bluuebunny/crossref_metadata_2025_split huggingface dataset:
Why carers of frail older people are not using available respite services: an Australian study
Authors: Stockwell‐Smith Gillian , Kellett Ursula , Moyle Wendy 
Published: June 2010

Aim.  The purpose of this study was to explore the limiting and motivating factors that influence carers’ use of respite services and the ability of currently available respite services to meet the needs of carers of frail older people.Background.  The development of community carer support services, their availability and usage and the common barriers that affect or impact on carers’ use of community services in general and respite services in particular need to be examined to ensure they meet client needs.Design.  A qualitative descriptive approach informed by critical social theory was used to expose the inequities inherent in community services.Methods.  A qualitative examination of carer relationships with respite services was informed and guided by critical theory. Sixteen carers took part in four focus groups. A purposeful sampling strategy was adopted to engage with carers not currently using respite services. Study participants were recruited from a state‐wide carer support organisation and a community service organisation in Queensland, Australia.Results.  Three themes emerged from the data: ‘Commitment’ characterised by reciprocity, role definition and role frustration, ‘Needing Help’ discussed in terms of trust, confidence in service, fear and resistance, and ‘Support’ discussed in relation to informal networking, misinformation and lack of knowledge.Conclusion.  This study improves our understanding of the caring role, its significance in carer’s lives and how this shapes their formal service expectations and use. The findings suggest that further investigation of the factors involved in carers’ service expectations and service‐seeking is warranted to develop a deeper understanding of how care giving influences the ways carers seek help from formal services.Relevance to clinical practice.  Service delivery changes towards a model of care, which engages and promotes user control and fosters genuine participatory relations between informal and professional carers may improve uptake of respite services.
‘Again’: the impact of recurrence on survivors of cancer and family members
Authors: Vivar Cristina G , Whyte Dorothy A , Mcqueen Anne 
Published: June 2010

Aim.  To examine the psychosocial impact of recurrence on survivors of cancer and their family members.Background.  Cancer recurrence is described as one of the most stressful phases of cancer. Recurrence brings back many negative emotions, which are different and may be more intense than those after first diagnosis of cancer. Survivors and their family members have to deal with new psychological distress.Design.  A qualitative descriptive study was conducted in four cancer units of two hospitals in North of Spain.Methods.  Fifteen survivors of cancer with a recent diagnosis of recurrence, 13 family members and 14 nurses were interviewed. Data collection and analysis were based on the constant comparative method of grounded theory.Results.  Four major categories were found: (1) ‘Again’: when cancer comes back, (2) the shock of recurrence, (3) the impact of the diagnosis on family life, and (4) factors that influence the impact of recurrence. Learning that cancer had come back was, for most of the families, more devastating than hearing that they had cancer for the first time. Signs of shock and suffering were experienced by families as an initial response to recurrence. The new diagnosis often entailed a change in the family life. Survivorship period and age seemed also significant in the psychosocial experience of recurrence.Conclusions.  The term ‘again’, used by all the participants to describe a recurrence of the disease, symbolised a beginning and a continuation with cancer; it implied a re‐encounter with health services, and it represented new suffering for the families.Relevance to clinical practice.  Therapeutic nursing interventions should be planned and provided to both patients with recurrent cancer and their family members. Family nursing can play an important role in helping families master the impact of the recurrent illness.
Quality of life in chronic disease: a comparison between patients with heart failure and patients with aphasia after stroke
Authors: Franzén‐Dahlin Åsa , Karlsson Monica Rydell , Mejhert Märit , Laska Ann‐Charlotte 
Published: June 2010

