bluuebunny/crossref_metadata_2025_split huggingface dataset:
Surgical management of anal fistulae: a systematic review
Authors: Malik A. I. , Nelson R. L. 
Published: May 2008

AbstractObjective The anal fistula has been a common surgical ailment reported since the time of Hippocrates but little systematic evidence exists on its management. We aimed to systematically review the available studies relating to the surgical management of anal fistulas.Method Studies were identified from PubMED, EMBASE, Cochrane Controlled Trials Register, ClinicalTrials.Gov and Current Controlled Trials. All uncontrolled, nonrandomized, retrospective studies, duplications or those unrelated to the surgical management of anal fistulas were excluded.Results The search strategy revealed 443 trials. After exclusions 21 randomized controlled trials remained evaluating: fistulotomy vs fistulectomy (n = 2), seton treatment (n = 3), marsupialization (n = 2), glue therapy (n = 3), anal flaps (n = 3), radiosurgical approaches (n = 2), fistulotomy/fistulectomy at time of abscess incision (n = 5) and intra‐operative anal retractors (n = 1). Two meta‐analyses evaluating incision and drainage alone vs incision + fistulotomy were obtained.Conclusion Marsupialization after fistulotomy reduces bleeding and allows for faster healing. Results from small trials suggest flap repair may be no worse than fistulotomy in terms of healing rates but this requires confirmation. Flap repair combined with fibrin glue treatment of fistulae may increase failure rates. Radiofrequency fistulotomy produces less pain on the first postoperative day and may allow for speedier healing. Major gaps remain in our understanding of anal fistula surgery.
Antibody response to insulin in children and adolescents with newly diagnosed Type 1 diabetes
Authors: Holmberg H. , Mersebach H. , Kanc K. , Ludvigsson on behalf of the Insulin Aspart Study Group on Im J. 
Published: May 2008

AbstractAims  To compare levels of insulin antibodies in children and adolescents after initiation of insulin therapy using either insulin aspart (IAsp) or human insulin (HI) in combination with Neutral Protamine Hagedorn (NPH) insulin, and to investigate the relationships between insulin antibodies and HbA1c and insulin dose.Methods  IAsp‐specific antibodies (IAsp‐Ab) and antibodies cross‐reacting with HI and IAsp (HI‐cross‐Ab) were analysed by radioimmunoassay at diagnosis of diabetes and every 3–6 months for 30 months. Seventy‐two patients (HI = 30, IAsp = 42) with Type 1 diabetes, aged 2–17 years were included. Data on HbA1c, insulin dose and serious adverse events (SAEs) were collected retrospectively.Results  IAsp‐Ab levels remained low throughout the study. After 9 months, the level of HI‐cross‐Ab increased [mean (sd) HI, 48.8% (21.53); IAsp, 40.2% (17.92)] and remained elevated. Repeated measurement analysis of HI‐cross‐Ab levels showed no significant difference between treatments (P = 0.16). HI‐cross‐Ab were significantly associated with total insulin dose (U/kg) (P = 0.001) and time (P < 0.0001), but not with HbA1c (P = 0.24). Mean (± sd) HbA1c was similar at diagnosis (HI 9.5 ± 1.97%; IAsp 9.6 ± 1.62%); HbA1c then decreased and stabilized to about 6.0% in both groups. Few SAEs were reported, the majority being hypoglycaemic episodes.Conclusions  Treatment with IAsp and with HI was associated with an increase in HI‐cross‐Ab in insulin‐naive children, but this did not influence treatment efficacy or safety. These results support the safe use of IAsp in children and adolescents with Type 1 diabetes.
Brainstem auditory evoked potentials and middle latency auditory evoked potentials in patients with impaired glucose tolerance
Authors: Yitmen İ. , Oflazoǧlu B. , İşak B. , Çiprut A. , Akdaş F. , Tanrıdaǧ T. , Us Ö. 
Published: May 2008

