bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effects of modified constraint-induced movement therapy on reach-to-grasp movements and functional performance after chronic stroke: a randomized controlled study
Authors: Lin K.-C. , Wu C.-Y. , Wei T.-H. , Gung Chang , Lee C.-Y. , Liu J.-S. 
Published: November 2007

Objective: To evaluate changes in (1) motor control characteristics of the hemiparetic hand during the performance of a functional reach-to-grasp task and (2) functional performance of daily activities in patients with stroke treated with modified constraint-induced movement therapy. Design: Two-group randomized controlled trial with pretreatment and posttreatment measures. Setting: Rehabilitation clinics. Subjects: Thirty-two chronic stroke patients (21 men, 11 women; mean age=57.9 years, range=43—81 years) 13—26 months (mean 16.3 months) after onset of a first-ever cerebrovascular accident. Intervention: Thirty-two patients were randomized to receive modified constraint-induced movement therapy (restraint of the unaffected limb combined with intensive training of the affected limb) or traditional rehabilitation for three weeks. Main measures: Kinematic analysis was used to assess motor control characteristics as patients reached to grasp a beverage can. Functional outcomes were evaluated using the Motor Activity Log and Functional Independence Measure. Results: There were moderate and significant effects of modified constraint-induced movement therapy on some aspects of motor control of reach-to-grasp and on functional ability. The modified constraint-induced movement therapy group preplanned reaching and grasping (P=0.018) more efficiently and depended more on the feedforward control of reaching (P=0.046) than did the traditional rehabilitation group. The modified constraint-induced movement therapy group also showed significantly improved functional performance on the Motor Activity Log (P<0.0001) and the Functional Independence Measure (P=0.016). Conclusions: In addition to improving functional use of the affected arm and daily functioning, modified constraint-induced movement therapy improved motor control strategy during goal-directed reaching, a possible mechanism for the improved movement performance of stroke patients undergoing this therapy.
Rehabilitation of decreased motor performance in patients with chronic fatigue syndrome: should we treat low effort capacity or reduced effort tolerance?
Authors: Van Houdenhove B. , Verheyen L. , Pardaens K. , Luyten P. , Van Wambeke P. 
Published: November 2007

Aim: The aetiology, pathophysiology, diagnostic delineation and treatment of chronic fatigue syndrome (CFS) remain a matter of debate. Here some aspects of the debate are elucidated, with a particular focus on the patients' decreased motor performance. Hypothesis: The pathophysiological basis of decreased motor performance in CFS may, theoretically, involve three components: (1) a peripheral energetic deficit (impaired oxidative metabolism and/or physical deconditioning); (2) a central perceptual disturbance (higher effort sense or increased `interoception'); and (3) a fundamental failure of the neurobiological stress system, leading to an abnormal `sickness response'. It is proposed that the first two components may lead to low effort capacity, while the third component may lead to reduced effort tolerance. Although there is evidence for low effort capacity influencing symptoms and functional limitations in CFS, it is assumed that reduced effort tolerance might be the primary disturbance in CFS. Diagnostic implications: Distinguishing low effort capacity and reduced effort tolerance may contribute to a refinement of current diagnostic criteria of CFS and the identification of subgroups. Therapeutic implications: The above-mentioned distinction may make it possible to formulate a rationale for an effective implementation and adequate outcome evaluation of rehabilitation strategies in CFS. Research implications: This new heuristic framework may inform future research aimed at disentangling the complex determination of impaired motor performance in CFS, as well as studies aimed at customizing treatment to different subtypes of patients.
Palliative care: training needs, developments, difficulties and perspectives
Authors: Rapin Ch-H , Weber A. 
Published: November 2007

Approximately 3600 copies of a questionnaire on palliative care were sent out towards the end of 1989. Of the 594 returned, 61 % came from nurses, 23% from medical doctors and 16% from others. Fifty-six per cent had already had training in palliative care but 91 % wanted training or additional training, suggesting that instruction is incomplete or inadequate. The selective character of the persons approached and the low response rate prevent the generalization of the findings to all carers and persons concerned with palliative care. Additional training was requested most on pain control, communication, relationships between carers and those cared for, relationships with families and support for family and friends. The majority of the respondents wanted both lectures as theoretical instruction and opportunities for practical training. Meetings with practitioners and seminars and workshops were the preferred teaching methods for theoretical instruction. Fifty-one per cent of the respondents considered that the practice of palliative care had progressed in their region since 1987, and 41 % that there had been practically no progress or that it had regressed. Seventy-two per cent estimated that palliative care is better accepted by the carers and 70% by patients and those around them. Ninety-two per cent felt that the practice of palliative care still encounters difficulties in their region, the commonest causes of the difficulties being lack of knowledge of palliative care by the carers, reticence on the part of the doctors and inadequate training. The developments most desired are palliative care at home, in homes for the aged, and in geriatric and medical services. Priority in such developments should be given to patients with cancer or with AIDS.
Communication with parents of children with cancer
Authors: Eden OB , Black I. , MacKinlay GA , Emery Aeh 
Published: November 2007

