bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effect of nicotine on the pelvic afferent nerve activity and bladder pressure in rats
Authors: Kontani Hitoshi , Okamura Takashi , Kimura Satoko , Ishida Kazuumi , Takeno Satoshi 
Published: July 2009

Objectives:  To record afferent nerve activity and bladder pressure in anesthetized male rats and to investigate whether increased afferent nerve activity induced by nicotine is able to evoke reflex bladder contractions.Methods:  Using continuous infusion cystometrography, bladder pressure was measured via a bladder cannula. Afferent activity was recorded in the uncut L6 dorsal root. Nicotine was injected intra‐arterially through a cannula placed near the bifurcation of the internal iliac artery a few minutes after micturition.Results:  Nicotine (0.15–1.5 µmol) evoked a marked elevation of afferent discharge without a simultaneous increase in bladder pressure. Bladder contractions appeared about 43 and 19 s after bolus injection of nicotine at 0.45 and 1.5 µmol, respectively. Firing rates of afferent nerves were reduced when the contraction appeared. Continuous infusion of nicotine at 0.75 µmol/min for 20 min evoked marked elevation of afferent discharge, which was maintained during infusion of nicotine and after it had been withdrawn. Repetitive contractions were observed thereafter and disappeared when the L6 dorsal roots were bilaterally resected.Conclusions:  A transient increase in afferent discharges induced by bolus injection of nicotine was unable to evoke reflex bladder contraction. Repetitive bladder contractions after withdrawal of continuous nicotine infusion were induced in a reflex manner by the increased afferent activity.
Lateral view dissection of the prostato‐urethral junction to reduce positive apical margin in laparoscopic radical prostatectomy
Authors: Sasaki Hiroshi , Miki Jun , Kimura Takahiro , Sanuki Kunitaro , Miki Kenta , Takahashi Hiroyuki , Egawa Shin 
Published: July 2009

Objective:  To assess the impact of lateral view apical dissection in laparoscopic radical prostatectomy (LRP) on the reduction of positive surgical margin rates and recovery of postoperative continence.Methods:  One hundred and forty‐four consecutive patients underwent LRP from October 2004 to March 2008. Lateral view dissection of the prostato‐urethral junction was conducted in 76 of them (Group 2). Standard dissection was used in the remaining patients (Group 1). The effect of this technical modification on the reduction of positive surgical margin rates and postoperative recovery of urinary continence was assessed in the two groups.Results:  Overall, the incidence of positive margins decreased from 23 (35.9%) in Group 1 to 16 cases (21.9%) in Group 2 (P = 0.07). Positive margin rates in pT2 decreased from 30.6% to 6.5% (P = 0.006). Apical and dorso‐apical margins were reduced from 26.5% to 4.3% (P = 0.009) and from 10.2% to 0% (P < 0.001), respectively. Postoperative recovery of urinary continence improved significantly, with a pad‐free rate over the first 3 months of 55.9% in Group 1 vs 71.7% in Group 2 (P = 0.01). Multivariate logistic regression analysis showed this modified surgical technique to predict a lower rate of positive margins.Conclusion:  Lateral view dissection of the prostato‐urethral junction is an easily applicable technical modification. It provides better visualization of apical anatomy substantially contributing to the reduction of positive surgical margin rates, especially at the level of prostatic apex.
What are the most effective strategies for improving quality and safety of health care?
Authors: Scott I. 
Published: July 2009

