bluuebunny/crossref_metadata_2025 huggingface dataset:
Non‐accidental carbon monoxide poisoning from burning charcoal in attempted combined homicide−suicide
Authors: Lee ACW , Ou Y , Lam SY , So KT , Kam CW
Published: March 2003

Objective:  To describe an emerging form of serious child abuse in combined homicide−suicide in Hong Kong.

Method:  This is a retrospective hospital chart review in a regional hospital in Hong Kong from January to December 2000.

Results:  Eight children, with a mean age of 7.8 years (range 0.5−11 years), from four families were admitted to hospital because of non‐accidental exposure to carbon monoxide when their parents attempted suicide by burning charcoal. A 7‐year‐old boy died on arrival. His 5.6‐year‐old sister and another 6‐month‐old boy had cerebral hypoxia on admission. Hyperbaric oxygen therapy was used in both cases, with rapid improvement, although there were persistent neurological deficits in the girl. The other children in the present study were asymptomatic and none had delayed neurological sequelae. Concomitant use of sedatives was also detected in three of the surviving patients.

Conclusions:  Non‐accidental poisoning with carbon monoxide appears to be a new means of child abuse with potentially serious consequences. Concomitant intoxication with psychotropic drugs is common in such cases. The reason for parents killing their own children under such circumstances was unclear, but a desire to exact revenge on an estranged partner was suggested.
A child with Miller Fisher syndrome
Authors: Garrett J , Ryan P
Published: March 2003

Abstract:  We describe the case of a six‐year‐old girl who presented with a 3‐day history of diplopia and gait disturbance following a febrile flu‐like illness. On examination she was found to have ataxia, areflexia and ophthalmoplegia, and a diagnosis of Miller Fisher syndrome was made after the exclusion of other conditions. This report outlines the frequency of Miller Fisher syndrome and lists the differential diagnoses that should be considered in Australia. In addition, the occurrence of pupillary dysfunction is discussed.
Fate of abstracts published in the proceedings of the first annual Perinatal Society of Australia and New Zealand Congress in 1997
Authors: Davies MW , Dunster KR , East CE , Lingwood BE
Published: March 2003

Objectives:  To examine the fate of research presented at the first annual Perinatal Society of Australia and New Zealand (PSANZ) Congress in 1997, by determining: the rate of publication in peer‐reviewed biomedical journals; publication rate by discipline; journals in which work was published; concordance for aims, conclusions, authors and number of study subjects; and time from presentation to publication.

Methods:  A MEDLINE search was conducted for any publication in a peer‐reviewed journal resulting from a publishable abstract from the proceedings of the first annual PSANZ Congress in 1997. Searching was completed 42 months post‐congress. The concordance of aims, conclusions, authors and number of subjects between abstract and published paper was determined.

Results:  There were 172 publishable abstracts in the proceedings of the PSANZ Congress in 1997, and 78 (45%) were published as 83 articles. Basic sciences had the highest publication rate (67%) and midwifery the lowest (20%). Articles were published in 41 journals, with one‐third of the articles in three paediatric journals. There was a match with aims in 75%, and with conclusions in 65%. There were 47/77 with the same number of subjects, 20/77 with more and 10/77 with fewer. There were 22 articles with one author added, 12 had more than one author added, 11 had one author removed and five had more than one author removed. Median time‐to‐publication was 18 months (interquartile range 9−26 months).

Conclusions:  A publication rate of 45% is comparable to other conferences. Basic science and neonatology had the highest publication rates. There were considerable differences between abstract and published article in terms of aims, conclusions, number of subjects and authors.
Controlling seizures in the prehospital setting: Diazepam or midazolam?
Authors: Rainbow J , Browne GJ , Lam LT
Published: March 2003

Objective:  To determine which is the most effective and safe treatment for controlling seizures in children out‐of‐hospital: diazepam or midazolam.

Methods:  A retrospective review of the medical records of children presenting to the Emergency Department of the Children's Hospital at Westmead (CHW‐ED) with seizures requiring treatment in the field by paramedics was carried out over a 4‐year period (April 1996 to March 2000). In New South Wales, children with seizures in the prehospital setting received 0.5 mg/kg per rectum (p.r.) or 0.1 mg/kg i.v. diazepam until March 1998 and from March 1997 onwards they received 0.15 mg/kg i.m. or 0.1 mg/kg i.v. midazolam. The main outcome measured was cessation of seizure in the prehospital setting. Secondary outcomes were time taken to initiate treatment and the frequency of cardiorespiratory compromise.

Results:  Over the 4‐year period, 2566 children presented to CHW‐ED with a seizure; 107 children were eligible for entry into the present study. Of these 107 patients, 62 received diazepam and 45 received midazolam. Thirty‐one (50.0%) in the diazepam group and 15 (33.3%) in the midazolam group were febrile seizures. Both groups were similar in terms of demographics and seizure type. A comparison of diazepam with midazolam showed that both drugs were effective in stopping seizures within 5 min of drug administration (37.1% cf. 51.1%). Fewer patients in the midazolam group suffered apnoea (20.0% cf. 29.0%; P < 0.05).

