bluuebunny/crossref_metadata_2025_split huggingface dataset:
Negotiating the transition: caring for women through the experience of early miscarriage
Authors: Murphy Fiona , Merrell Joy 
Published: May 2009

Aim. To explore women’s experiences of having an early miscarriage in a hospital gynaecological unit.Background. Miscarriage is a global health issue affecting significant numbers of women and is usually considered a distressing experience. This distress is often interpreted as being characteristic of grief. Nurses and other health professionals in hospital and community settings are therefore expected to provide appropriate care to meet the physical and emotional needs of the woman.Design. A qualitative, ethnographic study of a hospital gynaecological unit in the UK.Methods. The primary method was 20 months of part‐time participant observation. Data were also collected through documentary analysis of key documents in the setting and formal interviews. These were with eight women who had an early miscarriage and 16 health professionals (nurses, doctors, ultrasonographers) working in the unit.Results. Three clear phases emerged in the women’s experience of miscarriage and hospital admission; first signs and confirmation, losing the baby and the aftermath. These were interpreted as being components of a process of transition. The hospital admission emerged as vital in these early phases in which the importance of nurses and other health professionals providing sensitive, engaged care to meet the emotional and physical needs of the woman was identified.Conclusions. The hospital setting emerged as highly influential in shaping the care that was given to women and influencing their experiences. Transition models were felt to be more appropriate than grief and bereavement models in guiding the psychological care given to women.Relevance to clinical practice. The experience of hospital admission and the actions of nurses and other health professionals is influential in how women negotiate the transition through miscarriage.
A critical view of how nursing has defined spirituality
Authors: Clarke Janice 
Published: May 2009

Aims.  To offer a detailed discussion of the issue of ‘lack of critique’ in the literature on spirituality in nursing. The discussion will include the limited use of sources from theology and religious studies and the demand to separate spirituality and religion and will go on to examine the consequences of the resulting approach. The drive for unique knowledge to further professionalisation and the demands of inclusiveness are suggested as possible reasons for the development of the current model. The dangers and pitfalls of definition are explored. The paper suggests that theology could provide insights into explaining spirituality.Background.  The last four decades have seen a proliferation of definitions of spirituality in the nursing literature. Recently, in response to their own concerns and prompts from outside the ‘spirituality’ community authors have suggested that we revisit this literature with a more critical stance. This paper is in response to that suggestion. During the course of a PhD supervised from a department of practical theology I have critically analysed the literature from several perspectives and this paper is one result of that review.Design.  Literature review.Methods.  Critical reflection on how spirituality has been defined.Conclusion.  The lack of critique has produced a bias in the literature towards broad, generic, existential definitions which, together with the intentional divorce from religion and theology have led to definitions which have the tendency to result in a type of spiritual care which is indistinguishable from psychosocial care, hard to explain to patients and difficult to put into practice.Relevance to clinical practice.  The acceptance of a diverse range of understandings of spirituality and a greater focus on practical ways of using it in nursing care are the direction the profession should be moving into.
The experiences of people with an intersex condition: a journey from silence to voice
Authors: MacKenzie Drew , Huntington Annette , Gilmour Jean A 
Published: May 2009

Aim and objectives. The aim of this research was to explore the experiences of people with intersex conditions. The main objective was to contribute to knowledge of the condition by giving voice to a group of people who are invisible in society.Background. Medical management of intersex conditions has historically focused on erasing visual bodily difference through gender assignation and medical/surgical intervention to ensure congruent body appearance. People with intersex conditions require support to live free from shame in a normalising society and need particularly sensitive care when engaged with the health system.Design. A small‐scale qualitative study was undertaken. Recruitment of participants was difficult because of barriers created by invisibility and marginalisation. After extensive and careful negotiation with one contact, three people in New Zealand agreed to participate in the research.Methods. In‐depth interviews were undertaken and thematic analysis used to develop themes that were common across participants’ experiences.Results. Three themes emerged from the data: managing silence, coping with difference and development of acceptance. These themes highlight: the negative impact of societal ignorance, lack of acceptance of body difference and the journey from silence to disclosure and acceptance of individuality and choice in gender identification.Conclusion. These findings highlight the need for nurses to be knowledgeable and skilled communicators to ensure age‐appropriate information and support is provided to enable individual choice in gender identification and normalisation for people with intersex conditions.Relevance to clinical practice. Many nurses will be unaware of the condition of being intersex and have little knowledge of the challenges faced by this group yet are likely to be involved in their care. People with intersex conditions require particularly sensitive care and nurses can provide appropriate, supportive and ‘safe’ care if they are aware of the condition and its challenges.
A review of smoking cessation: potentially risky effects on prescribed medications
Authors: Schaffer Susan D , Yoon Saunjoo , Zadezensky Immo 
Published: May 2009