AbstractThere is now a plethora of different quality improvement strategies (QIS) for optimizing health care, some clinician/patient driven, others manager/policy‐maker driven. Which of these are most effective remains unclear despite expressed concerns about potential for QIS‐related patient harm and wasting of resources. The objective of this study was to review published literature assessing the relative effectiveness of different QIS. Data sources comprising PubMed Clinical Queries, Cochrane Library and its Effective Practice and Organization of Care database, and HealthStar were searched for studies of QIS between January 1985 and February 2008 using search terms based on an a priori QIS classification suggested by experts. Systematic reviews of controlled trials were selected in determining effect sizes for specific QIS, which were compared as a narrative meta‐review. Clinician/patient driven QIS were associated with stronger evidence of efficacy and larger effect sizes than manager/policy‐maker driven QIS. The most effective strategies (>10% absolute increase in appropriate care or equivalent measure) included clinician‐directed audit and feedback cycles, clinical decision support systems, specialty outreach programmes, chronic disease management programmes, continuing professional education based on interactive small‐group case discussions, and patient‐mediated clinician reminders. Pay‐for‐performance schemes directed to clinician groups and organizational process redesign were modestly effective. Other manager/policy‐maker driven QIS including continuous quality improvement programmes, risk and safety management systems, public scorecards and performance reports, external accreditation, and clinical governance arrangements have not been adequately evaluated with regard to effectiveness. QIS are heterogeneous and methodological flaws in much of the evaluative literature limit validity and generalizability of results. Based on current best available evidence, clinician/patient driven QIS appear to be more effective than manager/policy‐maker driven QIS although the latter have, in many instances, attracted insufficient robust evaluations to accurately determine their comparative effectiveness.
Aspirin for primary prevention: do potential benefits outweigh the risks?
Authors: Shakib S. 
Published: July 2009

AbstractThe role of aspirin for primary prevention in healthy individuals has been the subject of clinical trials for more than a quarter of a century. Because of this evidence, or sometimes despite it, many individuals self‐administer aspirin to prevent cardiovascular events. This article reviews the published work for aspirin in primary prevention of cardiovascular and malignant diseases and considers whether aspirin would be approved by regulatory authorities for this use if it were to be marketed for this indication today.
Hypercalcaemia caused by a carcinoid tumour
Authors: Brzozowska M. M. , Wolmarans L. , Conaglen J. V. 
Published: July 2009

AbstractHumoral hypercalcaemia resulting from carcinoid tumours is uncommon. We report a case of hypercalcaemia because of excessive secretion of parathyroid hormone‐related protein (PTHrP) in a 77‐year‐old woman with an advanced carcinoid tumour. Fibroblast growth factor 23 levels were also elevated. The hypercalcaemia responded to adjunctive therapy with long‐acting octreotide analogue therapy, bisphosphonates and steroids. The role of PTHrP in humoral hypercalcaemia of malignancy, its association with neuroendocrine tumours, as well as the therapeutic use of somatostatin analogues are reviewed.
Transition to psychiatric/mental health nursing programs: Expectations and practical considerations
Authors: Cleary Michelle , Horsfall Jan , Happell Brenda 
Published: July 2009

ABSTRACTMental health services have developed transition programs to attract staff, including new graduates, staff with mental health nursing experience without formal qualifications, experienced nurses wishing to move into mental health, and nurses returning to the workforce. Transition to psychiatric/mental health programs are considered to be particularly significant in the mental health field because of the relative under‐representation of mental health content in undergraduate curricula. Unfortunately, transition programs have received only minor attention in the literature and there is a paucity of published evaluations to determine their effectiveness. The aim of this paper is to examine transition programs and consider how they meet the expectations of stakeholders, such as consumers of mental health services, and program participants' expectations. It is concluded that published systematic evaluations are lacking, particularly those considered from the perspective of stakeholders. Consideration of these expectations should be reflected in the design and delivery of mental health nursing transition programs.
Negotiating complexities: An ethnographic study of intellectual disability and mental health nursing in New Zealand
Authors: Taua Chris , Farrow Tony 
Published: July 2009

ABSTRACTThis paper presents the findings from a study undertaken to describe nursing practice in one dual diagnosis (DD; coexisting mental illness and intellectual disability) inpatient unit in New Zealand. A focused ethnographic approach (using fieldwork observations, a review of documents, and five semistructured interviews) was used to gather data. A model of culture was used to analyze data to allow a description of DD nursing practice. Additionally, this framework allowed for an exploration of the artefacts, values, and assumptions that underpin these practices. Three key themes emerged from the data: keeping everyone safe, managing the complexities in assessment, and narrating their work. Together, these themes indicate that in the absence of a defined model of DD nursing, practice is based on an institutional psychiatric model. We argue that DD nursing models need to be made explicit in order to advance nursing in this area.
Cochrane Reviews of non‐medication‐based psychotherapeutic and other interventions for schizophrenia, psychosis, and bipolar disorder: A systematic literature review
Authors: Jung Xenia Tricia , Newton Richard 
Published: July 2009