Conclusion:  Midazolam controls seizures as effectively as diazepam in the prehospital setting. Furthermore, midazolam potentially reduces respiratory depression and time to treatment.
Ceftriaxone‐induced haemolytic anaemia in a child with no immune deficiency or haematological disease
Authors: Çitak A , Garratty G , Ücsel R , Karabocuoglu M , Uzel N
Published: March 2003

Abstract: A 5‐year‐old girl, with no underlying immune deficiency or haematologic disease, was treated with ceftriaxone for a urinary tract infection. After receiving ceftriaxone intramuscularly, massive haemolytic anaemia developed. Laboratory studies showed the presence of an antibody against ceftriaxone, and the findings reflected immune complex type haemolysis. High‐dose corticosteroids appeared to be effective therapeutically.
Incident monitoring in psychiatry
Authors: WRIGHT M , PARKER G
Published: March 2003

Critical Incident Monitoring (CIM) as an instrument of quality assurance (QA) has received increasing attention in recent years. The present study was developed to explore a potential role for CIM in QA for clinical psychiatry. A questionnaire was sent to psychiatrists and requested retrospective reporting of clinical incidents, and a pilot study of an inpatient‐based incident reporting system was performed. All Fellows of the Royal Australian and New Zealand College of Psychiatry (RANZCP) were sent a questionnaire. Eight psychiatric inpatient services were invited to participate in the pilot study. The returns of the questionnaires were aggregated and analysed to reveal a relatively small number of separate incident types, with little difference between the ‘adverse outcome’ and ‘near‐miss’ categories. Similar results were found with the pilot study. It was concluded that the development of a unified incident reporting system for use by psychiatric clinicians and psychiatric services may add usefully to existing quality improvement processes.
Towards the safer use of dosettes
Authors: Levings B , Szep S , Helps SC
Published: March 2003

Abstract Patient compliance has long been recognized to be a problem associated with drug treatment. Dosettes constitute a compliance aid; their aim is to maintain patient independence, while facilitating patient compliance. However, those patients most in need of such devices are the least likely to be able to manage them. It was therefore decided to examine incidents in which problems involving dosettes had been identified; 52 such incidents were found. Half the incidents involved filling errors, and most of these involved nurses; some incidents were potentially dangerous systematic errors. A second type of incident involved a problem with use, mainly caused by hurried or confused patients; these sporadic errors were less dangerous than filling errors. The remainder of the incidents involved patients taking medication in addition to the medication in the dosette. Recommendations include objectively assessing that a dosette is appropriate for the individual patient, and education about the need for compliance, meticulous care and checking when filling, and regular checks to confirm correct use.
Chemical characteristics of sediments and interstitial waters in some small Hawkesbury Sandstone freshwater streams of the Sydney area
Authors: Hayes Warwick J. , Buckney Rodney T.
Published: March 2003

Sediments of three streams draining sandstone catchments in Sydney, Australia, were sampled under low flow conditions over a 2‐year period. Two streams receive urban contaminants, one (the reference creek) has an undeveloped catchment. Levels of sediment copper, zinc, cadmium and lead (total and speciated) and phosphorus (total and organic) were determined, as well as total organic carbon, particle size fractionation and cation exchange capacity. A range of quality parameters were also measured for interstitial waters. Sediments were characterized by very low organic matter (< 2% by weight) and low cation exchange capacity (< 3 mmol Na 100 g−1), due to high contents of coarse and fine sands (> 95%). Despite a low accumulation of heavy metals and phosphorus in the long term, the sediments were nevertheless a sink for these constituents. Greatest proportions of sediment zinc and lead were associated with hydrous metal oxide coatings, or coarse waste particles. Apart from a substantial residual component, copper was preferentially associated with organic matter. Cadmium was rarely detected in any stream. Multidimensional scaling showed that under low flow conditions the three sites had distinct sediment chemistries. However, high levels of temporal and spatial variability were apparent within the urbanized sites, consistent with those streams regularly receiving discharges of diverse composition. Poor sediment and interstitial water qualities were often observed in the two urban sites, although such conditions did not occur continuously. Poor interstitial water quality was also seen on occasion in the reference stream; however, poor sediment quality was never detected at this site. Considering surficial sediments of Hawkesbury Sandstone streams may be suspended during high flow conditions, it was concluded that surface waters were a more reliable indicator of stream condition for short‐term monitoring studies.
A model to predict reservoir sedimentation
Authors: Tarela Pablo A. , Menéndez Angel N.
Published: March 2003

