bluuebunny/crossref_metadata_2025 huggingface dataset:
Aggression towards health care staff in a UK general hospital: variation among professions and departments
Authors: Winstanley Sue , Whittington Richard
Published: December 2004

Background.  Aggression towards health care staff is an increasing problem and although many studies have examined psychiatric settings, few have considered general hospitals and in particular, variation among professions and locations. In addition, studies often fail to include all forms of aggression such as threatening behaviour and verbal aggression.

Methods.  This study extends existing research by evaluating physical assault, threatening behaviour and verbal aggression from patients/visitors towards general hospital staff in the context of different professions and departments.

Results and conclusions.  The survey of staff showed that aggression is widespread. Within the preceding year, 27% of the respondents were assaulted, 23% experienced threatening behaviour from patients and 15.5% experienced threatening behaviour from visitors. Over 68% reported verbal aggression, 25.7% experiencing it more regularly than monthly. By departments, over 42% of the medical department staff, 36% of the surgical staff and over 30% of the Accident and Emergency staff were assaulted. By profession, staff nurses and enrolled nurses reported the most assaults (43.4%) and doctors, the fewest (13.8%). Other nursing grades and health care professions all reported levels of physical assault in excess of 20%. Correspondingly high levels of threatening behaviour and verbal aggression were also reported although the patterns of victimization differed according to the various professions and departments. Independently, significant levels of assault, threatening behaviour and verbal aggression were reported. When aggregated they demonstrate the higher levels of victimization that general hospital staff experienced on a regular basis.

Relevance to clinical practice.  Institutional averages actually obscure the much higher levels of aggression experienced by the particular professions in particular departments. This study helps to localize the problem and identify those at most risk, but more research is needed into the aetiology of the aggression and of vulnerability factors associated with victimization.
The meaning of caring to nurses: an investigation into the nature of caring work in an intensive care unit
Authors: Wilkin Kathleen , Slevin Eamonn
Published: December 2004

Background.  The purpose of the study was to generate knowledge, which informs the discipline of nursing as caring represents an essential human need. Despite the wealth of research discussing caring in nursing, little is related to the highly technological intensive care unit environment.

Aims of the study.  To explore the meaning of caring to intensive care unit nurses. To determine if the meaning of caring to these nurses has potential for altering nursing practice and to gain an insight into how caring experiences were evident to them.

Design and method.  The design of the study was descriptive and qualitative. Semi‐structured interviews were conducted to collect data on the experiences of twelve nurses who were selected by purposive sampling. Data analysis involved using Colaizzi's reductive procedure.

Results.  Findings suggest that the nurses in the study participated in delivering holistic and humane care of the patient and their relatives. The essential structure of caring was identified as a process of competent physical and technical action imbued with affective skills.

Conclusions.  This study revealed caring to be synonymous with nursing. The descriptive accounts of the nurses’ experiences of caring in this study attempt to illuminate the nature of intensive care unit nursing. It legitimates, from the perspectives of these particular participants, the importance of caring. The participants described caring as a process involving feelings together with professional knowledge, competence, skill and nursing action. This involved the holistic care of the patient and relatives in meeting their individual needs.

Relevance to clinical practice.  This study demonstrated that the lived experience of caring reflects the humanistic nature of nursing. It confirms that to care is human and the capacity to care is affirmed and actualised in caring for the critically ill patient and their relatives.
Standardized care plans: experiences of nurses in Taiwan
Authors: Lee Ting‐Ting , Chang Pi‐Chen
Published: December 2004

Background.  Nursing care plans have been viewed as structured plans of action for patient care. Studies have investigated the outcomes or effectiveness of using different types of care plans, but have seldom reported nurses’ perceptions of using care plans in daily practice.

Aims and objectives.  The purpose of this study was to explore nurses’ experiences using a standardized care plan.

Design.  Nineteen clinical nurses at a teaching hospital in Taiwan were interviewed one‐on‐one and in depth from April to June 2000. Data analysis was based on Miles and Huberman's data reduction, data display, and a conclusion verification process to identify themes and concepts that represented nurses’ experiences using a care plan.

Results.  The following themes emerged from the interview data: being reminded of care procedures, time‐saving in making care plans, time‐consuming in making shift reports, undesirable content design, and paperwork‐oriented/not patient‐centered.

Conclusion.  With the considerable amounts of money spent on education and training to meet nurses’ needs, a careful examination of nurses’ experiences in using care plans, should assist in care plan development and lead to observable effects on patient care.

Relevance to clinical practice.  Nursing documentation reflects nurses’ observations, assessments, and interventions. It is expected that better use of standardized care plans will enhance nurses’ access to appropriate and accurate information in decision‐making, thus improving the charting process and care quality.
Blood exposure: factors promoting health care workers’ compliance with guidelines in connection with risk
Authors: Lymer Ulla‐Britt , Richt Bengt , Isaksson Barbro
Published: December 2004

Background.  Health care workers compliance with guidelines, universal precautions, in connection with tasks that could involve contact with patient's blood is unsatisfactory. In a previous paper, we identified different forces that undermine compliance. Socialization into infection control, routinization, stereotyping, perceptions of patients’ wishes and the presence of competing values and norms are examples of such forces.