ABSTRACTMental health‐care professionals are striving to keep up to date with health interventions that are effective and beneficial to patients. The Cochrane Reviews make available a systematic and up‐to‐date review of a comprehensive range of health interventions. We identified a total of 28 interventions from a systematic search and review of the Cochrane Reviews for either schizophrenia, psychosis, schizoaffective, or bipolar disorder. These interventions have been graded into tables of: strong support that merits application, moderate support that warrants consideration of application, not supported, and data that is deemed inconclusive. The tables provide a comprehensive summary and classification of evidence‐based practices. This information is presented in a way to enable nurses and other health‐care professionals to analyze their own practices to improve mental health services and outcomes for patients. Of the 28 interventions identified in this review, four had strong support and five had moderate support meriting application. Limitations of this review are discussed.
Duly Authorized Officers' practices under mental health law in New Zealand: Are nurses meeting the requirements of the law?
Authors: McKenna Brian , Thom Katey , O'Brien Anthony , Crene Sally , Simpson Alexander 
Published: July 2009

ABSTRACTThe Mental Health (Compulsory Assessment and Treatment) Act (1992) introduced a number of statutory roles that are undertaken by mental health nurses. One of these roles is that of Duly Authorized Officer (DAO). The DAO is responsible for the procedural requirements necessary to facilitate compulsory assessment. Under Section 9(2)(d), the DAO is required to ensure that the purpose of the assessment and the requirements of the notice of assessment are explained to the person in the presence of a member of their family, a caregiver, or other person concerned with the welfare of the person. Three recent High Court decisions under the Habeas Corpus Act 2001 have challenged existing DAO practices in arranging the presence of a third party. This paper presents research, which focuses on unravelling some of the complexities associated with meeting this procedural requirement. It illustrates these complexities through a discussion of the results of an audit of files and three focus groups with mental health nurses who practise as DAO. The paper concludes that national guidelines for practice need to be developed for DAO to assist mental health nurses in meeting this statutory requirement.
Are specialists at risk under environmental change? Neoecological, paleoecological and phylogenetic approaches
Authors: Colles Audrey , Liow Lee Hsiang , Prinzing Andreas 
Published: July 2009

AbstractThe question ‘what renders a species extinction prone’ is crucial to biologists. Ecological specialization has been suggested as a major constraint impeding the response of species to environmental changes. Most neoecological studies indicate that specialists suffer declines under recent environmental changes. This was confirmed by many paleoecological studies investigating longer‐term survival. However, phylogeneticists, studying the entire histories of lineages, showed that specialists are not trapped in evolutionary dead ends and could even give rise to generalists. Conclusions from these approaches diverge possibly because (i) of approach‐specific biases, such as lack of standardization for sampling efforts (neoecology), lack of direct observations of specialization (paleoecology), or binary coding and prevalence of specialists (phylogenetics); (ii) neoecologists focus on habitat specialization; (iii) neoecologists focus on extinction of populations, phylogeneticists on persistence of entire clades through periods of varying extinction and speciation rates; (iv) many phylogeneticists study species in which specialization may result from alackof constraints. We recommend integrating the three approaches by studying common datasets, and accounting for range‐size variation among species, and we suggest novel hypotheses on why certain specialists may not be particularly at risk and consequently why certain generalists deserve no less attention from conservationists than specialists.
Integrating physiological, ecological and evolutionary change: a Price equation approach
Authors: Collins Sinéad , Gardner Andy 
Published: July 2009