An efficient mathematical model to predict the sedimentation process in a reservoir is presented. It is based on a parabolized and laterally integrated form of the governing equations. For its numerical solution the finite element method is used. The model formulation and numerical scheme are both explained. The model is validated through comparisons with empirical curves that quantify sedimentation in a reservoir. The velocity and sediment concentration profiles in typical situations are shown. Solid discharge longitudinal evolution, as well as stratification conditions, are studied. The formation and growth of bottom structures are explained. It is shown that the reservoir bottom evolution depends strongly on the geometry of the reservoir and the sediment size. It is also shown that the system acts as a filter for the coarse and fine fractions of the solid discharge.
Social ecology in the Danube Delta: Theory and practice
Authors: Boja Virginia , Popescu Ioana
Published: March 2003

Approximately 15 000 people make their homes in the Danube Delta. They live in small villages throughout the Delta and subsist on fishing with subsidiary occupations of agriculture and animal husbandry. Their homes are traditional and built of locally available materials. Efforts during the communist regime to centralise, homogenise and industrialise the population were not a resounding success. There is a large degree of ethnic diversity: four ethnic and three religious groups are present, although interactions between the groups are harmonious. There is little entertainment in the region and a poor infrastructure for education and health care. Fishing is controlled through fisheries who assign quotas and purchase the fish harvest. Prices are low and black market fisheries flourish. Conservation of the Delta is being carried out by the Danube Delta Biosphere Reserve (DDBR). The implementation of fish and wildlife control is carried out by rangers, who are disliked by the inhabitants because of their aggressive tactics. They are regarded as complementary to the Delta police. The separation of the DDBR, regional politicians and the people is unfortunate and there is a need to involve all parties in the maintenance of the Delta ecosystem and the lifestyle associated with the ecosystem.
Water use (and abuse) and its effects on the crater‐lakes of Valle de Santiago, Mexico
Authors: Alcocer Javier , Escobar Elva , Lugo Alfonso
Published: March 2003

Most Mexicans live in the arid and semiarid regions that represent two‐thirds of the Mexican territory, where water is scarce. Natural, as well as human, causes are favouring the degradation of Mexican lakes. There is a clear need to develop and implement sustainable water‐use programmes at a catchment scale. However, the accelerated degradation rate of the Mexican lakes means that there will not be enough time to perform whole‐basin evaluations to establish sustainable water‐use programmes before the lakes dry up. The case of the Valle de Santiago crater‐lakes clearly illustrates the declining trend that Mexican inland aquatic resources follow. Vegetation clearance, overgrazing, abatement of phreatic waters and salinization have induced severe erosion and overall desertification (land degradation) in the basin for what, it seems, a long time (i.e. prehispanic times). In this way, human activities could be provoking at least the following negative consequences: a hotter and drier local climate, water scarcity, dust storms and soil salinization. The aquatic (surface and groundwater) resources of the Valle de Santiago basin have been seriously threatened. Two of the four crater‐lakes have already dried up and phreatic mantle abatement reaches up to 2.5 m per year. In spite of these facts, no sustainable water‐use programme has been established yet. The future scenery of this Mexican basin looks alarmingly like many other basins in the central and northern Mexican territories.
Meningiomas associated with hemorrhage: A report of two cases with a review of the literature
Authors: Jr Shanop Shuangshoti , Shuangshoti Samruay , Vajragupt Laddawan
Published: March 2003

Two cases of extensive spontaneous hemorrhage related to intracranial angioblastic meningiomas are reported. One of these also had glandular and papillary formations with mucin production. A review of 115 meningiomas with significant hemorrhage including the two current instances disclosed that they occurred in the first to ninth decades of life but were most common in the fourth to eighth decades (85%), with a peak occurrence in the fifth decade (24%). The average age of 51 years was 9 years more than in those patients with non‐bleeding meningiomas. The female‐ to‐male ratio was 6:5 for the entire series. Bleeding meningiomas arose most often on the cerebral convexity followed by the parasagittal region, the lateral ventricle, and the sphenoid ridge. Bleeding most frequently involved multiple sites, and was followed in decreasing frequency by hemorrhage into the subarachnoid space, subdural space, intracerebral tissue including the peritumoral region, and intratumoral substance. Meningocytic menin‐gioma was the most common type of bleeding meningioma, followed in decreasing frequency by the angioblastic, fibroblastic, transitional and malignant types. The mech‐anism of bleeding was uncertain in many cases, and multiple factors are probably involved. Patients with bleeding meningiomas had worse prognoses than those with non‐bleeding meningiomas.
Dysembryoplastic neuroepithelial tumor
Authors: Hirose Takanori
Published: March 2003

Dysembryoplastic neuroepithelial tumor (DNT) is a mixed neuronal‐glial tumor associated with a history of partial complex seizures. This uncommon lesion must be disting‐uished from other infiltrating gliomas with similar histo‐logical features. DNT frequently affects the temporal and frontal lobes of adolescents and young adults. On neuroimaging, the tumor is well demarcated and located in the superficial layers of the cortex. The presence of intracortical nodules is a positive sign indicating DNT. DNT can be divided into complex and simple forms. Complex forms comprise specific glioneuronal elements, glial nodules and/or cortical dysplasia while the simple forms may be composed of glioneuronal elements only. Glioneuronal elements consist of oligodendroglial‐like cells which often exhibit alveolar and microcystic patterns. In addition, mature neurons of varying size may be present within the mucinous matrix. Surgical resection is usually sufficient for the treatment of DNT. The heterogeneous histology of DNT supports the hypothesis that it is derived from cells in the subpial granular layer.
Is Ihara's genetically epileptic rat an adequate model for studying human temporal lobe epilepsy? Verification of suitability from the clinical and pathomorphological perspectives
Authors: Amano S
Published: March 2003