Aims and objectives.  The aim of this article is to describe and analyse different forces that promote adherence to universal precautions. Behavioural variations are seen as a consequence of differences between wards with regard to the safety culture. Safety culture is conceptualized as the outcome of a constant interplay between deactivating and reactivating forces. In this article the focus is on the latter.

Method.  The grounded theory approach. Data were collected through interviews with nurses and assistant nurses.

Results.  The charge nurse, informal leaders, students, infection control nurses, type of work, availability of equipment, blood‐exposure incidents and media‐coverage of infectious diseases are described as potentially important for compliance. The properties these agents must possess in order to be influential are also described.

Relevance to clinical practice.  The outcome of an occupationally acquired infection can be fatal. Hence it is important that health care workers take protective measures. The results imply that mere information about safe practices alone is insufficient to achieve that goal. All factors of importance for compliance must be taken in to consideration in clinical work and in education.
Technology – an actor in the ICU: a study in workplace research tradition
Authors: Wikström Ann‐Charlott , Larsson Ullabeth Sätterlund
Published: December 2004

Background. The present study focuses on human–machine interaction in an intensive care unit in the West of Sweden.

Aims. The aim of the present study was to explore how technology intervenes and challenges the ICU staff's knowing in practice.

Theoretical perspective. The study's theoretical starting point draws on workplace research tradition. Workplace studies encompass the interaction between the actors’ situated activities and the technological tools that make their activities possible.

Method. Fieldwork orin situstudies of everyday practice in an intensive care unit documented in written field notes constituted the data.

Results. The findings show first how technology intervenes in the division of labour when the taken‐for‐granted ‘old’ everyday practice is disrupted when a new machine intervenes in the morning's work; secondly, it reveal how technology challenges practical knowing and thirdly, it shows how technology reformulates practice. Staff members’ awareness of routine problems is often connected to the ability to see, which is always related to cultural/contextual competence.

Conclusion. It is concluded that it is not talk alone that helps the caregivers to ‘(dis)solve’ the problems. The ability to see the problems, the work environment and to find the relevant supporting tools for ‘(dis)solving’ the routine problems is also crucial. But it is not possible to say that it is the skillful work of humans that solve problems, nor do we claim it is the tools that do so. Humans and tools are interwoven in the problem‐solving process.

Relevance to clinical practice. Routine problems in the intensive care unit are not ‘(dis)solved’ through the cognitive work of individual staff members alone. Problems are also ‘(dis)solved’ jointly with other staff members. Staff members ‘borrow’ the knowing from each other and problems are re‐represented through communication. The knowing has to be distributed among the intensive care unit staff to make the everyday work flexible.
Discharge planning: ‘fooling ourselves?’– patient participation in conferences
Authors: Efraimsson Eva , Sandman PO , Hydén Lars‐Christer , Rasmussen Birgit H
Published: December 2004

Background.  The aim of discharge planning conferences (DPCs) is to co‐ordinate resources and to enhance patient involvement in care in connection with relocation from hospital. DPCs can be characterized as institutional conversations, and are often executed as standard procedures, but the scientific basis for the activity is weak.

Aims and objectives.  The aim of this study was to illuminate and describe the communication at DPCs.

Design.  A purposeful and consecutive sample of eight DPCs was collected in which the future care of eight women, aged 70 years or more, was discussed.

Methods.  Transcribed video recordings were analysed in two steps. ‘The initial analysis’ aimed at describing the structure and content of the communication. This description constituted the basis for an interpretation, leading to ‘the focused analysis’ aiming at finding evidence for the assumptions made in the interpretation.

Results.  The result revealed that the participation of patients was very less the DPCs. The decisions had often already been made, and the women were expected to be pleased with the decision; institutional representatives (IRs) frequently justified their actions by referring to bureaucratic praxis.

Conclusions.  The women were both encouraged and excluded from participation by the IRs. This dichotomy occurred because the IRs, as professionals, struggled to simultaneously realize their caring mission and their obligation to enforce the values and rules of the institution, i.e. efficiency and rationality. Thus, IRs and patients were equally imprisoned within the institutional system.

Relevance to clinical research.  This result illustrates how conflicting paradigms are imbedded and reproduced by healthcare professionals in their communicative praxis. Awareness of this is a prerequisite for improvements in working procedures congruent with a caring paradigm that support patient participation.
Caring and uncaring encounters in nursing in an emergency department
Authors: Wiman Elisabeth , Wikblad Karin
Published: December 2004

Background.  Caring is a core characteristic of nursing. Nurses’ caring behaviour has been explored in several studies. When caring for trauma patients, the most important caring behaviour must be the procedures associated with lifesaving. However, it is important not to forget the patient's psychological needs.

Aim.  The aim of this study was to highlight encounters between injured patients and nurses in the trauma team and to explore whether the theory of caring and uncaring encounters in nursing and health care is applicable in emergency care.

Data collection and analysis.  Data were collected by videotaping caring episodes between slightly injured patients and nurses in the trauma team. Five episodes involving 10 nurses were studied. The analysis was carried out in four steps. First the videotapes were studied several times and then transcribed into narratives, which were reduced into courses of events. These were subsequently classified according to aspects of caring and uncaring.

