bluuebunny/crossref_metadata_2025_split huggingface dataset:
Room for improvement: nurses' and physicians' views of a post‐operative pain management program
Authors: HARTOG C. S. , ROTHAUG J. , GOETTERMANN A. , ZIMMER A. , MEISSNER W. 
Published: November 2009

Background: The practice of post‐operative pain therapy continues to be a problem. We conducted a survey among nurses and physicians about their views of an established post‐operative pain management program.Methods: A questionnaire was sent to all nurses and physicians of nine surgical wards (general, trauma, cardio‐thoracic and oromaxillofacial surgery and gynecology). Questions were developed from qualitative interviews with staff. Patient data were derived from a post‐operative pain registry.Results: Seventy‐eight physicians and nurses answered; the overall response rate was 23%. Post‐operative pain therapy had high personal priority on an 11‐point numeric rating scale (mean 9.08±1.27 standard deviation), but the success of pain management on the ward was rated as 7.32±1.37. Staff rating of success tended to correspond with patients' actual pain ratings. Knowledge of pain therapy was assessed as 6.85±1.82; nurses consistently rated levels higher than physicians. Staff over‐ or underestimated the painfulness of typical procedures and females rated procedures as more painful than men. There was considerable confusion about responsibilities and duties. 10.7% of staff perceived time delays exceeding 6 h between a request for acute pain services (APS) consultation and administration of medication to the patient. Invited comments suggested improvement in personnel education, team coordination, communication with patients and speed of action to increase the quality of pain therapy.Conclusion: Despite staff's high personal priority and well‐established APS and pain management program, post‐operative pain therapy still leaves room for improvement. Considerable confusion about responsibilities and duties underlines the importance of better organizational approaches.
Mapping of resistance against Barley mild mosaic virus‐Teik (BaMMV) – an rym5 resistance breaking strain of BaMMV – in the Taiwanese barley (Hordeum vulgare) cultivar ‘Taihoku A’
Authors: Humbroich K. , Jaiser H. , Schiemann A. , Devaux P. , Jacobi A. , Cselenyi L. , Habekuss A. , Friedt W. , Ordon F. 
Published: November 2009

With 1 figure AbstractThe Taiwanese barley (Hordeum vulgare L.) cultivar ‘Taihoku A’, which has been described as resistant to Barley mild mosaic virus (BaMMV), Barley yellow mosaic virus (BaYMV) and BaYMV‐2, contains the BaMMV resistance gene rym13 located on chromosome 4HL. Furthermore, ‘Taihoku A’ shows resistance to the newly detected virus strain BaMMV‐Teik, which is able to overcome the resistance gene rym5. By analysing a set of 154 DH‐lines of the cross ‘Taihoku A’ x ‘Plaisant’ it turned out that resistance to BaMMV‐Teik is inherited in a monogenic manner, the gene located on chromosome 4HL. Resistance to BaMMV‐Teik is also encoded by rym13 or an additional gene being closer linked to rym13 than 0.65 centiMorgan (cM). Using bulked segregant analysis employing Simple sequence repeats (SSRs) and Amplified fragment length polymorphisms (AFLPs), a map comprising 39.1 cM was constructed with the closest marker linked to the BaMMV/BaMMV‐Teik resistance at a distance of 1 cM. Respective markers are useful tools to introduce resistance to BaMMV‐Teik into adapted breeding lines carrying other resistance genes, which are not effective against all BaMMV/BaYMV strains known in Europe, e.g. rym4, rym5.
Retirement: What will you do? A narrative inquiry of occupation‐based planning for retirement: Implications for practice
Authors: Hewitt Alana , Howie Linsey , Feldman Susan 
Published: November 2009

Aim:  To examine, using a retrospective narrative study, the factors influencing four older people’s decision to plan for the activities they would undertake once retired, the planning process undertaken and their subsequent experience of retirement. Method:  Semi‐structured interviews were conducted to examine the factors influencing older people’s decision to commence pre‐retirement planning, the planning process undertaken and their experience of retirement. In keeping with narrative inquiry, paradigmatic‐type narrative analysis led to the development of categories and subsequent themes to reveal the participants’ experiences of these issues. Results:  Three themes: environmental influences, the planning process and retirement experiences: the outcome of planning, were derived from the participants’ narratives. Overall, retirement activities that were continued or initiated led to a positive experience even when these planned activities were temporarily interrupted or altered. Planning for future years in retirement and older age also continued.Conclusion:  Occupational therapists have a unique understanding of the centrality of occupation to health and wellbeing. Thus occupational therapists are well‐positioned to assist people identify, plan and engage in meaningful occupations outside work in retirement.
Transumbilical single‐port laparoscopic partial nephrectomy in a pig model
Authors: Boylu Ugur , Oommen Mathew , Thomas Raju , Lee Benjamin R. 
Published: November 2009