AbstractAims  The aim was to investigate the effects of impaired glucose tolerance (IGT) on the central nervous system via brainstem auditory evoked potentials (BAEPs) and middle latency auditory evoked potentials (MLAEPs), and on the peripheral nervous system via nerve conduction studies (NCS).Methods  Thirty patients with IGT and 20 control subjects underwent NCS, BAEPs and MLAEPs.Results  Tibial distal motor latencies were significantly prolonged in the IGT group; no differences in other parameters, including BAEPs and MLAEPs, were observed between the IGT and control subjects.Conclusion  Brainstem involvement may not be seen in IGT patients as in DM. The was no obvious electrophysiological finding indicating peripheral nervous system disfunction in our patients.
MEASURE IT, IMPROVE IT: the Safer Patients Initiative and quality improvement in subcutaneous insulin therapy for hospital in‐patients
Authors: Rushmer R. , Voigt D. 
Published: May 2008

AbstractAims  NHS Tayside, UK, identified risks with subcutaneous insulin therapy for hospital in‐patients: overlooked abnormal blood glucose readings; prescription errors and failure to administer insulin. Involvement in the Safer Patients Initiative provided opportunities to use different methods of quality improvement, to create a process that facilitated prevention, detection and mitigation of diabetes management problems for in‐patients requiring subcutaneous insulin therapy. The aim was to explain these methods, their use and results obtained.Methods  A failure modes effect analysis identified present risks in the process of subcutaneous insulin therapy. In response, an evidence‐based care cluster was developed and used to design a new insulin prescribing chart. The chart was introduced and modified using small tests of change [plan–do–study–act cycles (PDSAs)]. Compliance data on completing the actions required by the chart were gathered (small‐scale audits), and results displayed (process run charts) to those delivering care.Results  Practice improved over the 9 months: patient identification: 97–100%; identification of insulin device 11–100%; insulin administration 75–95%; hypoglycaemic control 85–94%. The chart prompted compliance with the evidence base, identified trouble‐shooting actions to mitigate arising problems and presented opportunities to educate non‐specialist staff.Conclusion  Using these methods ensured changes were evidence‐based, posed negligible risk to patients and provided a set of tasks against which compliance could be measured to assess changes to practice. Implementation through PDSAs allowed the chart to be adjusted to fit the context and meet the needs of those using it, while preserving the evidence base.
Serum bicarbonate, anion gap and insulin resistance in the National Health and Nutrition Examination Survey
Authors: Farwell W. R. , Taylor E. N. 
Published: May 2008

AbstractAims  Metabolic acidosis may contribute to the development of insulin resistance. To date, there have been no population‐based studies of acid‐base status and insulin resistance. We examined the cross‐sectional relations between serum bicarbonate, anion gap, and insulin resistance in a subset of healthy participants in the 1999–2000 and 2001–2002 National Health and Nutrition Examination Surveys.Methods  We included 1496 adults without diabetes or other chronic diseases. Insulin sensitivity was estimated by an index based on fasting insulin and triglyceride levels (MFFM). Linear regression was used to adjust for age, race, body mass index, albumin and other factors. Sample weights were used to produce weighted regression parameters.Results  Median values of bicarbonate, anion gap and fasting levels of insulin, triglycerides and glucose were 23 mmol/l, 12.5 mmol/l, 48 pmol/l, 1.08 mmol/l and 5.0 mmol/l, respectively. After multivariable adjustment, bicarbonate was positively associated and anion gap was inversely associated with MFFM (P < 0.01). Participants in the highest quartile of bicarbonate had fasting insulin 12.76 pmol/l lower [95% confidence interval (CI) 5.96, 19.55; P for trend < 0.01] than those in the lowest quartile. Participants in the highest quartile of anion gap had fasting insulin 4.39 pmol/l higher (95% CI 0.47, 8.31; P for trend < 0.01) than those in the lowest quartile.Conclusions  Lower bicarbonate and higher anion gap are independently associated with insulin resistance. Further research is needed to elucidate the relations between organic acid production, insulin resistance, and the pathogenesis of Type 2 diabetes.
Weight history of patients with newly diagnosed Type 2 diabetes
Authors: De Fine Olivarius N. , Richelsen B. , Siersma V. , Andreasen A. H. , Beck‐Nielsen H. 
Published: May 2008