Objectives.  This study aimed to describe the impact of heart failure and of stroke with aphasia on quality of life (QoL) and to compare the different domains of QoL in these groups.Background.  The prevalence of chronic conditions has increased during the last decades, and chronic diseases such as stroke and heart failure may have a great impact on QoL.Design.  Comparative study of patients from two randomised controlled studies.Method.  Seventy‐nine patients with heart failure and 70 patients with aphasia after stroke were evaluated concerning the severity of their disease and by QoL, as measured with the Nottingham Health Profile, in the acute phase and after six months.Results.  The severity of the disease improved between baseline and six month for both groups. Correlations between New York Heart Association (NYHA) class and all QoL domains were seen in patients with heart failure after six months. The degree of aphasia correlated to mobility, social, emotional and total score after six month. QoL in patients with heart failure was more affected in the domains of sleep and energy in the acute phase and in the energy domain at six months.Conclusion.  Although low energy is more frequent among patients with heart failure, both groups report poor QoL. Improvement in severity of the disease is not necessarily accompanied by improvement in QoL.Relevance to clinical practice.  Nottingham Health Profile can easily be used as a screening instrument, aiming to identify patients at risk for adverse effects on QoL. A better understanding of the subjective QoL of patients with chronic disease is fundamental for health care professionals to be able to identify and support vulnerable patients.
The effect of clothes on sphygmomanometric blood pressure measurement in hypertensive patients
Authors: Pinar Rukiye , Ataalkin Sıddıka , Watson Roger 
Published: June 2010

Aims.  To test whether there is any difference between blood pressure readings with patients wearing clothes under the manometer’s cuff and not wearing clothes.Background.  The few studies published on this subject have shown that blood pressure measurements give similar results whether the patients’ arm is covered by clothing or not. However, it has not been clarified whether this is also true in hypertensive patients.Method.  Blood pressure was measured on non‐sleeved arm, sleeved arm and again on non‐sleeved arm in 258 hypertensive patients using a mercury‐filled column sphygmomanometer. Three nurses who were experienced and specially trained for the study performed blood pressure measurements. They were unaware of the purpose of the research.Results.  Measuring blood pressure with the manometer’s cuff over participant’s sleeved arm did not differ significantly from non‐sleeved arm measurements.Relevance to clinical practice.  Sleeves have no effect on blood pressure results. Blood pressure readings taken over the sleeves will be much more practical and time saving in busy departments like emergency rooms, during disasters like earthquake where decisions have to make in minutes. Additionally, it will be time saving for general health screening surveys. Finally, it may have preferable because of hygiene concerns, patient privacy and religious beliefs.
Metastatic spinal cord compression: a review of practice and care
Authors: Kilbride Lynn , Cox Marie , Kennedy Catriona M , Lee Siew Hwa , Grant Robin 
Published: June 2010

Aim and objectives.  The aim of this review was to address: (1) How is spinal stability assessed? (2) What is the role of bracing/should braces be used? (3) When is it safe to mobilise the patient? (4) What position should the patient be nursed in?Background.  Controversy surrounds the care for patients with metastatic spinal cord compression (MSCC). There is some evidence to indicate that care for patients with MSCC is based on individual clinician preference rather than evidence‐based guidelines which has been shown to cause delays and discrepancies in patient treatment.Design.  A structured literature review to synthesise the available evidence about the management of MSCC.Methods.  The following databases were searched: Medline, EMBASE, Cochrane Systematic Reviews Database, SIGN (Scottish Intercollegiate Guidelines Network), NICE (National Institute for Clinical Excellence), AMED (Allied and Complementary Medicine), CINAHL (Cumulative Index to Nursing and Allied Health Literature) and BNI (British Nursing Index). Publications were selected from the past 10 years. The search yielded a total of 1057 hits, 755 abstracts were screened, and 73 articles were retrieved and examined. Thirty‐five articles were included.Results.  The findings identified a gap and evidence relating to spinal stability, bracing, patient mobilisation, and positioning is limited and may be inconclusive. It is important for patients with a poor prognosis that their preferences and quality of life are considered.Conclusion.  Currently, the evidence base to underpin care is limited, and further research in this area is necessary for patients and healthcare professionals alike.Relevance to clinical practice.  Patients who suffer from MSCC suffer numerous physical, psychological and social issues. Because of lack of consensus, the current guidelines to inform clinical decision‐making of professional staff are of limited benefit.
The competence of primary care doctors in the investigation of patients with elevated blood pressure: results of a cross‐sectional study using clinical vignettes
Authors: Windak Adam , Gryglewska Barbara , Tomasik Tomasz , Narkiewicz Krzysztof , Yaphe John , Grodzicki Tomasz 
Published: June 2010