The purpose of this study was to assess the receptiveness of parents to information given about their child's life threatening illness. Three months after the child's diagnosis, an independent interviewer, using a structured questionnaire, interviewed the parents about what and how they had been told, and assessed the stage of parental coping reached at that time. All patients were treated at a regional paediatric oncology centre (RHSCE) and the interviews were conducted preferably in the family home (61 %), or in a 'quiet' hospital room (39%). Twenty-five, unselected, consecutive patients with cancer and leukaemia diagnosed and treated at the RHSCE and their families were recruited into the study (1988-1989). One child died during the first three months and one single parent family refused co-operation. Eighteen of the 23 interviews conducted were with both parents, and five were with single parents (all maternal). All 23 sets of parents admitted deep shock and devastation on hearing the initial diagnosis, with 12 sets feeling that they had taken in little or none of the information given. A long interview was conducted a few days after the initial talk with the consultant. The parents of four children (17%) denied that the long interview had occurred whilst 10/19 who remembered it expressed specific lack of understanding of some or all details. All families remembered a large number (10-20) of subsequent talks with a wide range of staff, but 14/23 felt that some of the information was still confusing or conflicting, and 9/14 did not want to ask for further clarification, principally because they did not want to hear more bad news. The majority felt the child understood little of what was going on. At the study interview, most parents were assessed as still being very anxious about their child's illness, whilst two couples, one single mother and one father, were content with what and how they had been told about their child's illness and were in a state of emotional homeostasis. It is concluded that communication of bad news is a two-way process requiring skilled medical staff, but also a receptive audience. The emotional state of the parent determines his or her ability to hear and comprehend the information given. The results imply that repetition and clarification at consultation interviews is required until parents are emotionally able to hear, accept and comprehend complex news. Written material, taped interviews and simple videos can assist in this process.
Nurses working 12-hour shifts in the hospice setting
Authors: Hodgson Linda A 
Published: November 2007

A system of 12-hour nursing shifts was adopted at a newly-opened independent hospice. This paper presents the results from an exploratory, descriptive study in which nursing staff reported perceived advantages, disadvantages and satisfaction with the 12-hour shift system. A small sample (n = 11) of both qualified and unqualified nurses working the 12-hour shift completed the questionnaire. A content analysis of the qualitative data produced a number of categories relating to the perceived advantages and disadvantages of the 12-hour shift system in relation to the respondents, to the hospice and to patient and family care. The need for continuing to monitor and evaluate the shift system was demonstrated, particularly in relation to patient and family satisfaction, and the quality of care. It was concluded that examining the advantages and disadvantages of the 12- hour shift system increased awareness of the needs of staff, presented a useful way of identifying and managing potential difficulties within the workplace, and highlighted areas for future research.
Non-pharmacological intervention for breathlessness in lung cancer
Authors: Corner J. , Plant H. , A'Hern R. , Bailey C. 
Published: November 2007

Objective - To evaluate the effect of non-pharmacological intervention for breathlessness in lung cancer on breathlessness ratings and patient functioning. Design - Randomised controlled pilot study. Setting - A nurse led clinic in a specialist cancer centre. Subjects - 20 patients with advanced small cell and non-small cell lung cancer. Intervention - Weekly sessions with a nurse research practitioner over 3-6 weeks using counselling, breathing re-training, relaxation and teaching coping and adaptation strategies. Main outcome measures - Visual analogue scale ratings of breathlessness, distress caused by breathlessness, functional capacity, ability to perform activities of daily living and the Hospital Anxiety and Depression Scale. Results - Improvements in median scores on all measures were observed in the intervention group with the exception of depression, compared with the control group where median scores were static or worsened. Distress from breathlessness was improved by a median of 53%, breathlessness at worst by 35% and functional capacity by 21 %. In contrast, distress in the control group worsened by a median of 10%. Significant improvements compared with the control group were observed in breathlessness at best (p < 0.02), breathlessness at worst (p < 0.05), distress caused by breathlessness (p < 0.01), functional capacity (p < 0.02) and ability to perform activities of daily living (p < 0.03) but were not observed for anxiety or depression. Conclusion - Lung cancer patients suffering from breathlessness benefited from this rehabilitative approach to breathlessness management and strategies employed in this pilot study warrant further multicentre research. Macmillan nurses and palliative care teams are recommended to explore the potential of adopting similar approaches.
Schooling as a part of palliative care in paediatric oncology
Authors: Bouffet E. , Zucchinelli V. , Costanzo P. , Blanchard P. 
Published: November 2007