We developed a novel epileptic mutant with spontaneous generalized tonic clonic convulsions, Ihara's genetically epileptic rat (IGER). Judging from the characteristics of the symptomatology, electroencephalographic correlates, and neuropathological findings, this epileptic mutant can be expected to be a useful model for studying human temporal lobe epilepsy (TLE). Verification of the suit‐ability of IGER as a model for human TLE was carried out from the clinical and pathomorphological perspectives. IGER basically meets the first and the second criteria for an animal model, that is, similarity of symptomatology of the disease in the animal model and humans, and similarity of pathomorphological changes in the lesions of the model and humans. Causative similarity, the third criterion, re‐mains to be established for IGER and human TLE. Judging from the first and second criteria, IGER seems to be a useful tool for studying human TLE.
Neuropathological features of mesial temporal sclerosis: Histochemical studies of surgically resected specimens from patients with temporal lobe epilepsy
Authors: Matsuda Kazumi , Kubota Yuko , Kageyama Michiyo , Tottori Takayasu , Mihara Tadahiro , Yagi Kazuichi , Hirano Asao
Published: March 2003

Mesial temporal sclerosis (MTS) is the most common pathological finding in temporal lobe epilepsy (TLE), but the relationship between MTS and hyperexcitability has not been defined. The neuropathological findings of MTS on the basis of our histochemical investigations using surgically resected specimens from patients with intractable TLE will be reviewed and discussed. Various sclerotic changes including neuronal loss and astrogliosis were observed not only in the hippocampus but also in the other mesial temporal structures such as the amygdala and entorhinal cortex. Moreover, aberrant residual pyramidal neurons were recognized, which showed morphological abnormalities; abnormal distribution of zinc, γ‐aminobutyric acid‐A receptor and glutamate decarboxy‐lase; and disorganization of the granule cell layer (dispersion and bilaminar distribution). Increases in density of the corpora amylacea and peripheral type benzodiazepine receptor binding corresponded with glial proliferation. Histochemical studies demonstrated the association of mossy fiber sprouting with synaptic reorg‐anization and changes of several chemically defined inter‐neuron systems in the dentate gyrus. Quantitative analysis using in vitro autoradiography showed that neurotrans‐mitter receptor bindings related to neuronal excitation (AMPA and NMDA receptor) and inhibition (central type benzodiazepine receptor) were reduced differently as a function of neuronal loss in MTS. These cytochemical changes associated with neurotransmitters and their receptors in the sclerotic hippocampus may constitute the pathological background of epileptogenesis in TLE.
HTLV‐I‐associated myelopathy
Authors: Izumo Shuji , Umehara Fujio , Osame Mitsuhiro
Published: March 2003

HTLV‐I was first described as a pathogenic human retrovirus that causes adult T‐cell leukemia (ATL). Soon after the discovery of HTLV‐I, an association of this virus with a slowly progressive neurological disorder was found independently in Japan and Caribbean islands, and this new clinical entity (HTLV‐I‐associated myelopathy with tropical spastic paraparesis) was named HAM/TSP. Autopsy findings clarified the chronic inflammatory nature of the disease. Detailed neuropathological analysis demonstrated: (i) T‐cell‐dominant mononuclear cell infiltration; (ii) diffuse and symmetrical degeneration of the antero‐lateral and inner portion of the posterior columns involving both myelin and axons; (iii) the presence of cytotoxic T cells and apoptosis of helper/inducer T cells; (iv) in vivo localization of HTLV‐I provirus in the perivascular infiltrated T cells; and (v) accentuation of inflammatory lesions at the site with slow blood flow. From these findings it is suggested that a T‐cell‐mediated chronic inflammatory process targeting the HTLV‐I‐infected T cells is the primary pathogenic mechanism of HAM/TSP.
Growth factors in progressive renal disease
Authors: Johnson David W
Published: March 2003