AbstractAims  To estimate and illustrate how the 10 years of weight change immediately preceding diabetes diagnosis vary with weight at the age of 20 years and with socio‐demographic variables, risk factors and comorbidities at diagnosis.Methods   Data were from a population‐based cohort of 1320 persons newly diagnosed with diabetes aged ≥ 40 years. Patients’ weight at diagnosis was measured by the doctor, while patients recalled their weight approximately 1, 5 and 10 years prior to diagnosis and at age 20 years.Results  Median weight gain from age 20 years to diabetes diagnosis at median age 65.3 years was 14.7 kg (interquartile range 6.0–23.0). Women gained weight more than men, and the lower the weight at age 20 years, the greater the weight gain. The average weight gain from 10 years prior to diabetes diagnosis until diagnosis, however, was only 1 kg and decreased markedly with age. These 10 years of weight change were also associated with sex and the following baseline characteristics: diagnostic plasma glucose, urinary glucose, urinary albumin, fasting triglycerides, systolic blood pressure, smoking habits, and presence of diabetic retinopathy.Conclusions  The results add to the evidence that it is important to advise young patients in particular, especially women, who have gained and sustained considerable weight to curb this upward weight trend in order to prevent the development of diabetes.
Is the European (Active) Citizenship Ideal Fostering Inclusion within the Union? A Critical Review
Authors: MILANA MARCELLA 
Published: May 2008

This article reviews 1) the establishment and functioning of EU citizenship, 2) the resulting perception of education for European active citizenship and 3) the question of its adequacy for enhancing democratic values and practices within the Union. Key policy documents produced by the EU help to unfold the basic assumptions on which democratic principles and values are being promoted through education; while the literature produced primarily in political and social science challenges these assumptions.By doing so, the author argues that citizenship of the Union is creating new mechanisms of exclusion rather than promoting social equality and a strong sense of belonging to a bonding multicultural community, which are at the very core of democratic participation processes. Thus, the rhetoric embedded in the integrative process of the Union — based on the recognition of equal opportunities, access and democratic participation of all EU citizens — is founded on a limited interpretation of democratic citizenship rather than its concretisation as a multiple citizenship.As a result, the mechanisms in place at European level are creating specific patterns of social exclusion supported by educational reforms. Most citizens are therefore being excluded, due to the distinction between active and non‐active citizens, which results from institutional demand on individual's conduct, whereas little, if any, attention is paid to actual institutional practices. On the contrary, this shift in paradigm — i.e. from the institutional demand on citizens to the recognition of citizens as performing subjects — challenges the ‘activism’ embedded in recent debate on citizenship. Therefore it needs to be properly addressed, from a multicultural perspective, if education and learning processes are to sustain full democratic participation of all citizens and the construction of a multicultural Europe.
Education for Learning to Live Together: what can we learn from the South African experience?
Authors: VOLMINK JOHN D. 
Published: May 2008

In 1994, South Africa moved away from its cruel and divided past to a future where its citizens would learn together, work together and grow together. In short we had to learn what it meant to live together by unlearning the ideas introduced by apartheid that permeated every aspect of our society. This required a new Constitution, brave and exemplary leadership by Nelson Mandela and others and a Truth and Reconciliation Commission led by Desmond Tutu.None of these efforts, as important as they may have been, could ever be sufficient to sustain change. Ordinary people who have no positional authority are those who will sustain change. Roughly one quarter of the South African population is at school and these are people who will take the message of reconciliation into the future.In this article we describe attempts to redefine what is good. In particular what kind of teacher, learner and curriculum we will need to form the basis of a transformed and admirable society, one in which we will know how to live together.
The Role of Language in the Internationalisation of Higher Education: an example from Portugal
Authors: KERKLAAN VINCENT , MOREIRA GILLIAN , BOERSMA KEES 
Published: May 2008