Study Type – Therapy (case series) Level of Evidence 4OBJECTIVETo determine the feasibility, instrumentation, and learning curve for single‐port laparoscopic partial nephrectomy (SPLPN) in a pig model.MATERIALS AND METHODSTen transumbilical SPLPN were performed using the R‐Port (Advanced Surgical Concepts, Wicklow, Ireland) multi‐instrument port, a 5‐mm flexible laparoscope (Olympus Surgical, Orangeburg, NY, USA), and custom‐engineered articulating needle drivers, graspers, and scissors (Cambridge Endo, Framingham, MA, USA). After general anaesthesia, the pig was placed in the flank position. After umbilical placement of the R‐Port, Gerota’s fascia was incised and hilar dissection performed with the newly engineered articulating instruments. Either the upper or lower pole of the kidney was scored and excised after placing a bulldog clamp on the renal pedicle. The bolsters were prepared with absorbable haemostat, placed at the site of excision, and secured with polyglactin sutures.RESULTSA fascial incision of ≥2.5 cm should be made to allow adequate room for passing the instruments. Also, use of the 5 mm flexible laparoscope minimizes instrument crowding and allows for optimal visualization. The mean (sd, range) time for hilum dissection was 12.2 (4.3, 7–20) min, while that for total excision was 9.8 (1.7, 8–12) min. Modified suturing techniques were developed to achieve reconstruction in a small working space. Specialized instrumentation is essential for a successful SPLPN with no need for an additional port for triangulation. The mean duration of intracorporeal suturing was 27.7 min (declining from 40 to 15 min). The total ischaemia time decreased from 50 min in the first case to 27 min in the last (mean 37.4 min). The mean estimated blood loss was 81.1 (31.7, 50–150) mL.CONCLUSIONSSPLPN is technically feasible but further refinement of instrumentation and techniques is needed to decrease the ischaemia time and optimize the procedure.
Medical management of acute urolithiasis in one American academic emergency room
Authors: Kaplon Daniel M. , Sterrett Samuel , Nakada Stephen Y. 
Published: November 2009

Study Type – Therapy (case series) Level of Evidence 4OBJECTIVETo determine the implementation of medical expulsive therapy (MET) for ureterolithiasis in one tertiary‐care emergency room (ER); referral patterns in the surgical and metabolic follow‐up of ureterolithiasis were also assessed.PATIENTS AND METHODSIn this retrospective review we identified 556 patients with ureterolithiasis in the ER at our centre between 2005 and 2007. Of these, 131 patients met inclusion criteria, including first‐time stone formers and no urological visit within the previous 5 years. ER records were reviewed and telephone interviews conducted to determine if MET was used, if the patient was referred to a urologist, if surgery was ultimately required, and if there was ultimately a metabolic evaluation.RESULTSThe mean (range) stone size was 4.2  (2–10) mm. Ten patients were admitted directly from the ER and 121 were discharged home. Of the 121 discharged patients, 48 (40%) were prescribed MET. In all, 46 patients received tamsulosin 0.4 mg and two received doxazosin 2 mg; no patient was prescribed steroids. The mean size of passed stones was statistically significantly lower than that of stones that did not pass (P < 0.05). Patients prescribed MET had a 23% chance of needing surgery, vs 32% in those not prescribed MET (P < 0.05). Seventy‐one (61%) patients were followed up by a urologist, 27 (23%) by a primary‐care physician, and eight (7%) had no further follow‐up. Ultimately, 31 (23%) patients had a metabolic evaluation and it was abnormal in 29 (95%).CONCLUSIONSIn this single‐institution ER experience, 40% of patients with symptomatic ureterolithiasis were treated with MET on discharge from the ER. Our data also show that only patients referred to a urologist received a metabolic evaluation. This is notable given that the vast majority of those evaluated were found to have a correctable abnormality.
A randomized trial of photoselective vaporization of the prostate using the 80‐W potassium‐titanyl‐phosphate laser vs transurethral prostatectomy, with a 1‐year follow‐up
Authors: Bouchier‐Hayes David M. , Van Appledorn Scott , Bugeja Pat , Crowe Helen , Challacombe Ben , Costello Anthony J. 
Published: November 2009