SUMMARY: Numerous studies of clinical and experimental renal disease have identified potentially pathogenetic roles for a large number of individual polypeptide growth factors, including transforming growth factor‐β, insulin‐like growth factor‐I and ‐II, platelet‐derived growth factor, angiotensin II, nitric oxide, connective tissue growth factor, hepatocyte growth factor, vascular endothelial growth factor, fibroblast growth factor, heparin‐binding epidermal growth factor‐like growth factor, epidermal growth factor and endothelins. Activation of renal growth factor pathways may be initially triggered by glomerular hyperfiltration injury and/or tubular hyper‐resorption injury. The production and actions of these growth factors are contextually influenced by the ambient cytokine milieu and perturbations of the extracellular matrix. Their overall balance, intensity and duration determine whether the net outcome is ultimately a co‐ordinated repair of tissue or a pernicious, fibrotic destruction of renal parenchyma. Specific growth factor blockade has been shown to ameliorate various experimental models of progressive renal disease. Moreover, current treatments proven to retard the progression of human renal disease (such as angiotensin converting enzyme inhibition, hydroxymethylglutaryl coenzyme A reductase inhibition, calcium channel blockade and low‐protein dietary intake), have also been found to antagonize numerous growth factor pathways. The clinical development of more specific growth factor therapies for progressive renal disease has been significantly limited to date by difficulties with selectively targeting and timing cytokine interventions, applying treatments in the setting of heterogeneous renal injury, modulating growth factors with opposing beneficial and deleterious actions, and overcoming growth factor network redundancies. Nevertheless promising new growth factor intervention strategies are being developed and clinical trials are already underway to assess the renoprotective efficacy of several novel pharmacological agents which manipulate renal growth factor activity (including endothelin antagonists, L‐arginine, trapidil and somatostatin analogues). Such strategies will hopefully strengthen our presently limited and relatively ineffective therapeutic armamentarium for progressive renal insufficiency.
Development of cadaver renal transplantation in India
Authors: MANI M. Krishna
Published: March 2003

SUMMARY: We have established a successful cadaver transplant programme in Chennai that could serve as a model for any developing country. A survey of public opinion showed that the higher the educational level, the more willing was the subject to donate. This was because of greater awareness of the possibility of successful transplantation, and indicated the need for education of the public on this aspect. the first step is to enact suitable legislation. Families of potential donors might hesitate to consent to donation if they doubt the legality of the procedure. In India, the doctor commands respect and is more likely to be able to obtain consent than a coordinator. the patient is permitted to stay on dialysis at any convenient city, so long as he or she can reach Chennai within 24h of being called. to improve the yield, we accept kidneys from donors in acute renal failure, if we know renal function was normal at the time of entry to the hospital. We also accept non‐heart beating donors. Marginal kidneys are accepted and both kidneys are transplanted to one recipient. the success with all these procedures is as good as with the others. We were able to perform 88 renal transplants in 4.5 years with a 1 year graft survival of 72%, and a 4 year survival of 63%. Ten donors were in acute renal failure and the 1 year graft survival was 70%. Nine dual transplants were performed with 75% 1 year graft survival.
Lack of efficacy of low molecular weight heparin in a boy with congenital nephrotic syndrome
Authors: GIRISCH Monika , RAUCH Ralf , RIES Martin , KLINGE Jens
Published: March 2003

SUMMARY: The congenital nephrotic syndrome (CNS) is characterized by severe proteinuria, followed by hypoalbuminaemia and hypercoagulopathy. the boy was born in the 39th gestational week (1980 g bodyweight). In the first days of his life, he developed proteinuria and oedema, and on the 10th day, a thrombosis of the vena cava inferior was diagnosed. the boy was treated with unfractionated heparin, antithrombin concentrates and a low‐dose of recombinant tissue plasminogen activator (rtPA). After 2 days, a complete resolution of the thrombus was observed. Treatment with unfractionated heparin and antithrombin III was continued. At the age of 3 months, low molecular weight heparin (LMWH) was started before the patient was discharged. Despite a high dose of LMWH, 250 IU/kg bodyweight, the anti‐Xa‐activity was always below 0.1 U/mL. Therefore, anticoagulation was achieved by the administration of vitamin K antagonist. Low molecular weight heparin is bound to albumin and antithrombin. Therefore, the renal loss of these proteins may result in low plasma levels of LMWH, and may not be effective in patients with CNS.
Incidence of side‐effects associated with high‐dose ferric gluconate in patients with severe chronic renal failure
Authors: BASTANI BAHAR , JAIN ANIL , PANDURANGAN GOPAL
Published: March 2003

SUMMARY: Ferric gluconate complex in sucrose (Ferrlecit™) has been associated with less side‐effects than iron dextran; however, the recommended dose of 62.5–125 mg per treatment is only suitable for haemodialysis (HD) patients. We retrospectively analysed the incidence of the side‐effects associated with a high dose of Ferrlecit™ infusion (20 treatments in 13 patients; 10 treatments of 250 mg/3–4 h, and 10 treatments of 500 mg/5 h infusion). The patients were in the age range of 32–75 years old, seven with chronic renal failure (CRF), and six on dialysis treatment. One (10%) of the 10 treatments using a 250 mg dose was complicated with severe nausea/vomiting, diarrhoea and a burning sensation in the feet. Three (30%) of the 10 treatments using a 500 mg dose were complicated with: chills, severe nausea/vomiting, hypotension and syncope in one; severe nausea/vomiting, diarrhoea and hypotension in one; and an episode of vomiting in one patient. A single treatment with a 250 mg dose resulted in no significant change in haematological parameters. A single treatment with a 500 mg dose resulted in a significant increase in haemoglobin (Hgb) and haematocrit (Hct), but only a rising trend in serum iron,% transferrin saturation and ferritin pre versus 1–2 months postinfusion. In conclusion, Ferrlecit™ doses of 250 or 500 mg are complicated with significant untoward reactions in 10–30% of patients, in a dose‐dependent fashion.
Practical experience with the Renal Anaemia Management Database
Authors: Suranyi M , Bannister KM
Published: March 2003