Aims and objectives.  To identify prescription drugs that require dosage adjustment or monitoring in patients who quit smoking and to provide recommendations for dosage adjustment based on available evidence.Background.  Health care providers are urged to facilitate smoking cessation for patients who smoke, but the effects of smoking cessation on the metabolism of some drugs is not routinely considered.Design.  A comprehensive literature review.Methods.  The review was conducted in 2008 using a computerised drug interaction program and multiple PubMed and CINAHL searches to identify prescription drugs with clinically significant pharmacokinetic or pharmacodynamic changes caused by smoking cessation.Results.  Although much of the evidence is case report, dosage adjustments are clearly indicated for warfarin, olanzapine, clozapine and theophylline since they are metabolised by cytochrome P450 CYP1A2 and also have narrow therapeutic ratios. Careful monitoring is recommended for other CYP1A2 metabolised drugs, including those for hypertension and Alzheimer’s disease. For many affected drugs, smoking cessation reverses smoking‐induced CYP1A2 hepatic enzyme levels to normal, increasing plasma concentrations in patients whose dose was established while smoking. Because the effect on hepatic microsomal enzymes is not related to the nicotine component of tobacco, nicotine replacement will not alter the effect.Conclusions.  The effects of smoking cessation on drugs metabolised by CYP1A2 have been under‐appreciated by health care providers. Smoking cessation may increase plasma levels of some drugs to potentially toxic levels. Further research is warranted to clarify this effect.Relevance to clinical practice.  When patients stop smoking, providers should carefully review prescribed drug regimens and adjust or monitor drugs whose metabolism is affected by smoking cessation. This is particularly important for patients who abruptly stop smoking due to hospitalisation and for older patients who are likely to be taking multiple medications.
Triaging dysphagia: nurse screening for dysphagia in an acute hospital
Authors: Cichero Julie AY , Heaton Sarah , Bassett Lynell 
Published: May 2009

Aims and objectives.  To (1) develop a dysphagia screening tool to triage all patients at risk of aspiration/dysphagia on admission to acute hospital wards, (2) evaluate tool reliability, (3) evaluate nursing compliance and (4) develop a robust dysphagia training programme.Background.  Failure to diagnose dysphagia has significant medical and economic costs. Dysphagia screening reduces pneumonia threefold. Most nurse‐screening tools have focused on stroke. However, many other conditions are associated with dysphagia. A multidisciplinary team developed a nurse‐administered, evidence‐based swallow screening tool for generic acute hospital use.Design.  Prospective, quasi‐experimental.Methods.  Nurses were assessed for knowledge pre‐ and post‐training. All patients were nurse‐screened for dysphagia on admission. All patients were reviewed by speech pathologists to determine screening accuracy. Results were not blinded. The one page tool encompassed (1) diagnostic categories, (2) patient/carer interview, (3) dysphagia indicators and (4) if applicable, water swallow test.Results.  Thirty‐eight nurses participated in a seven‐week study; 442 patients were screened on two general medical wards. Three speech pathologists counter‐assessed each patient by clinical examination or chart review. Sensitivity was 95%; specificity was 97%. Positive predictive value was 92%; negative predictive value was 98%. 3·4% of clinical screening decisions were incorrect. Compliance rate was 85%.Conclusions.  Caution is advised in interpretation of the results due to lack of blinding. Initial results suggest that the dysphagia screening tool is a quick and robust tool for triaging individuals with dysphagia. Training is critical to successful screening.Relevance to clinical practice.  Twenty‐five to 30% of acute hospitalised individuals have dysphagia. All adult acute patients are screened for dysphagia using the Royal Brisbane and Women’s Hospital dysphagia screening tool. Patients are triaged into categories of ‘those requiring additional specialist intervention’ and ‘those who can proceed directly to regular diets and liquids’. Improved quality of care and cost savings is likely.
Using the cardiac depression scale in men recovering from coronary artery bypass surgery
Authors: King Kathryn M , Colella Tracey JF , Faris Peter , Thompson David R 
Published: May 2009