AbstractBackground  Specific laboratory tests are required to ensure adequate management of patients with hypertension, according to internationally accepted guidelines. There is wide variation in doctor test ordering behaviour. Many factors are known to affect this. Little is known about the interaction between doctor, patient and practice characteristics. The current study was designed to explore this.Methods  A series of eight case vignettes was designed to examine test ordering behaviour among primary care doctors in Poland. The cases differed with regard to the level of blood pressure and the presence or absence of other cardiovascular risk factors, including diabetes. Doctors stated their choices of laboratory investigations needed in these cases. Their responses were compared with recommendations in the 2003 European Society of Hypertension/European Society of Cardiology hypertension guidelines. Associations between the correct responses and patient, doctor and practice characteristics were tested.Results  One hundred and twenty‐five out of 192 invited doctors (65%) participated in the study. They ordered a mean of 4.9 laboratory tests per case. This represents 47.9% of the tests recommended by current guidelines. Older doctors working in smaller practices and private settings ordered fewer laboratory tests. Specialization in family medicine was associated with greater compliance with guidelines. Grade 2 hypertension and the presence of other risk factors of cardiovascular disease were associated with ordering more tests but the presence of diabetes did not improve compliance with guidelines.Conclusions  Further educational efforts are needed to promote rational test ordering for hypertensive patients by Polish primary health care doctors.
Impact of timing of bile duct interventions on resource use and clinical outcome of cholecystectomy patients in Japan
Authors: Kuwabara Kazuaki , Matsuda Shinya , Fushimi Kiyohide , Ishikawa Koichi B. , Horiguchi Hiromasa , Hayashida Kenshi , Fujimori Kenji 
Published: June 2010

AbstractAims  Laparoscopic cholecystectomy (LC) is increasingly used for acute cholecystitis, in conjunction with staged bile duct interventions (BDIs). However, few studies have evaluated the impact of BDI timing on costs and clinical outcomes during hospitalization. This study assessed the effects of several types of BDI and their timing on resource utilization and complications.Methods  A total of 13 738 cholecystectomy patients were treated for benign gallbladder diseases in 66 academic and 376 community hospitals in Japan in 2006. Variables analysed included: BDIs including endoscopic retrograde cholangiopancreatography (ERCP), percutaneous gallbladder or common bile duct drainage (external drainage), endoscopic sphincterotomy, clearance of choledocholithiasis (internal drainage); and length of stay (LOS), total charges (TCs), procedure‐related complications, and hospital function. Multivariate analysis was used to determine the impact of LC or BDIs on LOS, TCs and complications.Results  A total of 11 690 (85.1%) patients underwent LC. Inflammation was diagnosed in 70.7% of open cholecystectomy (OC) and 42.1% of LC patients. Complications were 7.7% in OC and 5.4% in LC patients. LC was associated with reduced LOS and TCs. BDIs were performed in more OC than LC patients. Preoperative was more costly than postoperative ERCP. Postoperative external drainage was significantly associated with LOS, TCs and complications. Advantages of pre‐ or postoperative internal drainage were not proven.Conclusions  External drainage should be completed preoperatively. Postoperative ERCP may be preferable for bile duct scrutiny alone. Further evaluation of the timing of cholecystectomy will determine precisely the superiority of pre‐ or postoperative BDIs in terms of quality of care for complicated patients.
Tai chi for lowering resting blood pressure in the elderly: a systematic review
Authors: Lee Myeong Soo , Lee Eun‐Nam , Kim Jong‐In , Ernst Edzard 
Published: June 2010

AbstractObjectives  To assess the evidence for tai chi in reducing resting blood pressure (BP) in the elderly.Methods  Databases were searched up to February 2009. All randomized clinical trials (RCTs) testing the effects of tai chi on resting BP in the elderly were considered. The selection of studies, data extraction and validation were performed independently by two reviewers. Methodological quality was evaluated using the Jadad score.Results  A total of 329 potentially relevant articles were identified and four RCTs met the inclusion criteria. One study suggested a significant BP reduction compared with no treatment or wellness education programme, while the others showed no effects compared with resistance exercise and usual activity. Two RCTs failed to show a reduction of resting BP compared with aerobic exercise, low impact exercise and no exercise control.Conclusion  The evidence for tai chi in reducing BP in the elderly individuals is limited. Whether tai chi has benefits over exercise is still unclear. The number of trials and the total sample size are too small to draw any firm conclusions. Further rigorous RCTs are warranted.
A population‐based cohort study of ambulatory care service utilization among older adults
Authors: Nie Jason X. , Wang Li , Tracy C Shawn , Moineddin Rahim , Upshur Ross E.G. 
Published: June 2010