AbstractWe use a general quantitative framework – the Price equation – to partition phenotypic responses to environmental change into separate physiological, evolutionary and ecological components. We demonstrate how these responses, which potentially occur over different timescales and are usually studied in isolation, can be combined in an additive way; and we discuss the main advantages of doing this. We illustrate our approach using two worked examples, concerning the emergence of toxin resistance within microbial communities, and the estimation of carbon uptake by marine phytoplankton in high‐CO2environments. We find that this approach allows us to exclude particular mechanistic hypotheses with regard to community‐level transformations, and to identify specific instances where appropriate data are lacking. Thus Price’s equation provides not only a powerful conceptual aid, but also a means for testing hypotheses and for directing empirical research programmes.
Earlier diagnosis and treatment of symptomatic bowel cancer: can it be achieved and how much will it improve survival?
Authors: Thompson M. R. , Heath I. , Swarbrick E. T. , Faulds Wood L. , Ellis B. G. 
Published: July 2009

AbstractAim  To determine current delays in diagnosis and treatment of bowel cancer, when and why they occur, and what effect they have on survival.Method  A detailed review of the literature based on the development of the GP referral guidelines in 2000.Results  There is no evidence of a reduction in the delay to diagnosis and treatment of bowel cancer over the last 60 years. There is no strong theoretical basis for a benefit from earlier diagnosis of symptomatic bowel cancer and this is consistent with observational studies.Conclusion  Campaigns to earlier diagnose bowel cancer will not be successful unless new strategies are developed. There is substantial evidence that earlier diagnosis of symptomatic bowel cancer will not improve survival in the majority of patients. However as excessive delays still occur in some patients it is reasonable to continue to aim to diagnose and treat all bowel cancer within 6 months of the onset of symptoms with an overall median of 3–4 months.
The assessment of lymph nodes missed in mesenteric tissue after standard dissection of colorectal cancer specimens
Authors: Hernanz F. , García‐Somacarrera E. , Fernández F. 
Published: July 2009

AbstractObjective  We studied fresh mesenteric and mesorectal tissue after standard dissection of colorectal cancer specimens using a clearing method to evaluate lymph nodes (LN) that could have been missed.Method  After traditional dissection, 50 consecutive unfixed residual mesenteric and mesorectal tissues were entirely managed by a new clearing solution, which incorporates hydrochloric acid obtaining a really good degree of fat dissolution, facilitating the identification of missed LNs.Results  By fat clearance, 498 (mean per specimen, 10) additional LNs were found, most of them (83%) varying in size from 1 to 5 mm. and 22 (4.41%) LNs revealed tumour metastases. In two rectal carcinoma specimens that had been treated by neoadjuvant chemoradiotherapy, no LNs were found by traditional dissection; after checking by the clearing method, additional LNs were harvested in both. Three patients were reclassified and upstaged.Conclusion  According to our findings, after standard dissection in the remaining mesentery of colorectal specimen there are missed positive LNs, which should be evaluated to avoid pathological understaging.
Randomized controlled trial of patient‐controlled sedation for colonoscopy: Entonox vs modified patient‐maintained target‐controlled propofol
Authors: Maslekar S. , Balaji P. , Gardiner A. , Culbert B. , Monson J. R. T. , Duthie G. S. 
Published: July 2009

AbstractAim  Propofol sedation is often associated with deep sedation and decreased manoeuvrability. Patient‐maintained sedation has been used in such patients with minimal side‐effects. We aimed to compare novel modified patient‐maintained target‐controlled infusion (TCI) of propofol with patient‐controlled Entonox inhalation for colonoscopy in terms of analgesic efficacy (primary outcome), depth of sedation, manoeuvrability and patient and endoscopist satisfaction (secondary outcomes).Method  One hundred patients undergoing elective colonoscopy were randomized to receive either TCI propofol or Entonox. Patients in the propofol group were administered propofol initially to achieve a target concentration of 1.2 μg/ml and then allowed to self‐administer a bolus of propofol (200 μg/kg/ml) using a patient‐controlled analgesia pump with a handset. Entonox group patients inhaled the gas through a mouthpiece until caecum was reached and then as required. Sedation was initially given by an anaesthetist to achieve a score of 4 (Modified Observer’s Assessment of Alertness and Sedation Scale), and colonoscopy was then started. Patients completed an anxiety score (Hospital Anxiety and Depression questionnaire), a baseline letter cancellation test and a pain score on a 100‐mm visual analogue scale before and after the procedure. All patients completed a satisfaction survey at discharge and 24 h postprocedure.Results  The median dose of propofol was 174 mg, and the median number of propofol boluses was four. There was no difference between the two groups in terms of pain recorded (95% confidence interval of the difference −0.809, 5.02) and patient/endoscopist satisfaction. There was no difference between the two groups in either depth of sedation or manoeuvrability.Conclusion  Both Entonox and the modified TCI propofol provide equally effective sedation and pain relief, simultaneously allowing patients to be easily manoeuvred during the procedures.
Patient satisfaction with lower gastrointestinal endoscopy: doctors, nurse and nonmedical endoscopists
Authors: Maslekar S. , Hughes M. , Gardiner A. , Monson J. R. T. , Duthie G. S. 
Published: July 2009

