. Results were compared with those in women from the same population who had not been HPV triaged.

Main outcome measures  Incident CIN2 or worse during follow up.

Results  Of 1063 eligible women 965 had documented follow up. The cumulative rate of CIN2+ at 3 years in these women was 4.4% (95% CI 4.0–7.0%); the median time from normal colposcopy to final result was 27 months. There was no significant increase in the risk of future disease associated with age or initial cytology result.

Conclusions  The rate of subsequent high‐grade CIN among colposcopically negative triaged women was sufficiently low to justify return to routine recall.
Geography and global health
Authors: BROWN TIM , MOON GRAHAM
Published: June 2011

In the wake of the report of the World Health Organisation's Commission on the Social Determinants of Health,Closing the gap in a generation(Marmot 2008), this invited commentary considers the scope for geographical research on global health. We reflect on current work and note future possibilities, particularly those that take a critical perspective on the interplay of globalisation, security and health.
NSAID gastropathy and enteropathy: distinct pathogenesis likely necessitates distinct prevention strategies
Authors: Wallace John L
Published: May 2011

The mechanisms underlying the ability of nonsteroidal anti‐inflammatory drugs (NSAIDs) to cause ulceration in the stomach and proximal duodenum are well understood, and this injury can largely be prevented through suppression of gastric acid secretion (mainly with proton pump inhibitors). In contrast, the pathogenesis of small intestinal injury induced by NSAIDs is less well understood, involving more complex mechanisms than those in the stomach and proximal duodenum. There is clear evidence for important contributions to NSAID enteropathy of enteric bacteria, bile and enterohepatic recirculation of the NSAID. There is no evidence that suppression of gastric acid secretion will reduce the incidence or severity of NSAID enteropathy. Indeed, clinical data suggest little, if any, benefit. Animal studies suggest a significant exacerbation of NSAID enteropathy when proton pump inhibitors are co‐administered with the NSAID. This worsening of damage appears to be linked to changes in the number and types of bacteria in the small intestine during proton pump inhibitor therapy. The distinct mechanisms of NSAID‐induced injury in the stomach/proximal duodenum versus the more distal small intestine likely dictate distinct strategies for prevention.
Preliminary evidence for biologic activity of toceranib phosphate (Palladia®) in solid tumours
Authors: London C. , Mathie T. , Stingle N. , Clifford C. , Haney S. , Klein M. K. , Beaver L. , Vickery K. , Vail D. M. , Hershey B. , Ettinger S. , Vaughan A. , Alvarez F. , Hillman L. , Kiselow M. , Thamm D. , Higginbotham M. L. , Gauthier M. , Krick E. , Phillips B. , LaDue T. , Jones P. , Bryan J. , Gill V. , Novasad A. , Fulton L. , Carreras J. , McNeill C. , Henry C. , Gillings S.
Published: June 2011

The purpose of this study was to provide an initial assessment of the potential biologic activity of toceranib phosphate (Palladia®, Pfizer Animal Health, Madison, NJ, USA) in select solid tumours in dogs. Cases in which toceranib was used to treat dogs with apocrine gland anal sac adenocarcinoma (AGASACA), metastatic osteosarcoma (OSA), thyroid carcinoma, head and neck carcinoma and nasal carcinoma were included. Clinical benefit (CB) was observed in 63/85 (74%) dogs including 28/32 AGASACA [8 partial response (PR), 20 stable disease (SD)], 11/23 OSAs (1 PR and 10 SD), 12/15 thyroid carcinomas (4 PR and 8 SD), 7/8 head and neck carcinomas [1 complete response (CR), 5 PR and 1 SD] and 5/7 (1 CR and 4 SD) nasal carcinomas. For dogs experiencing CB, the median dose of toceranib was 2.8 mg kg−1, 36/63 (58.7%) were dosed on a Monday/Wednesday/Friday basis and 47/63 (74.6%) were treated 4 months or longer. Although these data provide preliminary evidence that toceranib exhibits CB in dogs with certain solid tumours, future prospective studies are necessary to define its true activity.
Topical prolyl hydroxylase domain‐2 silencing improves diabetic murine wound closure
Authors: Wetterau Meredith , George Finny , Weinstein Andrew , Nguyen Phuong D. , Tutela John Paul , Knobel Denis , Cohen, BA Oriana , Warren Stephen M. , Saadeh Pierre B.
Published: May 2011