Results.  The nurses’ verbal and non‐verbal communication was poor, and they adopted a wait‐and‐see policy. A new uncaring aspect, instrumental behaviour, emerged from this poor communication. One of the caring aspects, being dedicated and having courage to be appropriately involved, could not be identified. Most encounters included several aspects of caring and uncaring, but the uncaring aspects predominated. The dominance of uncaring aspects indicates a lack of affective caring behaviour.

Conclusion.  The result showed that the theory is partly applicable in emergency care. A new aspect, instrumental behaviour emerged. The nurses’ behaviour in the five episodes was labelled as uncaring. Authentic nurse–patient encounters are essential in nursing.

Relevance to clinical practice.  The importance of meeting patients’ psychological needs and nurses’ affective caring behaviour should be emphasized in trauma care, trauma courses and nursing education. It is necessary to measure the caring behaviour of trauma nurses.
Older people living in nursing homes or other community care facilities: Registered Nurses’ views of their working situation and co‐operation with family members
Authors: Weman Karin , Kihlgren Mona , Fagerberg Ingegerd
Published: December 2004

Background.  Little attention has been paid to Registered Nurses’ working conditions and how they experience their working situation in community health care. The nurses’ vocational background is of interest, as well as their apprehension about communicating and co‐operating with the older persons’ family members.

Aims and objectives.  The aim of the study was to describe Registered Nurses’ views of their working situation in community health care and of co‐operation with family members of older people living in nursing homes or similar facilities.

Design.  The study was carried out in a geographically defined area in the south of Sweden. A questionnaire was sent to all the Registered Nurses (n = 314) working within community health care of whom 210 Registered Nurses replied to the questionnaires.

Methods.  Latent content analysis was used on the comments to six questions, in order to illuminate the statistical findings from the statements of the questions measured by the Likert scale.

Results.  The results showed that almost half of the Registered Nurses working in care of older people are not satisfied with their working situation. The nurses with less than 5 years working experience find their working situation most stimulating. All of them expressed that it is important that there is co‐operation between themselves and the family members and it was also considered important to develop models that could improve co‐operation. Male nurses believed, to a lesser extent, that family members were a resource in caring, compared with female nurses; however, all male nurses stressed the importance of facilitating informal caregivers. Nurses with more than 5 years of working experience expressed that it was important that family members show engagement in caring for older people. Furthermore, they expressed that it was necessary that the family members took care of the older persons’ interests.

Relevance to clinical practice.  The findings that half of the Registered Nurses are dissatisfied with their working situation have relevance in clinical practice because of the risk of losing competent nurses in this area.
Association of psoriasis vulgaris with HLA class I and class II antigens in the Turkish population, according to the age at onset
Authors: Kundakçi N. , Oskay T. , Ölmez Ü. , Tutkak H. , Gürgey E.
Published: December 2004

Background Association of psoriasis vulgaris with HLA antigens reference to age at onset has been reported in different racial or ethnic populations.

Objective Our purpose was to determine the distribution of HLA markers in the Turkish population according to the age at onset of the psoriasis vulgaris.

Methods HLA class I and class II antigens were performed by serologic methods in a group of 100 Turkish patients with psoriasis and 201 control subjects. Patients with psoriasis were subdivided into two groups based on age at onset (below or above 40 years of age) and family history.

Results The frequency of HLA A30, Cw3, Cw6, DR7, DR14, DQ8, and DQ9 antigens were significantly increased in the Turkish psoriatic patients whereas HLA A66, Cw2, Cw4 and DR11 were found to be negatively associated with psoriasis. However, there were striking differences in HLA antigens according to the age at onset of the disease. Type I, early onset was associated with a high frequency of A30, B50, Cw6 and DR7 antigens whereas patients with type II, late onset had an increased frequency of Cw7.

Conclusions We conclude that psoriasis is probably a genetically determined disease and suggest that HLA‐Cw6 antigen seems to associate commonly with early onset of psoriasis in Turkish patients.
Treatment of late‐stage Sézary syndrome with 2‐Chlorodeoxyadenosine
Authors: Bouwhuis Saskia A. , El‐Azhary Rokea A. , McEvoy Marian T. , Gibson Lawrence E. , Habermann Thomas M. , Witzig Thomas E. , Pittelkow Mark R.
Published: December 2004

Background  2‐Chlorodeoxyadenosine (2‐CdA), a purine adenosine analog, is safe and effective chemotherapy for patients with hairy cell leukemia and low‐grade lymphomas. Adverse effects include neutropenia, lymphocytopenia, and infectious complications. Our objective was to evaluate the efficacy of 2‐CdA (2–6 seven‐day cycles) in the treatment of late‐stage, recalcitrant Sézary syndrome.

Methods  Retrospective review of medical records of six patients with Sézary syndrome who had received 2‐CdA cycles at Mayo Clinic, Rochester between March 1995 and March 2000. Variables assessed from the records included improvement in global appearance, extent of erythroderma, size of lymph nodes, pruritus, and leukocyte, lymphocyte, and absolute Sézary cell counts.

Results  Two patients, both with stage III Sézary syndrome, whose previous treatment consisted of only two modalities, responded well to the treatment, with moderate to total clearing of erythroderma and pruritus associated with a significant decrease in Sézary cell counts. The other four patients had only a partial response (one patient) or no response (three patients) to 2‐CdA. The mortality rate was 50%. All three patients died of Staphylococcus aureus sepsis. However, only one patient was receiving 2‐CdA treatment when he died. The other two patients died 8 and 9 weeks after the last 2‐CdA cycle. This high mortality rate is attributed to infectious complications after 2‐CdA treatment in patients with recalcitrant disease.