AbstractAim  Assessment of patient satisfaction with lower gastrointestinal endoscopy (LGE) comprising colonoscopy and flexible sigmoidoscopy is gaining increasing importance. We have now trained non healthcare professionals such as nonmedical endoscopists (NMEs) to perform LGE to overcome shortage of trained endoscopists. The aim of this study was to prospectively determine patient satisfaction, factors affecting satisfaction with LGE and to compare with nurses, NME and medical endoscopists, in terms of patient satisfaction.Method  Consecutive patients undergoing LGE answered specially developed patient satisfaction questionnaire at discharge and 24 h thereafter. This questionnaire was a modification of m‐Group Health Association of America questionnaire. Construct and face validity of questionnaire were tested by an expert group. Demographic and clinical data was prospectively collected. Multivariate regression analysis was performed to determine factors influencing patient satisfaction.Results  Some 503 patients were surveyed after LGE. Examinations were performed by nurse (n = 105), doctor (n = 191), or NMEs (n = 155). There were no differences between three groups in terms of completion rates/complications. No differences were detected between endoscopists in patient rating for overall satisfaction (P = 0.6), technical skills (P = 0.58), communication skills (P = 0.61) or interpersonal skills (0.59). Multivariate regression analysis showed that higher preprocedure anxiety, history of pelvic operations/hysterectomy and higher pain scores were associated with adverse patient satisfaction and preprocedure anxiety, history of hysterectomy and female gender were associated with higher pain scores.Conclusion  This study has shown that there are no differences in patient satisfaction with LGE performed by nurse, doctor or NME. The most important factor affecting patient satisfaction is degree of discomfort/pain experienced by patient.
Laparoscopic excision of rectovaginal endometriosis: report of a prospective study and review of the literature
Authors: Maytham G. D. , Dowson H. M. , Levy B. , Kent A. , Rockall T. A. 
Published: July 2009

AbstractAim  The surgical management of rectovaginal endometriosis is challenging. We present our experience of the laparoscopic management of these difficult cases, together with a review of the current literature.Method  A prospective database was established for all patients undergoing surgery for Deep Infiltrating Endometriosis (DIE) with rectovaginal and/or ureteric and bladder nodules. Outcomes analysed include operation performed, conversion and complication rates, and length of stay. These outcomes were compared with other laparoscopic rectal resections for alternative diagnoses recorded in the database and with outcomes seen in a literature review of studies on the surgical management of endometriosis.Results  Between April 2004 and November 2007, 54 patients underwent laparoscopic excision of rectovaginal endometriosis by a combined colorectal and gynaecological surgical team. Out of the 54 patients, 37% of patients underwent a rectal wall shave, 13% had a disc excision of the rectal wall, and 50% underwent segmental resection. There was a conversion rate of 4%, median duration of stay was 3 days, with 2% requiring transfusion. Major complications occurred in 7% of patients, with 4% requiring reoperation. Patients undergoing segmental resection for endometriosis had a higher complication rate than those having surgery for other diagnoses. There was an increased incidence of anastomotic stenosis, with histopathological results suggesting that the disease process might have contributed to this occurrence.Conclusions  Laparoscopic resection of rectovaginal endometriosis may be associated with a higher incidence of complications than resections performed for other diagnoses.