Prolyl hydroxylase domain 2 (PHD2) has been implicated in several pathways of cell signaling, most notably in its regulation of hypoxia‐inducible factor (HIF)‐1α stability. In normoxia, PHD2 hydroxylates proline residues on HIF‐1α, rendering it inactive. However, in hypoxia, PHD2 is inactive, HIF‐1α is stabilized and downstream effectors such as vascular endothelial growth factor and fibroblast growth factor‐2 are produced to promote angiogenesis. In the present study we utilize RNA interference to PHD2 to promote therapeutic angiogenesis in a diabetic wound model, presumably by the stabilization of HIF‐1α. Stented wounds were created on the dorsum of diabetic Lepr db/db mice. Mice were treated with PHD2 small interfering RNA (siRNA) or nonsense siRNA. Wounds were measured photometrically on days 0–28. Wounds were harvested for histology, protein, and RNA analysis. Diabetic wounds treated with siRNA closed within 21±1.2 days; sham‐treated closed in 28±1.5 days. By day 7, Western blot revealed near complete suppression of PHD protein and corresponding increased HIF‐1α. Angiogenic mediators vascular endothelial growth factor and fibroblast growth factor‐2 were elevated, corresponding to increased CD31 staining in the treated groups. siRNA‐mediated silencing of PHD2 increases HIF‐1α and several mediators of angiogenesis. This corresponded to improved time to closure in diabetic wounds compared with sham‐treated wounds. These findings suggest that impaired wound healing in diabetes can be ameliorated with therapeutic angiogenesis.
Impact of Oxygenator Selection on Hemodynamic Energy Indicators Under Pulsatile and Nonpulsatile Flow in a Neonatal Extracorporeal Life Support Model
Authors: Vasavada Rahul , Khan Sameer , Qiu Feng , Kunselman Allen , Ündar Akif
Published: May 2011

This study compared the quality of perfusion delivered by two oxygenators—the hollow‐fiber membrane Capiox Baby RX05 and silicone membrane Medtronic 0800—using hemodynamic energy indicators. The oxygenators were tested across varying flow rates and perfusion modes in a neonatal extracorporeal life support (ECLS) model. The experimental ECLS circuit included a Jostra HL‐20 heart/lung machine with Jostra Roller pump, oxygenators with associated tubing and components, and a neonatal pseudo‐patient. We used a 40/60 glycerin/water solution in the circuit as a blood analog. Testing occurred at flow rates of 250, 500, and 750 mL/min at 37°C under both pulsatile and nonpulsatile flow conditions. Hemodynamic data points consisted of recording 20‐s intervals of data, and a total of 96 experimental repetitions were conducted. The pressure drop across the Capiox Baby RX05 oxygenator was significantly lower than the pressure drop across the Medtronic 0800 at all flow rates and perfusion modes. Furthermore, the Medtronic 0800 oxygenator showed significantly lower post‐oxygenator energy equivalent pressures, total hemodynamic energy values, and surplus hemodynamic energy retention values compared to those of the Capiox Baby RX05. These results indicate the Medtronic 0800 oxygenator significantly dampens the hemodynamic energy compared to the Capiox Baby RX05. Consequently, clinical use of the Medtronic 0800 in a pulsatile ECLS setting is likely to mitigate the benefits provided by pulsatile flow. In contrast, the Capiox Baby RX05 better transmits hemodynamic energy to the patient with much lower pressure drop.