Conclusion  2‐Chlorodeoxyadenosine shows efficacy in stage III Sézary syndrome, but it also carries a substantial risk of septic complications and mortality. It can be used if no other suitable alternatives are available. Caution should be exercised in all these patients regarding skin care and avoidance of infections or sepsis.
Bullous erythema nodosum leprosum (bullous type 2 reaction)
Authors: Sethuraman Gomathy , Jeevan Divakaran , Srinivas Chakravarthy Rangachary , Ramu Gopal
Published: December 2004

A 35‐year‐old man suffering from lepromatous leprosy with recurrent erythema nodosum leprosum (ENL) (bullous type 2 reaction) was admitted for acute exacerbation of the reaction. He had received regular WHO multibacillary multidrug therapy (WHO‐MB‐MDT) and corticosteroids for 11 months. The dose of corticosteroids could not be tapered below 20 mg/day due to sudden, frequent, and severe relapses of ENL. In hospital, he suddenly developed hypotension for which he was moved to the intensive care unit and managed. On the third day, he developed multiple, flaccid and tense bullae, some of which were hemorrhagic, over the face, trunk, and proximal extremities (Fig. 1). Some of the ENL lesions showed a central bluish hue. Investigations revealed leukocytosis, thrombocytopenia, and hypokalemia. Blood culture yielded coagulase‐negative Staphylococcus aureus. Slit skin smear and smear from the blister fluid showed numerous, fragmented, acid‐fast bacilli (AFB) in clusters and many neutrophils (Fig. 2). Skin biopsy revealed a subepidermal bulla that consisted of neutrophils and macrophage granulomas in the dermis together with perivascular neutrophilic infiltration (Fig. 3); however, there were no features suggestive of vasculitis. Fite's stain demonstrated fragmented AFB. Both direct and indirect immunofluorescence studies did not show features of autoimmune bullous disorders; however, moderately strong discontinuous fibrinogen deposits were seen along the basement membrane and around the blood vessels. There were no deposits of immunoglobulin G (IgG) and C3. He was treated with antimicrobials, potassium chloride, and hydrocortisone, 100 mg intravenously, twice daily, which was subsequently switched to oral prednisolone. He responded well and was discharged. Upon lowering the dose of corticosteroids, he again developed severe ENL with fewer bullous lesions.

Multiple, tense, hemorrhagic bullae over the trunk

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Smear from the blister fluid showing numerous, fragmented, acid‐fast bacilli (AFB) and neutrophils (Ziehl–Neelsen stain, × 200)

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Photomicrograph of the skin biopsy showing subepidermal bulla consisting of neutrophils and macrophage granulomas in the dermis together with perivascular neutrophilic infiltration (hematoxylin and eosin, × 200)

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Flycatcher song in allopatry and sympatry – convergence, divergence and reinforcement
Authors: Haavie J. , Borge T. , Bures S. , Garamszegi L. Z. , Lampe H. M. , Moreno J. , Qvarnström A. , Török J. , Sætre G.-P.
Published: December 2004

The theory of reinforcement predicts that natural selection against the production of unfit hybrids favours traits that increase assortative mating. Whether culturally inherited traits, such as bird song, can increase assortative mating by reinforcement is largely unknown. We compared songs of pied (Ficedula hypoleuca) and collared flycatchers (F. albicollis) from two hybrid zones of different ages with songs from allopatric populations. Previously, a character divergence in male plumage traits has been shown to reinforce premating isolation in sympatric flycatchers. In contrast, we find that the song of the pied flycatcher has converged towards that of the collared flycatcher (mixed singing). However, a corresponding divergence in the collared flycatcher shows that the species differences in song characters are maintained in sympatry. Genetic analyses suggest that mixed song is not caused by introgression from the collared flycatcher, but rather due to heterospecific copying. Circumstantial evidence suggests that mixed song may increase the rate of maladaptive hybridization. In the oldest hybrid zone where reinforcement on plumage traits is most pronounced, the frequency of mixed singing and hybridization is also lowest. Thus, we suggest that reinforcement has reduced the frequency of mixed singing in the pied flycatcher and caused a divergence in the song of the collared flycatcher. Whether a culturally inherited trait promotes or opposes speciation in sympatry may depend on its plasticity. The degree of plasticity may be genetically determined and accordingly under selection by reinforcement.
Who, when and where? Identification of patients at risk of an in‐hospital adverse event: Implications for nursing practice
Authors: Considine Julie , Botti Mari
Published: December 2004