Summary: To optimize the management of renal anaemia, a number of Australian renal units have recently appointed renal anaemia coordinators. In conjunction with these appointments, a novel computer software package, the Renal Anaemia Management Database has been implemented. The database is a patient‐centred clinical database featuring point‐of‐care data collection, display and analysis. The Renal Anaemia Management Database collects and collates data such as erythropoietin dose, frequency and route, as well as iron parameters and resulting haemoglobin levels. It also has the capacity to store, retrieve and analyse a number of patient demographics, comorbidities, treatments, results and outcomes. Patients can be reviewed in cohorts or a whole‐of‐unit review can be generated. Data may also be exported and aggregated with that from other renal units for global analysis.
The power of care: the Women’s Hospital 1884–1914*
Authors: McCalman Janet
Published: March 2003

The power of care: the Women’s Hospital 1884–1914

The effectiveness of late‐nineteenth‐century nursing care should not be underestimated. The archive of patient records at Melbourne’s Women’s Hospital reveals a commitment to patient care that more often than not made the difference between life and death in the recovery from major surgery or post‐partum infection. These records suggest the need to reassess the role of medical care in the mortality transition after 1850.
Hermeneutic philosophy. Part I: implications of its use as methodology in interpretive nursing research
Authors: Geanellos Rene
Published: March 2003

Increasingly, nurses use the philosophy of hermeneutics, especially Heideggerian and Gadamerian hermeneutics, to inform interpretive research. However, application of the work of these philosophers to interpretive nursing research has proved problematic as it fails to recognise, or act upon, obligations inherent in their work. Through a review of hermeneutically informed nursing research, methodological implications regarding the use of hermeneutic philosophy are examined in relation to: (i) the need to address forestructures and pre‐understandings; (ii) checking interpretations with research participants; (iii) seeking objectivity, consensus and accuracy in textual interpretation; (iv) evaluating interpretations; and (v) gaining entry into the hermeneutic circle. This review suggests that despite obligations inherent in Heideggerian and Gadamerian hermeneutic philosophy, nurses fail to actualise these obligations in their research. In following Heidegger, nurses need to make the scientific theme secure by working out their forestructures in terms of the phenomenon under investigation. Those following Gadamer need to accept that interpretation seeks to manifest textual meanings rather than individual ones. And, whether following Heidegger or Gadamer, the way to make manifest textual meanings is to engage with the text within the hermeneutic circle by continuing to address forestructures and pre‐understandings and by considering their influences upon the research.
The problem of dissemination: evidence and ideology
Authors: Traynor Michael
Published: March 2003

This paper recontextualises research evidence as an example of textually‐based social control. It does this by drawing on two areas of theoretical literature; feminist literary theory and the sociology of scientific knowledge. Accounts of literary works as ideological instruments of social control suggest that (at least some kinds of) research literature may fulfil a similar role among a clinical readership. There have also been compelling accounts of scientific writing as expressions of desire on the part of one group to ‘act at a distance’ upon others. In the light of this literature, it becomes less tenable to see research dissemination as the simple transfer of information, supplemented by organisational work. Research is implicated in the attempt by one group to enrol others in its own project and in the (self‐)construction of the identities of the healthcare worker. The accounts that literary theory can provide do not remain focused upon the text, but draw links between the reading process and the experience and place in society, for example the gender, of the writer and reader. As such their explanations create a space for the resisting reader.
Situating wound management: technoscience, dressings and ‘other’ skins
Authors: Rudge Trudy
Published: March 2003

This paper addresses the notion of wound care as a technology of skin and other skins imbued with the combined power of technology and science. It presents the discourses of wound care evident in the accounts of patients and nurses concerning this care, and discussions about wounds in wound care interest groups, journals, and advertising material about wound care products. The discussion focuses on wounds and wound dressings as effects immanent in the power relations of discourses of wound care. These effects colour and influence nurses’ responses to wounds and wound care products. Moreover, the discourses that portray these practices are evidence of the complex articulation between technoscience and gender. Nurses and patients are fascinated by wound technoscience and lured towards it by its potential for mastery and control over wounds. Such seductions are evident in the texts of nurses, patients, and pharmaceutical advertisements for wound care products. Finally, the ways that these representations are used to talk about and market wound care products are shown as exemplifying the finer points of wound management as a nursing technoscience.
Nursing older people: constructing need and care
Authors: Reed Jan , Clarke Charlotte L.
Published: March 2003