This article discusses the impact of internationalisation on the strategy and language policy of the Portuguese University of Aveiro. In addition, it analyses how the Department of Languages and Cultures of the University contributes to the language policy. For the University of Aveiro, internationalisation is a priority and a distinctive feature of its profile. It is a member of many international networks and consortia in Europe and participates in a wide range of international study and research programmes. The principles of the Bologna Process have challenged UA policy makers to adopt a language policy and to give study programmes a more international profile by considering the option of English as a medium of instruction.At the same time, and paradoxically, the role of the Portuguese language will become increasingly important in the near future because many of the foreign students at Aveiro come from the former Portuguese‐speaking colonies. We conclude that the question of language has led to local dilemmas, discussions and sometimes tensions about the role of the English language in processes of internationalisation and curriculum change at the University of Aveiro.
Educating the educators at Hue Medical College, Hue, Viet Nam
Authors: Pron A.L. , Zygmont D. , Bender P. , Black K. 
Published: May 2008

Background:  In June 2005, four faculty members from Temple University, Philadelphia, USA, conducted a nursing educator workshop in Hue, Viet Nam. Didactic and clinical instruction addressed paediatric, maternity, psychiatric and surgical nursing content as well as instructional methods and student evaluation techniques. This educator workshop was requested as means of increasing the professionalization of nursing in Viet Nam. Student nurses in Viet Nam are taught by physician‐faculty. Between the cultural and economic factors that contribute to the current status and practice of nursing in Viet Nam and the lack of nurse educator role models, the nursing profession has many obstacles to overcome in their quest for increased autonomy.Actions:  During the workshop, in addition to modelling interactive teaching methods as they taught the classroom and clinical content, these authors also demonstrated the level of knowledge expected of nurses in the USA.Conclusions:  Despite much advance planning for this workshop, there were many challenges for the USA faculty. Some of the lessons learned which might help others included having a sense of humour, maintaining flexibility in teaching styles and content, being prepared for the cultural and religious influences on health care, and utilizing all of one's nursing skills to find creative solutions when teaching nursing in another country.
Undergraduate occupational health nursing education in Turkey: a national survey
Authors: Esin M.N. , Emiroğlu O.N. , Aksayan S. , Beşer A. 
Published: May 2008

Background:  Occupational health nursing practice responds to and is influenced by the changing needs of the worker and workplace. Correspondingly, the International Labour Organization's recommendation on occupational health services includes a proposal for specialized training of occupational health nurses (OHNs). It was not known what OH nursing topics were covered and in how many hours at schools offering undergraduate nursing education in Turkey. These data were necessary to prepare the curriculum to train OHNs.Aim:  A national survey to evaluate undergraduate OH nursing education in nursing schools in Turkey.Design:  This descriptive survey included all of the nursing schools (n = 80) providing university level education in Turkey.Methods:  A questionnaire developed by the researchers as a data‐gathering tool was sent to the presidents of 80 nursing schools. The study achieved a response rate of 60 (82.5%). Frequency distribution and descriptive statistics were used to analyse the data.Findings:  Occupational health nursing topics were covered in public health courses at all schools. The length of time allotted for OH nursing topics was only on average of 3.2 ± 1.5 h (range: 1–6 h) in each semester. A total of 62 lecturers were responsible for teaching OH nursing.Conclusions:  The study results show that there is a need for the development of a standardized education programme in Turkey. It was decided therefore to develop a new curriculum for OH nursing that would address the amount of time spent on this subject and the content.
Doctoral prepared nurses in Denmark and their scientific production between 1976 and 2005
Authors: Bjørn A. , Hundrup Y.A. , Wagner L. 
Published: May 2008