Patients who suffer an adverse event (AE) are more likely to die or suffer permanent disability. Many AEs are preventable. Nurses have long played a pivotal role in the prevention of AEs. Much of the literature to date pertains to the role of nurses in the prevention of AEs such as falls, pressure areas and deep vein thrombosis. Prominent risk factors for AEs are the presence of physiological abnormality, failure to recognize or correct physiological abnormality, advanced patient age and location of patient room. Ongoing physiological assessment of patients is a nursing responsibility and the assessment findings of nurses underpin many patient care decisions. The early recognition and correction of physiological abnormality can improve patient outcomes by reducing the incidence of AEs, making nurses’ ability to identify, interpret and act on physiological abnormality a fundamental factor in AE prediction and prevention. This paper will examine the role of nurses in AE prevention, using cardiac arrest as an example, from the perspective of physiological safety; that is, accurate physiological assessment and the early correction of physiological abnormality.
The attitudes, concerns, gloving practices and knowledge of nurses in a Taiwanese hospital regarding AIDS and HIV
Authors: Juan Chi‐Wen , Siebers Robert , Wu Francis Fu‐Sheng , Wu Chia‐Ju , Chang Yu‐Jun , Chao Cindy
Published: December 2004

Many studies have documented nurses’ attitudes and concerns regarding AIDS/HIV, but little is known about Taiwanese nurses. We documented attitudes, concerns, gloving practices and practical AIDS/HIV knowledge of 1090 nurses from one metropolitan hospital in Changhua City, Taiwan. The response rate was 80.9%. Both HIV and hepatitis contraction in the workplace was nurses’ main concern. Two hundred and ten nurses (19.3%) were seriously considering leaving nursing because of fear of contracting AIDS/HIV. Virtually all nurses considered it their right to be informed of the presence of HIV‐positive patients in their direct work area and many believed that HIV testing of patients should be mandatory. Practical AIDS/HIV knowledge was deficient. These Taiwanese nurses have concerns and fears that might be related to deficiencies in practical AIDS/HIV knowledge. Continuous educational programmes are recommended to alleviate these nurses’ attitudes and concerns regarding AIDS/HIV.
A systematic review on the effectiveness of alcohol‐based solutions for hand hygiene
Authors: Picheansathian Wilawan
Published: December 2004

The use of alcohol has been proposed as an option for hand hygiene. A systematic review was conducted to evaluate the clinical evidence supporting the use of alcohol‐based solutions in hospitals as an option for hand hygiene. Studies published between January 1992 and April 2002 in English and Thai, related to the effectiveness of alcohol‐based solutions, were reviewed. The databases searched included Medline, DARE, CINAHL and Dissertation Abstracts International. All studies were assessed as having adequate methodological quality. Results of this systematic review supported that alcohol‐based hand rubbing removes microorganisms effectively, requires less time and irritates hands less often than does handwashing with soap or other antiseptic agents and water. Furthermore, the availability of bedside alcohol‐based solutions increases compliance with hand hygiene among health care workers.
Significance of renal function in changes in acid–base metabolism after orthotopic bladder replacement: Colon neobladder compared with ileal neobladder
Authors: MIYAKE HIDEAKI , HARA SHOJI , ETO HIROSHI , ARAKAWA SOICHI , KAMIDONO SADAO , HARA ISAO
Published: December 2004

Background:  The objective of this study was to determine whether renal function influences the acid–base metabolism in patients undergoing orthotopic bladder replacement using intestinal segment.

Methods:  Acid–base balance, serum electrolytes and renal function were studied in 30 patients with colon neobladder and 18 patients with ileal neobladder. Mean follow up was 51 months. Effects of renal function on acid–base metabolism in both types of bladder replacement were compared. Therapeutic efficacy of the sodium bicarbonate administration was also evaluated in cases with hyperchloremic acidosis.

Results:  No significant differences were observed in any of the variables examined between the colon and ileal neobladder groups, except for potassium concentration. Although metabolic acidosis was detected using the Siggard–Anderson acid–base nomogram in eight (26.7%) and seven (38.9%) patients in the colon and ileal neobladder groups, respectively, this difference was not significant. In both the colon and ileal neobladder groups, the serum creatinine concentrations in patients diagnosed with metabolic acidosis were significantly higher than in those diagnosed with a normal metabolic status. Furthermore, as a result of severe metabolic acidosis, three (10.0%) and three (16.7%) patients in the colon and ileal neobladder groups, respectively, were administered sodium bicarbonate and their metabolic status was fully normalized.

Conclusions:  Despite there being no statistical difference, patients with ileal neobladder may more easily develop metabolic acidosis compared with those with colon neobladder. In addition, a close association between the serum creatinine level and the degree of metabolic acidosis was observed in both groups. However, even if severe metabolic acidosis occurs, it is relatively easy to correct using sodium bicarbonate. These findings suggest that it might be safe to use a colon segment for orthotopic bladder reconstruction in patients with higher serum creatinine levels, despite no significant difference in acid–base metabolism and detection rates of metabolic acidosis between the colon and ileal neobladder groups.
Combination of a cholinergic drug and an α‐blocker is more effective than monotherapy for the treatment of voiding difficulty in patients with underactive detrusor
Authors: YAMANISHI TOMONORI , YASUDA KOSAKU , KAMAI TAKAO , TSUJII TOSHIHIKO , SAKAKIBARA RYUJI , UCHIYAMA TOMOYUKI , YOSHIDA KEN‐ICHIRO
Published: December 2004

Aim:  The aim of the present study was to compare the effectiveness of a cholinergic drug, an α‐blocker and combinations of the two for the treatment of underactive detrusor.