Aims.  To examine the utility and validate the use of the Cardiac Depression Scale in patients who had first‐time coronary artery bypass graft surgery.Background.  The Beck Depression Inventory, though frequently used, may not be sufficiently sensitive for use in cardiac patients. The Cardiac Depression Scale has been shown to identify the range of depression in medical cardiac patients.Design.  Survey.Methods.  The Beck Depression Inventory and Cardiac Depression Scale were administered to 120 men at hospital discharge, as well as six, 12 and 36 weeks postoperatively. Cronbach’s α scores were calculated for the measures at each point. Changes in scores over time were analysed using repeated measures analysis of variance. Associations between the measures scores were calculated using Pearson product–moment correlations. Agreement between the measures’ dichotomised scores (depression/no depression) was examined using Cohen’s Kappa statistic.Results.  Internal consistency was similar for the Beck Depression Inventory (0·793–0·904) and Cardiac Depression Scale (0·859–0·910). Depression scores decreased over time with the Beck Depression Inventory [F(2·50, 175·29) = 22·27, p < 0·001] and Cardiac Depression Scale [F(2·68, 190·37) = 13·18, p < 0·001]. The measures had similar power [Cohen’s f = 0·65 (Beck Depression Inventory) and 0·43 (Cardiac Depression Scale)] to reveal changes over time. The continuous scores were highly correlated at each point [0·737 (p < 0·001)–0·819 (p < 0·001)]. However, when dichotomised scores were compared, the chance corrected level of agreement was less impressive [0·198 (p = 0·014)–0·381 (p < 0·001)].Conclusions.  The Cardiac Depression Scale may have utility for use with surgical cardiac patients. However, continued examination of this measure of depression is warranted.Relevance to clinical practice.  Given the prevalence of depression and its negative impact on coronary artery disease, it is important to identify even mild depression in cardiac patients. Using a measure of depression specifically for cardiac patients, rather than a generic measure, may best accomplish this goal.
Linkage of T3 and Cpa pilins in the Streptococcus pyogenes M3 pilus
Authors: Quigley Bernard R. , Zähner Dorothea , Hatkoff Matthew , Thanassi David G. , Scott June R. 
Published: May 2009

SummaryThe important human pathogen Streptococcus pyogenes (group A streptococcus, GAS) initiates infection by pilus‐mediated attachment to host tissue. Thus, the pilus is an excellent target for design of anti‐infective strategies. The T3 pilus of GAS is composed of multiple covalently linked subunits of the T3 protein to which the two minor pilins, Cpa and OrfB, are covalently attached. Because the proteins of GAS pili do not contain either of the motifs required for pilus polymerization in other Gram‐positive bacteria, we investigated the residues involved in their linkage. We show that linkage of Cpa to T3 by the sortase family transpeptidase SrtC2 requires the VPPTG motif in the cell wall‐sorting signal of Cpa. We also demonstrate that K173 of T3 is required both for T3 polymerization and for attachment of Cpa to T3. Therefore, attachment of Cpa to K173 of a T3 subunit would block further addition of T3 subunits to this end of the growing pilus. This implies that Cpa is located exclusively at the pilus tip, a location supported by immunogold electron microscopy, and suggests that, as for well‐studied pili on Gram‐negative bacteria, the role of the pilus is to present the adhesin external to the bacterial capsule.
Biogenesis of bacterial membrane vesicles
Authors: Deatherage Brooke L. , Lara J. Cano , Bergsbaken Tessa , Barrett Sara L. Rassoulian , Lara Stephanie , Cookson Brad T. 
Published: May 2009

SummaryMembrane vesicle (MV) release remains undefined, despite its conservation among replicating Gram‐negative bacteria both in vitro and in vivo. Proteins identified in Salmonella MVs, derived from the envelope, control MV production via specific defined domains that promote outer membrane protein–peptidoglycan (OM–PG) and OM protein–inner membrane protein (OM–PG–IM) interactions within the envelope structure. Modulation of OM–PG and OM–PG–IM interactions along the cell body and at division septa, respectively, maintains membrane integrity while co‐ordinating localized release of MVs with distinct size distribution and protein content. These data support a model of MV biogenesis, wherein bacterial growth and division invoke temporary, localized reductions in the density of OM–PG and OM–PG–IM associations within the envelope structure, thus releasing OM as MVs.
Histological Studies of Growing and Mature Antlers of Red Deer Stags (Cervus elaphus)
Authors: Cegielski M. , Izykowska I. , Podhorska‐Okolow M. , Gworys B. , Zabel M. , Dziegiel P. 
Published: May 2009