Background:  Nursing research in Denmark has evolved over the last 30 years. By 2005, 48 Danish nurses had earned a doctoral degree. The Danish Nurses Organization formalized a strategy for development of nursing research for the period 1999–2002. The strategy was evaluated in 2004. One point in the evaluation was that the nurses' publication of peer‐reviewed articles in journals with an Impact Factor did not show in the bibliographic measure used in health sciences.Purpose:  The purpose of this study is to identify the number of Danish nurses holding a doctoral degree by the end of 2005 and to document their scientific production.Methods:  A descriptive design based on a national register of all nurses in Denmark holding doctoral degrees was used to explore the curricula vitae and publication lists of 38 out of 48 (79%) nurses on the register. Authorship of all 48 graduated nurses was sought in the databases: PubMed and CINAHL.Conclusions:  A pattern of growing engagement in publishing peer‐reviewed articles was identified among the Danish nurses holding a doctoral degree. Fifty per cent of these doctoral prepared nurses published peer‐reviewed papers. The majority apparently pursued a career in health sciences. Nursing as an academic discipline is evolving in Denmark but, with its roots in clinical nursing, scientists may have to be aware of the necessity to prevail as a discipline through scientific production.
Health providers' perceptions of adolescent sexual and reproductive health care in Swaziland
Authors: Mngadi P.T. , Faxelid E. , Zwane I.T. , Höjer B. , Ransjo‐Arvidson A.‐B. 
Published: May 2008

Aim:  To explore health providers' perceptions of adolescent sexual and reproductive healthcare services in Swaziland.Methods:  Fifty‐six healthcare providers, working in 11 health clinics in Swaziland in 2005, were surveyed using a semi‐structured questionnaire. The data were analysed by descriptive statistics and content analysis to identify key themes.Findings:  Most participants were women with a mean age of 36 years and a mean number of 6 years in the profession. Services provided included STIs/HIV/AIDS advice, pre‐ and post‐test counselling and testing on HIV, contraceptives and condom use. Half of the nurses/midwives had no continued education and lacked supervision on adolescent sexual and reproductive health care. The majority had unresolved moral doubts, negative attitudes, values and ethical dilemmas towards abortion care between the law, which is against abortion, and the reality of the adolescents' situation. Forty‐four wanted to be trained on post‐abortion care while eight on how to perform abortions. Twenty‐six wanted the government to support adolescent‐friendly services and to train heathcare providers in adolescent sexual and reproductive health services.Conclusion:  The curricula within nursing and midwifery preservice education need to be reviewed to incorporate comprehensive services for adolescents. There is need for provision of comprehensive services for adolescents in Swaziland and appropriate youth‐friendly services at all levels. There is need for nurse/midwifery participation, advocacy and leadership in policy development.
ADVANCE DIRECTIVES IN SPAIN. PERSPECTIVES FROM A MEDICAL BIOETHICIST APPROACH
Authors: SIMON‐LORDA PABLO , TAMAYO‐VELÁZQUEZ MARIA‐ISABEL , BARRIO‐CANTALEJO INÉS‐MARÍA 
Published: May 2008

ABSTRACTSpain is one of the most advanced European countries in terms of the legislative and administrative development of ADs. Article 11 of Law 41/2002, concerning Patient Autonomy, regulates ‘advance directives’ and has prompted various Autonomous Regions to develop legislation in this area. Nevertheless, whilst the variety of legislations in different territories presents advantages, the disparity of criteria also presents problems.Despite significant legislative development, only 23,000 Spanish citizens have filled in an AD. Clearly, AD use is confined to a minority. Several surveys, however, show that the Spanish population views these documents in a positive light. Thus, we must analyse this discrepancy between attitude and practice. A similar situation exists amongst health professionals. Whilst they generally feel that the use of ADs is positive and necessary, they are frequently unwilling to employ them.Bioethical literature and research on ADs has significantly increased in Spain over the last six years. It is likely that this trend will continue in the foreseeable future; but more resources and effort are required if ADs are to become consolidated.