For children with incurable life-threatening diseases, social reintegration is an illusion. Schooling for these children is both possible and desirable, but its specific objectives must be adapted. The educational career of 30 French school children with incurable cancer was followed. Data concerning the children's degree of motivation to attend school and its evolution during the course of the disease as well as the measures adopted to maintain school attendance were analysed. Sixty per cent of the children demonstrated a genuine desire to attend school until the advanced stages of their disease. Reading, mathematics and computer work were their favourite subjects. Increasing physical disability and fatigue diminished their motivation over time. Refusal to attend school occurred in 40% of the children, who had either extracurricular interests or poorly controlled pain. School attendance for the terminally ill child is part of palliative care and has specific medical and educational goals. As such, its objectives are quite distinct from those of other educational reintegration projects proposed for children with cancer.
Support needs in the last year of life: patient and carer dilemmas
Authors: Grande GE , Todd CJ , Barclay Sig 
Published: November 2007

The aim of this study was to identify needs for support and problems in the introduction of support to terminally ill patients and their carers. The design involved semistructured interviews with patients and carers as well as a survey of general practitioners' (GPs) views, and took place in GP practices and homes of patients in Cambridgeshire. The subjects comprised 43 terminally ill patients, 30 carers, 80 GPs and 13 of their GP partners. The main outcome measures were quantitative data about additional help required and qualitative data on reasons for reluctance to seek help. Needs for help with transport, personal care and housework were identified. Carers may also need reassurance from health professionals. The need for outside help may at times conflict with the need to preserve independence, dignity and familiar aspects of life. Sometimes carers may feel that there is need for more help, but that this conflicts with patients' wishes. There may also be reluctance to seek help because of a perceived lack of resources and professionals' time. In conclusion, an increase in services is necessary but not sufficient to meet patients' needs fully. Services should be introduced in ways that help patients to preserve independence, dignity and familiar aspects of life. The perception of accessibility to health professionals may need to be improved. Carers' needs should be assessed separately from patients' needs.
Landscape and plant community boundaries in biogeography
Authors: Kent Martin , Gill Wendy J. , Weaver Ruth E. , Armitage Richard P. 
Published: November 2007

The increasing relevance and importance of the subject of landscape ecology to bio geography are introduced. Research into landscape and plant community boundaries, never theless, remains comparatively neglected. In particular, the nature of those boundaries in terms of the patterns of floristic change and related ecosystem properties constitutes a potentially signifi cant new area of research for biogeographers. The term 'ecotone' has traditionally been used to describe boundaries between plant communities and ecosystems at a range of scales. Various definitions are presented and the often confusing terminology surrounding the word 'ecotone' is reviewed. Boundary types range from sharp, clearly defined boundaries (ecotones) between more highly modified plant communities and anthropogenically created land-use types at one extreme, to more gradual and diffuse boundaries (ecoclines) between natural and semi-natural plant communities at the other. It is proposed that the term 'transitional area' is used to describe all types of vegetation boundary when working at the local/community scale. There is little literature of direct significance to the subject of transitional areas. The concept can only be meaningfully discussed in the context of recent developments in the conceptualization of the plant community and these are summarized. The importance of mosaics within plant communities is described and the need to understand and recognize mosaics when studying transitional areas between plant communities is emphasized. The range of research methods available to describe and analyse variations in patterns of floristics and associated environmental variables across transitional areas is then critically reviewed. The potential relevance of remote sensing and geographical information systems, net work analysis and fractals is demonstrated. Ideas on possible adaptations of sampling strategies for the description of floristics and environmental/biotic factors to cater for boundary/transitional area situations are presented and the concept of a rectangular sampling area as an alternative to the more normal linear transect is introduced. The traditional approach to the description of vegetation change across boundaries using transects and similarity coefficients has now been superseded by new developments, notably moving-window analysis, the Mantel test, pattern analysis, semi-variograms, spectral analysis and analysis for spatial autocorrelation, and the scope of these methods is summarized. Finally, the dynamics of plant communities and their boundaries are considered and the implications of research into transitional areas for vegetation management and biological conserv ation are assessed. The importance of this whole subject as a possible new focus for biogeography and spatial ecology is then reiterated.
Interleukin-1 and Interleukin-6 Activities are Increased in the Cerebrospinal Fluid of Patients with CNS Lupus Erythematosus and Correlate with Local Late T-Cell Activation Markers
Authors: Alcocer-Varela Jorge , Aleman-Hoey Deborah , Alarcon-Segovia Donato 
Published: November 2007