Methods:  One hundred and nineteen patients with underactive bladder were assigned to three groups: the cholinergic group, consisting of 40 patients taking bethanechol chloride (60 mg/day) or distigmine bromide (15 mg/day); the α‐blocker group, consisting of 38 patients taking urapidil (60 mg/day); and the combination group, consisting of 41 patients taking both a cholinergic drug and an α‐blocker. The effectiveness of each therapy was assessed 4 weeks after initialization of the therapy.

Results:  Total urinary symptom scores (International Prostate Symptom Score, IPSS) remained unchanged after the cholinergic therapy, but were significantly lower after the α‐blocker treatment (P = 0.0001) and the combination therapy (P = 0.0001). With regard to the total IPSS, there were significant differences between the cholinergic and the α‐blocker groups (P = 0.0008), and also between the cholinergic and combination groups (P = 0.0033), in favor of the latter. The average and maximum flow rates did not increase significantly after monotherapy with either the cholinergic drug or the α‐blocker, but they significantly increased after combination therapy compared to baseline values (P = 0.0033 and P= 0.0004, respectively). Postvoid residual volume did not decrease significantly after the cholinergic drug therapy, but decreased significantly after the α‐blocker (P = 0.0043) and the combination therapies (P = 0.0008). The percentage of residual urine decreased significantly after therapy in all groups (P = 0.0005, P= 0.0176 and P= 0.0001, respectively).

Conclusion:  Combination therapy with a cholinergic drug and an α‐blocker appears to be more useful than monotherapy for the treatment of underactive detrusor.
Towards more effective use of decision support in clinical practice: what the guidelines for guidelines don’t tell you
Authors: Scott I. A. , Denaro C. P. , Bennett C. J. , Mudge A. M.
Published: December 2004

The Brisbane Cardiac Consortium Clinical Support Systems Program used multiple strategies in optimising quality of care of patients with either of two cardiac conditions. One of these strategies was the development and active implementation of decision support systems centred on evidence‐based, locally agreed clinical practice guidelines. Our experience in undertaking this task highlighted numerous operational challenges for which solutions were difficult to extract from existing published literature. In the present article we provide a methodology grounded in both theory and real‐world experience that may assist others in developing and implementing systems of guideline‐based decision support. (Intern Med J 2004; 34: 492−500)
Percutaneous pulmonary vein isolation for treatment of atrial fibrillation
Authors: Thomas S. P. , Boyd A. C. , Aggarwal G. , Jin Y. , Ross D. L.
Published: December 2004

Background:  Transvenous catheter ablation for the treatment of atrial fibrillation is an evolving technique.

Aim:  The purpose of this study was to identify subgroups of patients most likely to benefit from pulmonary vein electrical isolation.

Methods:  Patients with symptomatic atrial fibrillation resistant to pharmacological therapy were studied. Mapping‐guided segmental application of radio­frequency energy was used to electrically isolate the pulmonary veins in 74 patients. Ischaemic or dilated cardiomyopathy was present in 34% of patients. Atrial fibrillation had been present for a mean time (± standard deviation) of 6.6 ± 6.1 years. It was paroxysmal in 53 patients (72%).

Results:  The mean number of procedures was 1.6/patient. After 6 ± 6 months, 73% of patients (54/74) were in sinus rhythm. Thirteen of those in sinus rhythm were using anti‐arrhythmic medications (25%). Recurrence of atrial fibrillation soon after pulmonary vein isolation occurred in 50%. Patients with persistent/permanent atrial fibrillation were less likely to be in sinus rhythm at follow up (11/21 (52%) vs 43/53 (81%); P = 0.01). However, the rate of early recurrence was similar in the intermittent and the persistent/permanent groups (26/53 (49%) vs 11/21(52%), respectively; P‐value not significant). Patients with persistent atrial fibrillation were more likely to experience a recurrence of atrial fibril­lation (89%; P = 0.04). No other baseline factors predicted procedural success. Cardiac tamponade occurred in two patients and moderate pulmonary vein stenosis (>50% diameter narrowing) occurred in three patients.

Conclusions:  Pulmonary vein isolation is an effective curative treatment for a broad group of patients with atrial fibrillation. However, the procedure is only suitable for patients with problematic atrial fibrillation resistant to other therapies because of the small risk of serious complications. (Intern Med J 2004; 34: 453−457)
Comparison of estimated and measured maximal oxygen uptake during exercise testing in patients with chronic obstructive pulmonary disease
Authors: Chuang M.‐L. , Lin I.‐F. , Vintch J. R. E.
Published: December 2004

Background:  Maximal oxygen uptake (V̇O2max) and exercise modalities such as walking and standard pulmonary function testing are measurements that have been used by the surgical community as an indication of a patient's current exercise capacity to predict operative outcomes. There are equations available in published reports that allow an estimate of V̇O2max to be made by measuring a combination of the distance walked as well as lung function in patients with chronic obstructive ­pulmonary disease (COPD).

Aims:  The aim of the present study was to determine if estimates of V̇O2max and measured V̇O2max based on predictive equations are useful in individuals with COPD.

Methods:  Twenty‐eight male patients (mean age 68 years) with a mean forced expiratory volume in 1 s of 1.3 L were enrolled in the study after determining that they could perform a maximal exercise study. The estimated V̇O2max using equations reported by Chuang et al. and Cahalin et al. was cross‐validated with the measured V̇O2max determined during cardiopulmonary exercise testing.