AbstractRationale, aims and objectives  Age‐related effects on ambulatory care service utilization are not well understood. We aim to measure the utilization patterns of ambulatory health care services (i.e. family physician visits, specialist physician visits and emergency room visits) in the late life course (65 years and older).Methods  A population‐based retrospective cohort study was conducted for the period 1 April 2005 to 31 March 2006. All Ontario, Canada, residents aged 65+ and eligible for government health insurance were included in the analysis.Results  This population‐based cohort study demonstrates considerable increase in utilization rates and variability of ambulatory services as age increases. Variations in utilization were observed by gender as overall women were more likely to consult a family physician, and men more likely to visit specialists and the emergency room. A small group of high users, constituting 5.5% of the total population, accounted for 18.7% of total ambulatory visits. Finally, we report socio‐economic status (SES) based disparity for specialist services in which high users were more likely to have higher SES.Conclusions  There is increasing utilization and variability in ambulatory service utilization with increase in age. Further research is required to explain the gender and SES differences reported in this study.
Olfactory Experience Affects the Response of Meadow Voles to the Opposite‐Sex Scent Donor of Mixed‐Sex Over‐Marks
Authors: Ferkin Michael H. , Ferkin Daniel A. , Ferkin Benjamin D. , Vlautin Christian T. 
Published: June 2010

AbstractScent marking and over‐marking are important forms of communication between the sexes for many terrestrial mammals. Over the course of three experiments, we determined whether the amount of time individuals investigate the scent marks of opposite‐sex conspecifics is affected by 4 d of olfactory experience with those conspecifics. In Experiment 1, female meadow voles, Microtus pennsylvanicus, spent more time investigating the scent mark of the novel male conspecific than that of the familiar male donor, whereas male voles spent similar amounts of time investigating the scent mark of the familiar female and a novel female conspecific. In Experiment 2, voles were exposed to a mixed‐sex over‐mark in which subjects did not have 4 d of olfactory experience with either the top‐scent donor or the bottom‐scent donor. During the test phase, male and female voles spent more time investigating the scent mark of the opposite‐sex conspecific that provided the top‐scent mark than that of a novel, opposite‐sex conspecific. Male and female voles spent similar amounts of time investigating the scent mark of the bottom‐scent donor and that of a novel opposite‐sex conspecific. In Experiment 3, voles were exposed to a mixed‐sex over‐mark that contained the scent mark of an opposite‐sex conspecific with which they had 4 d of olfactory experience. During the test phase, male voles spent more time investigating the mark of the familiar, top‐scent female than the scent mark of a novel female donor but spent similar amounts of time investigating the mark of the familiar, bottom‐scent female and that of a novel female donor. In contrast, female voles spent more time investigating the mark of a novel male donor than that of either the familiar, top‐scent male or that of the familiar, bottom‐scent male. The sex differences in the responses of voles to scent marks and mixed‐sex over‐marks are discussed in relation to the natural history and non‐monogamous mating system of meadow voles.
Benefits and Costs of Dominance in the Angelfish Centropyge bicolor
Authors: Ang Tzo Zen , Manica Andrea 
Published: June 2010