As the population of the world ‘ages’, older people are increasingly viewed as a ‘problem’ whose needs challenge the resources of care services. However, this view is predicated on the negative and nihilistic attitudes that are held throughout society about older people and the effectiveness of therapeutic intervention. It is these pessimistic views which colour professional understandings of the needs of older people and the most appropriate ways of delivering care to meet those needs. However, any knowledge of need and care is a constructed story, and is limited by the knowledge base on which it rests. For example, western healthcare is dominated by an orientation to identified problems, the minimizing of physical risk or harm, and a reductionalist approach to problem solving. A social critical challenge to prevailing understandings of need and care produces a very different story about older age; one which emphasizes an individual’s strengths and their family and community relationships. In exploring these issues in policy and practice two key areas are highlighted. One is the role of critical gerontology in challenging the stories of negativity about old age, and replacing these with positive stories that allow older people to retain their social purpose. The second key area is the need to address issues of older age at both a practice and policy level, and to understand the interrelationship between them.
Nursing, social contexts, and ideologies in the early United States birth control movement *
Authors: Lagerwey Mary D.
Published: March 2003

Using historical discourse analysis, this study provides a thematic analysis of writings of nursing and birth control as found in The Birth Control Review from 1917 to 1927. The author contrasts this publication with the official journal of the American Nurses Association, the American Journal of Nursing from the same years to explore nursing voices and silences in early birth control stories. In dialogue with social contexts, nursing endeavors and inactivity have played important yet conflicting roles in the birth control movement in the United States. Nursing writings from the early twentieth century reflect eugenic beliefs, national fears of immigrants, and ambivalence about women’s roles in society and the home. Nurses simultaneously empowered women to choose when to become pregnant and reinforced nativist and paternalistic views of the poor.
Clinical exchange: one model to achieve culturally sensitive care
Authors: Scholes Julie , Moore Diana
Published: March 2003

Clinical exchange: one model to achieve culturally sensitive care

This paper reports on a clinical exchange programme that formed part of a pre‐registration European nursing degree run by three collaborating institutions in England, Holland and Spain. The course included: common and shared learning including two summer schools; and the development of a second language before the students went on a three‐month clinical placement in one of the other base institutions’ clinical environments. The aim of the course was to enable students to become culturally sensitive carers. This was achieved by developing a programme based on transcultural nursing principles in theory and practice. Data were gathered by interview, focus groups, and questionnaires from 79 exchange students, fostering the strategies of illuminative evaluation. The paper examines: how the aims of the course were met; the factors that inhibited the attainment of certain goals; and how the acquisition of a second language influenced the students’ learning about nursing. A model is presented to illustrate the process of transformative learning from the exchange experience.
The influence of liberal political ideology on nursing science
Authors: Browne Annette J.
Published: March 2003

The influence of liberal political ideology on nursing science

Previous notions of science as impartial and value‐neutral have been refuted by contemporary views of science as influenced by social, political and ideological values. By locating nursing science in the dominant political ideology of liberalism, the author examines how nursing knowledge is influenced by liberal philosophical assumptions. The central tenets of liberal political philosophy — individualism, egalitarianism, freedom, tolerance, neutrality, and a free‐market economy — are primarily manifested in relation to: (i) the individualistic focus of our science; (ii) our view of society as essentially egalitarian and equitable; (iii) our preference for politically neutral knowledge development, and (iv) an economy of knowledge development that supports rather than challenges the status quo. I argue that exposing, rather than ignoring, the liberal ideological values inherent in nursing science will render these assumptions open to debate, stimulate ongoing development of critically oriented knowledge, and increase our capacity to influence the social, political and economic determinants of health.
From the state to the family: reconfiguring the responsibility for long‐term nursing care at home
Authors: Björnsdóttir Kristin
Published: March 2003

From the state to the family: reconfiguring the responsibility for long‐term nursing care at home

This paper discusses the implications of the shift in the location of the provision of healthcare services from healthcare institutions to the home, which has occurred or is projected to occur in coming years. It is argued that the responsibility for the provision of care and assistance needed by the elderly living at home and people with long‐term conditions living at home has shifted from public services to the family. Studies of care‐givers have shown that in many situations they experience tremendous burdens, financial difficulties and health problems. Their social lives have been confined to the home, and contacts with friends and neighbors have been significantly reduced. This situation needs to be addressed by nurses, who in many cases serve as the bridge between the home and the official healthcare system. Using Foucault’s exploration of power, particularly his idea of governmentality, a genealogy of care‐giving in the home in Iceland’s health‐care has been constructed. The main findings were that, although this is occurring somewhat later than in many other countries, the state is withdrawing from its previously defined responsibility for the health and well‐being of the nation. At the same time the citizen’s responsibility for maintaining health is emphasized. Based on these findings, the argument is made that nurses in Iceland can have a profound influence on policy‐making in relation to the organization of services provided in those homes. Suggestions are made as to how this can be done, which may be of interest to nurses in other countries.
Police and pastoral power: governmentality and correctional forensic psychiatric nursing*
Authors: Holmes Dave
Published: March 2003