SummaryThis study aims at presenting histology of growing and mature antlers in red deer stag (Cervus elaphus). Growing antlers constitute a model organ for examining regeneration processes of tissues because they are the only mammalian appendages capable of regeneration. Histological study revealed that the tip of a growing antler consists of hairy skin, perichondrium, mesenchyme and chondroprogenitors area. By performing immunochistochemistry, we found that cell expressing Ki‐67 and PCNA antigens were localized in basal layer of epidermis, skin glands and beneath their secretory sections, mesenchyme as well as within and in the vicinity of central blood vessels. Ultrastructurally, cells from chondroprogenitors zone have chondroblast‐like morphology and take part in producing of collagen fibres followed by the process of cartilage mineralization. However, mature antlers also consist of lamellar osseous tissue.
Oviposition Preferences in Newts: Does Temperature Matter?
Authors: Dvořák Jan , Gvoždík Lumír 
Published: May 2009

AbstractA female’s decision where and when to place her eggs has important fitness consequences for her offspring. Although temperature is considered among the most relevant abiotic factors affecting female oviposition site choice in ectotherms, little is known about the relative importance of temperature cues in complex oviposition decisions. In this study, we examined female’s oviposition choice under conflicting demands for temperature and embryo protection by studying oviposition behaviour in female alpine newts, Triturus alpestris, exposed to various thermal conditions and the availability of egg‐wrapping vegetation. Females oviposited between 12.5 and 22.5°C in the aquatic thermal gradient (5–32.5°C) with the unrestricted availability of oviposition vegetation. The removal of the vegetation from predominantly chosen oviposition temperatures (15–20°C) induced egg‐retention in most females. This suggests that both temperature and the presence of egg‐wrapping vegetation play important roles in oviposition site choice of alpine newts.
Management of the rare entity of primary pancreatic cystic neoplasms
Authors: Stamatakos Michael , Sargedi Constantina , Angelousi Anna , Kontzoglou Konstantinos , Safioleas Panagiotis , Petropoulou Constantina , Safioleas Michael 
Published: May 2009

AbstractPrimary cystic neoplasms of the pancreas constitute a rare entity and are composed of a variety of neoplasms with a wide range of malignant potential. Approximately 90% of these lesions are serous cystic neoplasms or mucin‐producing neoplasms. In contrast to serous cystadenomas which are nearly always benign, the mucinous cystic neoplasms represent a more diverse, heterogenous spectrum of related neoplasms. Intraductal papillary mucinous neoplasms manifest a much greater latent or overt malignant potential than other cystic neoplasms of the pancreas. The various subgroups of cystic neoplasms of the pancreas are evaluated and compared through a review of current literature. No symptoms or signs are pathognomonic for the cystic pancreatic neoplasms. While identification of a cystic tumor is relatively easy, the identification of the specific tumor type may be difficult. Most investigators agree that accurate differentiation of benign from malignant neoplasms can be made only at histopathologic examination of the entire resected segment of the pancreas. Because of the low mortality and low postoperative morbidity, surgical resection is indicated in all patients with cystic tumors.
Comparison of one‐week and two‐week empirical trial with a high‐dose rabeprazole in non‐cardiac chest pain patients
Authors: Kim Jeong Hwan , Sinn Dong Hyun , Son Hee Jung , Kim Jae J. , Rhee Jong Chul , Rhee Poong‐Lyul 
Published: May 2009