AbstractSocial groups are often structured by dominance hierarchies in which subordinates consistently defer to dominants. High‐ranking individuals benefit by gaining inequitable access to resources, and often achieve higher reproductive success; but may also suffer costs associated with maintaining dominance. We used a large‐scale field study to investigate the benefits and costs of dominance in the angelfish Centropyge bicolor, a sequential hermaphrodite. Each haremic group contains a single linear body size‐based hierarchy with the male being most dominant, followed by several females in descending size order. Compared to their subordinate females, dominant males clearly benefited from disproportionately high spawning frequencies, but bore costs in lower foraging rates and greater aggressive defence of their large territories. Within the female hierarchy, more dominant individuals benefited from higher spawning frequencies and larger home ranges, but displayed neither higher foraging rates nor spawn order priority. However, dominance in females was also linked to aggressiveness, particularly towards immediate subordinates, suggesting that females were using energetically costly aggression to maintain their high rank. We further showed by experimentally removing dominant females that the linear hierarchy was also a social queue, with subordinates growing to inherit higher rank with its attendant benefits and costs when dominants disappeared. We suggest that in C. bicolor, the primary benefit of high rank is increased reproductive success in terms of current spawning frequency and the prospect of inheriting the male position in the near future, which may be traded off against the cost of aggressively defending rank and territory.
In vitro susceptibility of Aspergillus spp. to dithiocarbamate organoruthenium compounds
Authors: Nogueira Luciano J. , de Resende Maria A. , Oliveira Sheila R. , de Araújo Maria Helena , Magalhães Thais F. F. , de Oliveira Milena B. , Martins Cleide V. B. , Lopes Miriam T. P. , Araújo e Silva Ana C. , Donnici Claudio L. 
Published: June 2010

SummaryThe in vitro antifungal activity of ruthenium dithiocarbamate compounds (1–5) was investigated and assessed for its activity against seven different species of Aspergillus (Aspergillus clavatus, Aspergillus flavus, Aspergillus fumigatus, Aspergillus niger, Aspergillus nomius, Aspergillus tamarii and Aspergillus terreus). Analysis of in vitro susceptibility was performed using broth microdilution assay following the Clinical and Laboratory Standards Institute guidelines for filamentous fungi. The cytotoxicity was evaluated using 3‐(4,5‐dimethylthiazol‐2‐yl)‐2,5‐diphenyltetrazolium bromide assay. Aspergillus clavatus and A. fumigatus were more susceptible species for complexes 1 and 2. Other complexes showed excellent minimum inhibitory concentration (4–64 μg ml−1) against most microorganisms. Complexes 1 and 2 are respectively 180‐ and 95‐fold more active than the corresponding free ligands against A. clavatus and the complex 5 is 46‐fold more active than free ligand against A. niger. Aspergillus niger was more susceptible to the action of the complexes 1 and 5 (16 μg ml−1). A low cytotoxic activity (IC50 > 10−6 mol l−1) on normal mammalian cells (BHK‐21) to the evaluated complexes was measured. Ruthenium complexes are promising antifungal agents against the development of novel effective drug against different species of Aspergillus; however, for A. nomius and A. terreus, they were not active in the highest concentration tested.
The effect of brief exposure to sub‐therapeutic concentrations of chlorhexidine gluconate on germ tube formation of oral Candida dubliniensis
Authors: Ellepola Arjuna N. B. 
Published: June 2010

SummaryAdherence of Candida has been implicated as the first step in the pathogenesis of oral candidosis, and germ tube formation, a contributory attribute. While chlorhexidine gluconate is by far the most common antiseptic mouthwash prescribed in dentistry, its intraoral concentration fluctuates considerably because of the dynamics of the oral cavity. Hence, the main objective of this study was to investigate the effect of brief exposure to three different sub‐therapeutic concentrations of chlorhexidine gluconate on germ tube formation of Candida dubliniensis. Twelve oral isolates of C. dubliniensis were exposed to three different sub‐therapeutic concentrations of 0.005%, 0.0025% and 0.00125% chlorhexidine gluconate for 30 min. The antiseptic was removed, and following subsequent incubation in a germ tube inducing medium, the germ tube formation of these isolates was quantified microscopically. When compared with the controls, brief exposure to 0.005%, 0.0025% and 0.00125% chlorhexidine gluconate suppressed the ability to form germ tubes by 76.53% (P < 0.01), 49.17% (P < 0.01) and 3.45% (P > 0.05) respectively. These findings imply that brief exposure to sub‐therapeutic levels of chlorhexidine gluconate may modulate germ tube formation of C. dubliniensis, thereby suppressing its pathogenicity in vivo.