Police and pastoral power: governmentality and correctional forensic psychiatric nursing

Since 1978, the federal inmates of Canada have had access to a full range of psychiatric care within the penitentiary system. Several psychiatric units are now integrated into the correctional services of Canada. This paper presents the results of a grounded theory doctoral study undertaken in a multilevel secured psychiatric ward within the Canadian federal penitentiary system. The author describes and discusses the results of qualitative data that emerged from his fieldwork. The concept of governmentality, as defined by the late French philosopher Michel Foucault, constitutes one of the major theoretical tools that were helpful in analyzing these data. Police and pastoral power, two dimensions of the security apparatus of governmentality, were found to be useful in understanding and characterizing nursing practice caught between the penal and the psychiatric dispositifs. A Foucauldian perspective allows one to understand the manner in which forensic psychiatric nursing is involved in the governance of mentally ill inmates through three forms of power — sovereign, disciplinary and pastoral — which have posited nursing practice as a strategic tool of the correctional services. This research consists of a study of nursing practice in an extreme setting that deserves a radical analysis.
The history of nursing in the home: revealing the significance of place in the expression of moral agency
Authors: Peter Elizabeth
Published: March 2003

The history of nursing in the home: revealing the significance of place in the expression of moral agency

The relationship between place and moral agency in home care nursing is explored in this paper. The notion of place is argued to have relevance to moral agency beyond moral context. This argument is theoretically located in feminist ethics and human geography and is supported through an examination of historical documents (1900–33) that describe the experiences and insights of American home care/private duty nurses or that are related to nursing ethics. Specifically, the role of place in inhibiting and enhancing care, justice, good relationships, and power in the practice of private duty nurses is explored. Several implications for current nursing ethics come out of this analysis. (i) The moral agency of nurses is highly nuanced. It is not only structured by nurses’ relationships to patients and health professionals, i.e. moral context, it is also structured by the place of nursing care. (ii) Place has the potential to limit and enhance the power of nurses. (iii) Some aspects of nursing's conception of the good, such as what constitutes a good nurse–patient relationship, are historically and geographically relative.
Killing for the state: the darkest side of American nursing
Authors: Holmes Dave , Federman Cary
Published: March 2003

The aim of this article is to bring to the attention of the international nursing community the discrepancy between a pervasive ‘caring’ nursing discourse and a most unethical nursing practice in the United States. In this article, we present a duality: the conflict in American prisons between nursing ethics and the killing machinery. The US penal system is a setting in which trained healthcare personnel practice the extermination of life. We look upon the sanitization ofdeathworkas an application of healthcare professionals’ skills and knowledge and their appropriation by the state to serve its ends. A review of the states’ death penalty statutes shows that healthcare workers are involved in the capital punishment process and shielded by American laws (and to a certain extent by professional boards through their inaction). We also argue that the law's language often masks that involvement; and explain how states further that duplicity behind legal formalisms. In considering the important role healthcare providers, namely nurses and physicians, play in administering death to the condemned, we assert that nurses and physicians are part of the states’ penal machinery in America. Nurses and physicians (as carriers of scientific knowledge, and also as agents of care) are intrinsic to the American killing enterprise. Healthcare professionals who take part in execution protocols are state functionaries who approach the condemned body as angels of death: they constitute an extension of the state which exercises its sovereign power over captive prisoners.
Can primary breast cancer patients sense the presence of lymph node metastasis? An unexpected research finding
Authors: Brabander Bert De , Gerits Pol , Sacré Robert , Lamote Jan
Published: March 2003

We found that primary breast cancer patients with lymph node metastasis, compared to patients without apparent metastasis, had a greater expectation that their breast lump biopsy would be malignant. This difference in expectation between the two groups remained after controlling for a range of possible confounding variables.
Severe chronic active giftein‐Barr virus infection accompanied by virus‐associated hemophagocytic syndrome, cerebellar ataxia and encephalitis
Authors: YAMASHITA SHU‐ICHI , MURAKAMI CHISA , IZUMI YOICHIRO , SAWADA HITOSHI , YAMAZAKI YOSHIHIRO , YOKOTA TADA‐AKI , MATSUMOTO NOBUHIRO , MATSUKURA SHIGERU
Published: March 2003

We present a rare case of chronic active giftein‐Barr virus (EBV) infection showing various clinical outcomes. A 26‐year‐old man was admitted to our hospital due to persistent fever and dyspnea. Serologic response of the patient to EBV indicated chronic active infection. He showed pleuritis, parotitis, chronic hepatic dysfunction, disseminated intravascular coagulation, virus associated hemophaghocytic syndrome, acute rhabdomyolysis, acute renal failure, acute cerebellar ataxia, encephalitis and multiple brain abscesses. None of acyclovir, gancyclovir, prednisolone or interleukin‐2 was effectual to abolish those abnormalities. This is the first report of transient cerebellar ataxia which aggravated to panencephalitis associated with chronic EBV infection.