AbstractBackground:  In patients with non‐cardiac chest pain (NCCP), the optimal duration of an empirical trial with a high‐dose proton pump inhibitor (PPI) is unclear. We aimed to compare the efficacy of one‐week and two‐week PPI trial in patients with weekly or more than weekly NCCP and to determine its optimal duration for diagnosing gastroesophageal reflux disease (GERD)‐related NCCP.Methods:  Forty‐two patients with at least weekly NCCP were enrolled. The baseline symptoms were assessed using a daily symptom diary for seven days. Also, esophago‐gastro‐duodenoscopy and 24 h esophageal pH monitoring were performed for the diagnosis of GERD. Then, patients were treated with rabeprazole 20 mg twice daily for 14 days. To assess NCCP improvement during the PPI trial, the first week and the second week symptom diary were kept for 1–7 and 8–14 days. The PPI test was considered positive if a symptom score improved (50% compared to the baseline.Results:  There was no significant difference for a positive PPI test between GERD‐related NCCP group (n = 8, 50%) and non GERD‐related NCCP group (n = 6, 23%) during the first week of the PPI test. However, during the second week, GERD‐related NCCP had a higher positive PPI test (n = 13, 81%) than non GERD‐related NCCP (n = 7, 27%) (P = 0.001) with a sensitivity and specificity of 81% and 62%, respectively.Conclusions:  The rabeprazole empirical trial was diagnostic for patients with GERD‐related NCCP, and its optimal duration was determined to be at least two weeks.
Review article: Bone density in patients with chronic kidney disease stages 4‐5
Authors: OTT SUSAN M 
Published: May 2009

SUMMARYSkeletal fractures are common in dialysis patients. Bone density measurements predict fractures in the general population, but in patients with chronic kidney disease (CKD) there is limited ability to predict fractures with these techniques. A review of the literature in patients with CKD stage 5 shows that bone density in the cortical bone of the radius or hip is generally lower compared with normal reference ranges by about one to two standard deviations, whereas in the spine bone density tends to be closer to the average expected values. The bone density is not able to predict the underlying histology in patients with renal osteodystrophy. The serum PTH levels are inversely related to bone density in some studies, and not related in other studies, but none found a positive association of serum parathyroid hormone (PTH) and bone density. There are very few data about longitudinal changes of bone density in these patients, and also inadequate studies of whether osteoporosis medications are effective in this population. Therefore, at this time the clinical utility of bone density measurements in patients with CKD‐5 is uncertain.
Impact of non‐alcoholic fatty liver disease on microalbuminuria in patients with prediabetes and diabetes
Authors: Hwang S. T. , Cho Y. K. , Yun J. W. , Park J. H. , Kim H. J. , Park D. I. , Sohn C. I. , Jeon W. K. , Kim B. I. , Rhee E. J. , Oh K. W. , Lee W. Y. , Jin W. 
Published: May 2009

AbstractBackground: It is unknown whether microalbuminuria is associated with non‐alcoholic fatty liver disease (NAFLD) among patients with prediabetes and type 2 diabetes mellitus (DM). This study investigated the association of NAFLD with microalbuminuria among patients with prediabetes and diabetes.Methods: We evaluated 1361 subjects who had an abnormal oral glucose tolerance test (OGTT) on routine screening. All participants were divided into two groups, prediabetes and newly diagnosed type 2 DM, and the association of NAFLD with metabolic parameters on microalbuminuria was analysed.Results: The patients with NAFLD had higher prevalence rates of microalbuminuria (6.3% vs 19%; P= 0.001 in prediabetes, 4.5% vs 32.6%; P < 0.001 in diabetes) and also had a greater albumin‐to‐creatinine ratio (14.6 ± 52.0 µg/mg Cr vs 27.7 ± 63.9 µg/mg Cr; P= 0.051 in prediabetes, 11.4 ± 21.4 µg/mg Cr vs 44.7 ± 76.4 µg/mg Cr; P < 0.001 in diabetes) than those without NAFLD. The logistic regression analysis showed that NAFLD was associated with increased rates of microalbuminuria (odds ratio 3.66; 95% confidence interval (CI) 1.31–10.20, P= 0.013 in prediabetes, odds ratio 5.47; 95% CI 1.01–29.61, P= 0.048 in diabetes), independently of age, sex, body mass index, waist circumference, liver enzymes, lipid profiles, HbA1c, insulin resistance as estimated by homeostasis model assessment, hypertension, smoking status and the metabolic syndrome.Conclusions: The results of our study revealed a strong relationship between microalbuminuria and NAFLD in the patients with prediabetes and newly diagnosed diabetes. Further studies are required to confirm whether NAFLD is a predictor of the development of microalbuminuria in patients with prediabetes and diabetes.