Results : The mean estimated V̇O2max using the pre­diction equation did not differ from the mean measured V̇O2max (1.13 vs 1.18 L/min, respectively; P = 0.25). However, the scattered relationship between the measured and the estimated V̇O2max did not support the use of this equation to predict an individual's performance. The prediction equations currently available in published reports significantly underestimate the measured V̇O2max (P < 0.05−10‐12).

Conclusions : It is recommended that V̇O2max is measured rather than estimated using the prediction equations when a V̇O2max measurement is used for clinical decision‐making. (Intern Med J 2004; 34: 469−474)
Treatment of linear and spider telangiectasia with an intense pulsed light source
Authors: Retamar R A , Chames C , Pellerano G
Published: December 2004

Background  The flashlamp‐pumped pulsed dye laser (585 and 577 nm) has proved to be an effective and safe treatment option in the therapy of linear and spider facial telangiectasia. Nevertheless, the postoperative purpura, which most patients see as cosmetically disfiguring, has always been a matter of concern.

Aims  To test the effectiveness and safety of an intense pulsed light source (IPLS), which emits non‐coherent light adjustable within the 515–1200 nm range, in the treatment of linear and spider facial telangiectasia.

Patients & Methods  One hundred and forty patients with linear and stellate facial telangiectasia were treated with an IPLS.

Results  In 94 (67.1%) the results were considered excellent (clearance of 80–100%), 43 (30.7%) showed good results (clearance of 40–80%) and in 3 patients (2.1%) the results were poor (clearance < 40%). Post‐treatment side effects were minimal and well tolerated. There were no instances of scarring or other permanent side effects. Owing to the large spot size, a large area could be treated within one session. No anaesthesia was required.

Conclusion  IPLS is a highly effective and comparably safe therapeutic alternative to the pulsed dye laser in the treatment of facial telangiectasia. The rate of cosmetically relevant side effects is considerably smaller, patient compliance is excellent and the method can easily be applied in an outpatient setting.
Exogenous ochronosis following hydroquinone for melasma
Authors: Zawar V P , Mhaskar S T
Published: December 2004

A female Indian farmer with melasma developed progressive worsening of facial pigmentation while using topical hydroquinone. It manifested as bluish‐black pigmentation, confirmed microscopically as ochronotic change, i.e. exogenous ochronosis (EO).

Failure to follow adequate sun protective measures and usage of overly high concentrations of hydroquinone were the most likely causes of EO in this case.

It is necessary to recognize this disorder at the earliest stage to avoid treatment disappointments.
Iontophoresis for palmoplantar hyperhidrosis
Authors: Kreyden Oliver P
Published: December 2004

The pathogenesis of palmoplantar hyperhidrosis (HH) remains unknown. A causative therapy is therefore not possible yet. Step by step treatment for palmoplantar HH is advised. This includes: topical aluminium salts, tap water iontophoresis (TWI), botulinum toxin (BTX) injections and endoscopic thoracoscopic sympathectomy (ETS).

The mechanism of action of TWI has been previously studied but is still not completely understood. A widely accepted hypothesis is that the anodal current causes accumulation of H+ within the sweat duct. It is presumed that this causes an unknown lesion in the acrosyringium that inhibits sweating.

TWI is non‐invasive, safe, well tolerated, efficient and cheap. The patient can perform the therapy at home without medical assistance. TWI remains the best treatment for palmoplantar HH that has defied aluminium salts.

This article provides a review of the literature concerning TWI, including its historical development, its mechanism of action and its indication and also describes the method of administration of this helpful treatment.
Dermal fillers
Authors: Baumann Leslie
Published: December 2004

The new bioengineered human collagen products and the various hyaluronic acid (HA) fillers are all safe and effective agents for soft tissue augmentation. There is no one best filler for all purposes and optimal results are achieved by using these products in various combinations. In my opinion, HA‐containing products provide volume while collagen products are better suited to provide structural support. Less downtime is associated with the collagen products, due to the platelet‐aggregating effects of collagen and the eosinophil‐stabilizing effects of lidocaine. Using collagen in combination with HA, during the same office visit, may help reduce some of the bruising and swelling seen with HA alone.
Radical approach in BCH‐algebras
Authors: Roh Eun Hwan
Published: December 2004

We define the notion of radical in BCH‐algebra and investigate
the structure of [X; k], a viewpoint of radical in BCH‐algebras.
On derivations and commutativity in prime rings
Authors: De Filippis Vincenzo
Published: December 2004

Let R be a prime ring of characteristic different from 2, d a nonzero derivation of R, and I a nonzero right ideal of
R such that [[d(x), x], [d(y), y]] = 0, for all x, y ∈ I. We
prove that if [I, I]I ≠ 0, then d(I)I = 0.
Measures of concordance determined by D4‐invariant copulas
Authors: Edwards H. H. , Mikusiński P. , Taylor M. D.
Published: December 2004