Study Type – Therapy (RCT) Level of Evidence 2bOBJECTIVETo compare the potassium‐titanyl‐phosphate GreenlightTM 80‐W laser ablation system for photovaporization of the prostate (PVP; Laserscope, San Jose, CA, USA) with transurethral resection of the prostate (TURP), as many technologies have been proposed as equivalent or superior to TURP without gaining widespread acceptance, due to lack of data from randomized trials.PATIENTS AND METHODSIn all, 120 patients were randomized to undergo either TURP or PVP after a full urological evaluation, which was repeated at 1, 3, 6 and 12 months after surgery. Irrigation use, duration of catheterization (DOC), length of hospital stay (LOS), blood loss, cost and operative time were also assessed.RESULTSBoth groups showed a significant increase in mean (sd) maximum urinary flow rate from baseline (P < 0.05); in the TURP group from 8.9 (3.0) to 19.4 (8.7) mL/s (154%), and in the PVP group from 8.8 (2.5) to 18.6 (8.2) mL/s (136%). The International Prostate Symptom Score (IPSS) decreased from 25.4 (5.7) to 10.9 (9.4) in the TURP group (53%), and from 25.3 (5.9) to 8.9 (7.6) in the PVP group (61%). The trends were similar for the bother and Quality of Life scores. There was no difference in sexual function as measured by Baseline Sexual Function Questionnaires. The DOC was significantly less in the PVP than the TURP group (P < 0.001), with a mean (range) of 13 (0–24) h vs 44.7 (6–192) h. The situation was similar for LOS (P < 0.001), with a mean (range) of 1.09 (1–2) and 3.6 (3–9) days in the PVP and TURP groups, respectively. Adverse events and complications were less frequent in the PVP group. Costs were also 22% less in the PVP group.CONCLUSIONSThis trial shows that PVP is an effective technique when compared to TURP, producing equivalent improvements in flow rates and IPSS with the advantages of markedly reduced LOS, DOC and adverse events. A long‐term follow‐up is being undertaken to ensure durability of these results.
Penoscrotal plication as a uniform approach to reconstruction of penile curvature
Authors: Dugi Daniel D. , Morey Allen F. 
Published: November 2009

Study Type – Therapy (case series) Level of Evidence 4OBJECTIVETo present our 4‐year experience of using a minimally invasive technique, penoscrotal plication (PSP), as a uniform treatment for men with debilitating penile curvature resulting from Peyronie’s disease.PATIENTS AND METHODSIn 48 men (median age 58.7 years) with penile curvature the penis was reconstructed by imbricating the tunica albuginea opposite the curvature with multiple nonabsorbable sutures. All patients, regardless of the degree or direction of curvature, were approached through a small penoscrotal incision made without degloving the penis. Detailed measurements of penile shaft angle and stretched penile length were recorded and analysed before and after reconstruction, and the numbers of sutures required for correction were documented.RESULTSNearly all patients had dorsal and/or lateral deformities that were easily corrected via a ventral penoscrotal incision. The median (range) degree of correction was 28 (18–55)° and number of sutures used was 6 (4–17). Stretched penile length measurements before and after plication showed no significant difference. A single PSP procedure was successful in 45/48 (93%) patients; two were dissatisfied with the correction, one having repeat plication and the other a penile prosthesis; one other required a suture release for pain.CONCLUSIONSPSP is safe and effective and should be considered even for cases with severe or biplanar curvature.
Definition and preoperative predictors of persistently elevated prostate‐specific antigen after radical prostatectomy: results from the Shared Equal Access Regional Cancer Hospital (SEARCH) database
Authors: Moreira Daniel M. , Presti Joseph C. , Aronson William J. , Terris Martha K. , Kane Christopher J. , Amling Christopher L. , Freedland Stephen J. 
Published: November 2009