We examined cerebrospinal fluid (CSF) samples from 12 patients with SLE and active central nervous system (CNS) involvement for their levels of the following cytokines: interleukin- 1 (IL-1) by means of two different assays-the IL-1 responsive murine cell line LBRM 33-1a5 and an ELISA for IL-1 alpha; IL-2 by means of the CTLL cell line responsive to it; and interleukin-6 (IL-6) and tumor necrosis factor alpha (TNF) both determined by a specific ELISA. We found that SLE CSF had significantly higher levels of IL-1 and IL-6 than did those obtained at surgery from eight controls without inflammatory neurologic disease. IL-2 and TNF were not detectable in any of the CSF samples. We also studied the status of activation in CSF T cells using monoclonal antibodies against early (anti-IL-2R (CD25) and antitransferrin (CD71)), late (anti-T10) and very late (anti-VLA-1) activation antigens, and found increased percentages of T10-bearing (18 ± 2 vs 3 ± 0.7%) and VLA-1-bearing T cells (12 ± 2 vs 0.7 ± 0.2%) in SLE patients as compared to controls (both P < 0.01). Levels of IL-1 and IL-6 correlated with T10 and those of IL-1 correlated also with VLA-1. Markers of early T-cell activation did not differ in SLE and control CSF. Because of these findings we analysed the effect of recombinant IL,-I, IL-6 or normal CSF on normal T cells and found that they did not induce the expression of activation markers. However, incubation in SLE CSF caused CD25, T10 and VLA-1 activation markers to become significantly expressed on cultured normal T cells. This expression of T10 and VLA-1 was partially inhibited by pre-incubation in anti-human IL-1 alpha polyvalent antibody. Our findings suggest increased in situ production of IL- and IL-6 and perhaps other factors in CNS lupus that might condition T-cell activation in the CNS compartment. These findings could have pathogenetic significance.
Clinical Renal Involvement in Afro-Caribbean Lupus Patients
Authors: Nossent J.C. 
Published: November 2007

This study reports the severity of clinical lupus nephritis (LN), defined as the sustained presence of proteinuria and/or cellular casts, in a group of 68 newly diagnosed patients with systemic lupus erythematosus (SLE) in Curaçao. Fifty-four patients (78%) developed clinical signs of LN, of whom 31 (34%) had clinical LN at the time of SLE diagnosis. The probability of developing clinical LN reached 80% in the first 3 years after SLE diagnosis and hardly increased later. No clinical or serological differences existed at the time of SLE diagnosis or at onset of LN between patients with early-or late-onset LN. Survival in patients without LN was 100% at 5 years, while for patients with clinical LN these rates at 1 and 5 years were 91% and 59%, respectively (P = 0.0001); male LN patients had a worse prognosis than females (P = 0.012), while time of LN onset did not influence survival. Six patients (11 %) developed end-stage renal failure; all were female, five had early LN and one had late-onset LN (P = 0.17). Renal survival was 97% and 80% at 1 and 5 years, with decreased rates for patients with nephroticrange proteinuria (P = 0.02). Hypertension was present in 13% of LN patients, but had no influence on patient or renal survival. Thus, clinical LN was a frequent complication, which carried a poor prognosis in these Afro-Caribbean lupus patients.
Lupus Anticoagulant and Cardiac Manifestations in Systemic Lupus Erythematosus
Authors: Jouhikainen Taneli , Pohjola-Sintonen Sinikka , Stephansson Eua 
Published: November 2007

The occurrence of cardiac manifestations and their relationship with the lupus anticoagulant (LA) in SLE was studied in 74 patients who were followed up for 22 years (median), of which 16 years were after the initial LA testing. Pericarditis was the most common cardiac event occurring in 16 (22%) patients but it did not correlate with LA. Valvular heart disease, coronary artery disease, left ventricular failure and/or cor pulmonale were observed in 16 (22%) patients. Taken together, their occurrence was associated with a history of leg ulcers (odds 3.8, P = 0.028) but not with LA or other common clinical manifestations of the antiphospholipid syndrome. Valvular heart disease in five patients was significantly associated with LA (P = 0.05). Cor pulmonale due to chronic pulmonary embolism was present in two patients with LA. Myocardial infarctions in five patients occurred late in the course of disease but in relatively young patients (mean 43 years). Fatal myocardial infarction in the absence of atherosclerosis in two LA-positive patients supports a pathogenetic role for LA in these cases. In conclusion, of the various cardiac complications in SLE, valvular heart disease and cor pulmonale appear to be connected with the antiphospholipid syndrome. Both conditions should be actively sought in patients with LA to decrease possible adverse events (arterial emboli and right ventricular failure) affecting the patients' prognosis.