A continuous random vector (X, Y) uniquely determines a
copula C : [0, 1] 2 → [0, 1] such that when the distribution
functions of X and Y are properly composed into C, the
joint distribution function of (X, Y) results. A copula is
said to be D4‐invariant if its mass distribution is
invariant with respect to the symmetries of the unit square.
A D4‐invariant copula leads naturally to a family of
measures of concordance having a particular form, and all
copulas generating this family are D4‐invariant. The
construction examined here includes Spearman’s rho and
Gini’s measure of association as special cases.
Limited access data sets from studies funded by the National Heart, Lung, and Blood Institute
Authors: Geller Nancy L , Sorlie Paul , Coady Sean , Fleg Jerome , Friedman Lawrence
Published: December 2004

The NHLBI has recently developed standards for protection of subject confidentiality which enable distribution of large data sets collected in completed epidemiological studies and clinical trials. This allows other investigators to pursue research using the data these studies have generated. An ethical commitment to protect the privacy of the research subjects requires careful review and some compromise in data details prior to distribution. To meet the challenge posed by the ethical and legal requirements to protect participants' privacy and making data sets useful for researchers, the NHLBI has devised a policy which seeks to balance these two opposing forces. This paper describes this policy as well as the limited access data sets currently available from NHLBI.
Closing out a large clinical trial: lessons from the Prospective Study of Pravastatin in the Elderly at Risk (PROSPER)
Authors: Dinnett Eleanor M , Mungall Moira MB , Kent Jane A , Ronald Elizabeth S , Gaw Allan ,   PROSPER Study Group
Published: December 2004

Relatively little has been written about the practicalities of the closeout of large, multi-centre clinical trials, but this aspect of trial conduct and design is both important and requires careful planning in order to be accomplished in a timely and orderly fashion. Here, we document our recent experiences of closing down the Prospective Study of Pravastatin in the Elderly at Risk (PROSPER). This five-year study with over 5800 subjects was closed down and published in 2002. We describe the methods used to ensure the speedy progression from the start of the closeout period through data lock to publication and presentation of the results. We discuss the strategic planning of all aspects of the closeout process, the training of staff for final visits, the methods used to follow-up all study participants including those used in dealing with “difficult to contact” and defaulted patients, and the strategies employed to ensure that study participants were left with positive feelings about the study. We also detail the methods employed to expedite the throughput of study paperwork and endpoints and the cleaning of data in preparation for data lock and subsequent publication and presentation of the results. Based on our experiences we summarize the most important aspects of closeout design and make recommendations for future studies, the most important of which is that a well-planned and well-managed closeout is a key feature of any large scale clinical trial and a coherent and practicable closeout strategy should be an integral part of the design.
Mehrkonfigurationen‐Wellenfunktionen – die etwas bessere Theorie
Authors: Janoschek Rudolf
Published: December 2004

Im Lichte des Erfolges stehen konventionelle quantenchemische Theorien und Rechenverfahren, wenn es um Eigenschaften von Molekülen aus dem unerschöpflichen Reservoir der stabilen Verbindungen geht. Begibt sich aber ein Experimentalchemiker wie Günther Maier@ in das Gebiet der hoch reaktiven, nur unter extremen Bedingungen beobachtbaren Verbindungen und weiter in das Schattenreich der (noch) nicht existierenden Moleküle, so können ihm verbesserte Theorien Licht ins Dunkel bringen. Verbessert wird hier die Ein‐ zur Mehrkonfigurationen‐Wellenfunktion, und es werden die daraus resultierenden Konsequenzen anhand aktueller Beispiele geschildert. @ Vgl. seinen Beitrag auf Seite 51.
Strukturen von Carbokationen
Authors: Buzek Peter , von Ragué Schleyer Paul , Sieber Stefan
Published: December 2004

Trotz der ungeheuren Fülle von Forschungsarbeiten auf dem Gebiet der Carbokationen sind deren exakte Strukturen nur selten experimentell zugänglich. Die Röntgenstrukturanalyse als Mittel der Wahl scheidet in den allermeisten Fällen aus. Völlig unabhängig von experimentellen Unzulänglichkeiten ist die Quantenchemie. Strukturen von Carbokationen lassen sich heute mit ab‐initio‐Computerprogrammen exakt und zuverlässig berechnen. Das wird durch den Vergleich berechneter und gemessener NMR‐ und IR‐Spektren demonstriert.
Studieren in Sanssouci
Authors: Ruppelt Dirk
Published: December 2004

Im Sommer 1994 kam ich nach einjährigem Studium in England nach Deutschland zurück. Zuvor hatte ich drei Jahre an der Humboldt‐Universität, Berlin, studiert und stand nun vor der Wahl, wo ich mein Studium fortsetzen würde, wobei ich wieder im Großraum Berlin studieren wollte. Da für mich zu diesem Zeitpunkt feststand, daß meine Diplomarbeit auf dem Gebiet der Polymerchemie angesiedelt sein sollte, kam meine ehemalige Uni nicht in Betracht. Die Fortsetzung des Studiums an der Technischen Universität Berlin oder der Freien Universität Berlin hätte mindestens drei weitere Semester vor der Diplomarbeit erfordert, was nicht in meinem Interesse lag. An der Uni Potsdam stellte mir die Studienberaterin anhand der vorhandenen Scheine eine Liste noch zu besuchender Lehrveranstaltungen und Praktika zusammen. Dieses Programm war in einem Jahr zu schaffen, und so entschied ich mich für die Uni in meiner Heimatstadt Potsdam.