Study Type – Prognosis (inception cohort) Level of Evidence 1bOBJECTIVESTo define a level of persistently elevated prostate‐specific antigen (PSA) after radical prostatectomy (RP) that equates with high‐risk for disease progression, and to identify preoperative predictors of PSA persistence among men from the Shared Equal Access Regional Cancer Hospital (SEARCH) database.PATIENTS AND METHODSA total of 901 men treated with RP between 2001 and 2008 were separated into groups based upon PSA nadir within 6 months after RP. We explored the association between nadir groups and time to biochemical recurrence (BCR) using multivariate Cox proportional hazards and determined the preoperative predictors of PSA persistence using logistic regression.RESULTSRelative to men with undetectable PSA levels, those with a PSA nadir of 0.03 (hazard ratio [HR] 3.88, P < 0.001), 0.04 (HR 4.87, P < 0.001), 0.05–0.09 (HR 12.69, P < 0.001), 0.1–0.19 (HR 13.17, P < 0.001), and 0.2 ng/mL (HR 13.23, P < 0.001) were at increased risk of BCR while men with a nadir of 0.01 (HR 1.36, P = 0.400) and 0.02 (HR 1.64, P = 0.180) were not. Using the PSA persistence definition of a PSA nadir ≥0.03 ng/mL, 230 men (26%) had persistence. The independent preoperative predictors of PSA persistence were higher body mass index (BMI, P = 0.002), pathological Gleason score (relative to 2–6: 4 + 3–10, P = 0.001) and preoperative PSA level (P < 0.001).CONCLUSIONSMen with a PSA nadir ≥0.03 ng/mL after RP were at higher risk for BCR. Using a PSA persistence definition of a PSA nadir ≥0.03 ng/mL, persistence was predicted by known factors associated with aggressive disease (tumour grade, PSA level and BMI). Validation of the present definition in different populations using later end‐points remains necessary to assess its prognostic usefulness.
Prognostic significance of global grading system of Gleason score in patients with prostate cancer with bone metastasis
Authors: Kambara Tsunehito , Oyama Tetsunari , Segawa Atsuki , Fukabori Yoshitatsu , Yoshida Ken‐Ichiro 
Published: November 2009

Study Type – Prognosis (case series) Level of Evidence 4OBJECTIVETo investigate the influence of the revised Gleason grading system (GGS, revised at a consensus conference organized by the International Society of Urological Pathology in 2005) on prediction of prognosis for patients with prostate cancer with bone metastasis.PATIENTS AND METHODSProstatic needle biopsy specimens from 113 patients with prostate cancer with bone metastasis were scored using the conventional GGS (CGGS), modified global GGS (MGGGS), and modified highest GGS (MHGGS). The patients were divided into two groups (Gleason score ≤7 and ≥8) using each grading system. Prostate‐specific antigen failure‐free survival after hormone therapy (HT) was estimated retrospectively. The Cox proportional hazard method was used for univariate and multivariate analysis.RESULTSPatients with a Gleason score of ≤7 had a significantly longer remission than patients with a score of ≥8 according to each GGS. However, the better prognosis patients were detected more precisely by the CGGS and MGGGS than the MHGGS. Multivariate analysis showed that the CGGS and MGGGS were significant prognostic indicators for the outcome of HT after adjustment for other prognostic factors.CONCLUSIONSThese results suggest that the CGGS and MGGGS are more useful than the MHGGS as prognostic indicators for HT. Further evaluation in larger series is needed to define its clinical usefulness.
‘We want you! But . . .’ Recruiting Migrants and Encouraging Transnational Migration Through Progressive Inclusion
Authors: Farahat Anuscheh 
Published: November 2009

AbstractThe article submits a proposal for outlining the present body of legal norms in the field of European migration and immigration law. To this end, it suggests understanding European migration and integration law as shaped by two principles: the principle of congruence between a state's territory, authority and citizenry and the principle of progressive inclusion. According to the established principle of congruence, the granting of rights to third‐country nationals (TCNs) is always geared to the ideal image that the persons permanently living on a territory are—in reality—part of the citizenry of that state and subject to the state's authority. According to the more recent principle of progressive inclusion, TCNs are to be gradually included into the host country's society by approximating their rights progressively to the rights of citizens. There are potential tensions between the two principles, which can be explained by the diverging philosophical and political concerns that they follow and the conceptions of migration that each uses. The article then goes on to explore the influence of both principles in current European migration and integration law. It brings forward the argument that current European migration and integration law is structured as much by the ‘older’ principle of congruence as by the principle of progressive inclusion. This assumption will be illustrated by the examples of the Long‐term Residents Directive (LTR Directive). Important provisions of the proposal for a framework directive intended to guarantee TCNs' equal treatment with EU citizens in social matters (Draft Framework Directive) and the directive on the highly skilled migrant workers (Blue Card Directive) will also be taken into account. Against the background of the highly contested legal field of migration and integration law, using the language of principles provides a useful tool not only for better grasping the current shape of this legal field, but even more for the legal discourse on the future development of European migration and integration law.
Outcome of intracerebral haemorrhage patients pre‐treated with statins
Authors: Gomis M. , Ois A. , Rodríguez‐Campello A. , Cuadrado‐Godia E. , Jiménez‐Conde J. , Subirana I. , Dávalos A. , Roquer J. 
Published: November 2009

Background:  Statins treatment may have potential clinical impact in vascular disease beyond cholesterol lowering. Its benefits have been documented in cerebral ischaemia and in subarachnoid haemorrhage. In intracerebral haemorrhage (ICH), experimental models in statin‐treated animals have better outcome than non‐treated ones, but in humans the relationship is unclear. We investigated whether patients treated with statins before the onset of intracerebral haemorrhage have a better outcome at 3 months than patients without statins pre‐treatment.Methods:  Retrospective review of primary intracerebral haemorrhage case series from a prospective stroke register. We recorded demographics, vascular risk factors, previous statin treatment, Glasgow coma scale (GCS) at onset, ICH scale, hematoma volume and location, ventricular extension of the hematoma, and functional outcome at 3 months. The effect of prior statin treatment on good outcome (modified Rankin scale [mRS] 0 to 2) was analysed by logistic regression analysis.Results:  We included 269 patients (age 71.9 ± 12.4, mean ± SD, 152 males). Thirty‐four patients (12.6%) were on prior statin treatment when admitted. There were no differences in fasting serum cholesterol and triglycerides levels between the statin pre‐treated groups and the group without statin pre‐treatment. Multivariate regression analysis showed a significant association between age (OR: 0.95; CI 0.92–0.97), ICH volume (OR: 0.96; CI 0.94–0.98), GCS (OR: 1.55; CI 1.21–1.98), pre‐treatment with statins (OR: 4.21; CI 1.47–12.17; P = 0.008), and good outcome at 3 months.Conclusions:  Statins pre‐treatment of patients with intracerebral haemorrhage may provide better functional outcome at 3 months of acute onset.
Influence of antiplatelet pre‐treatment on the risk of intracranial haemorrhage in acute ischaemic stroke after intravenous thrombolysis
Authors: Dorado L. , Millán M. , De La Ossa N. Pérez , Guerrero C. , Gomis M. , López‐Cancio E. , Ricciardi A. C. , Dávalos A. 
Published: November 2009

Background:  Pre‐treatment with antiplatelet agents (AP) is present amongst 30% of acute stroke patients. Previous studies have shown conflicting results on the effect of these drugs regarding haemorrhagic transformation after thrombolytic therapy. The hypothesis that pre‐treatment with AP may increase the risk of cerebral haemorrhage (ICH) after intravenous tissue plasminogen activator (tPA) was assessed.Methods:  Retrospective study of consecutive prospectively registered patients with acute ischaemic stroke treated with iv tPA (n = 235) in the last 5 years. Baseline characteristics and prior AP therapy were registered on admission. Computed tomography (CT) scan was performed on admission and 24–36 h after tPA. ICH was classified according to the ECASS II criteria into haemorrhagic infarction and parenchymal haematoma (PH). Symptomatic intracerebral haemorrhage (SICH) was defined as a worsening of ≥ 4 points in the NIHSS score during the first 36 h in any haemorrhage subtype.Results:  Seventy‐two (30.6%) patients were pre‐treated with AP (55 aspirin, 14 clopidogrel, 2 aspirin + clopidogrel, 1 triflusal). PH was observed in 33 (14.1%) patients (PH1 13, PH2 12, PHr 8) of whom 16 were symptomatic. Male gender (78.8% vs. 21.2%, P = 0.036), prior AP therapy (54.5% vs. 26.9%, P = 0.001), stroke severity (median NIHSS, 17 vs. 12, P = 0.005) and early CT signs of infarction (12.5% vs. 2.1%, P = 0.004) were associated with PH. The adjusted odds ratios of PH for patients pre‐treated with AP therapy was 3.5 (1.5–7.8, P = 0.002) and for SICH 1.9 (0.6–5.9, P = 0.2).Conclusions:  Pre‐treatment with AP is associated with an increased risk of PH after intravenous thrombolysis in patients with acute ischaemic stroke.