bluuebunny/crossref_metadata_2025_split huggingface dataset:
Regional anaesthesia in developing countries
Authors: Schnittger T. 
Published: October 2007

SummaryIn modern anaesthesia practice, regional techniques are preferred to general anaesthesia for many types of surgery, particularly in obstetric care. Improved outcomes have been recorded in UK practice, but the techniques remain underutilised in many parts of the world. With encouragement, training and a regular supply of appropriate needles and local anaesthetic agents, the advantages of regional techniques in the developing world could be realised.
Anaesthesia equipment for resource‐poor environments
Authors: McCormick B. A. , Eltringham R. J. 
Published: October 2007

SummaryThe design of anaesthesia equipment for use in hospitals in the developing world must take into account the local conditions, particularly whether reliable supplies of compressed oxygen and electricity are available. Designs should ensure that maintenance is feasible locally. International standards should encourage the design of suitable equipment to ensure safe anaesthesia for patients worldwide.
Primary Trauma Care
Authors: Wilkinson D. , McDougall R. 
Published: October 2007

SummaryThe Primary Trauma Care programme is a course designed to train anaesthetists, surgeons and others in the systematic review and management of severe trauma victims at the District Hospital. Over the last 10 years, many individuals have been involved in training, empowering and supporting doctors and nurses in a number of countries. Local programmes and training courses are increasingly co‐ordinated by regional offices in South America, India, China, Indonesia, the South Pacific and Africa. The Primary Trauma Care Foundation continues to support these regional offices in their need for qualified instructors, fund‐raising, and for updating educational material. With anaesthetic support, the Primary Trauma Care Foundation will continue to empower anaesthetists worldwide as they work with their surgical colleagues to treat severely injured patients in areas where, previously, due to inadequate resources and training, comprehensive treatment was not available.
The World Health Organization and Anaesthesia
Authors: Cherian M. N. , Merry A. F. , Wilson I. H. 
Published: October 2007

SummaryThe World Health Organization has been involved in a wide range of global healthcare initiatives for many years. Recently an initiative ‘Safe Surgery Saves Lives’ has been launched to improve the safety of surgery throughout the world. Safe anaesthesia is a key component to achieving this aim.
The World Federation of Societies of Anaesthesiologists: supporting education in the developing world
Authors: Enright A. , Wilson I. H. , Moyers J. R. 
Published: October 2007

SummaryThe World Federation of Societies of Anaesthesiologists (WFSA) was formed in 1955 and is currently composed of 120 national societies. The aims of WFSA are to improve the standards of anaesthesia worldwide, with a particular emphasis in developing countries. This article details the structure of the WFSA, the various activities carried out by the different committees, and our achievements in education and training.
Educational resources: website and book review
Authors: Stevenson C. 
Published: October 2007

SummaryGood quality educational material for anaesthesia providers in the developing world is limited in both quantity and availability. Traditionally, textbooks have been the main source of information but these are frequently expensive, easily damaged and rapidly become outdated. Many first world texts concentrate on the use of expensive drugs for an increasingly complex range of patients and procedures, making them less suitable for practitioners in resource‐poor locations. Improved access to broadband internet connections will increasingly be a major portal for the delivery of up to date educational material.
Mothers of Africa – an anaesthesia charity
Authors: Morris S. , Clyburn P. , Harries S. , Rees L. , Sewell J. , Hall J. 
Published: October 2007

SummaryAn anaesthetic charity ‘Mothers of Africa’ has been established as a link between the academic departments of anaesthesia in Togo and Benin and the University Hospital of Wales. Visits by UK consultant anaesthetists have identified a number of clinical areas where collaborative working in both classroom and theatre has the potential to improve outcomes in maternal mortality and morbidity.
Lessons from working overseas
Authors: Henderson K. 
Published: October 2007

SummaryTo spend time in a developing country may not appear an obvious choice in a UK‐based anaesthetic career. However, dealing with challenging situations and meeting people who spend their working lives in this environment can be an unforgettable experience. Reliance on personal clinical skills and basic techniques teaches us an enormous amount about the ability within us as physicians. There are benefits to us as individuals, the country involved, the people, and also the NHS in the long term. This article gathers personal experiences that are representative of commonly expressed opinions.
Outcome analysis of 4 years’ follow‐up of patients referred for colposcopy with one smear showing mild dyskaryosis
Authors: Ahmed A. S. , Goumalatsos G. , Akbar N. , Lawton F. G. , Savvas M. 
Published: October 2007

Objective:  To assess the 4‐year outcome of patients after one smear showing mild dyskaryosis with respect to smear regression rate, prevalence of cervical intraepithelial neoplasia (CIN) and the effect of age.Methods:  Retrospective analysis of patients diagnosed with initial mildly dyskaryotic smear during the year 2000 with a follow‐up period of 48 months. These women had not had any previous abnormal smears.Settings:  Cytopathology Department and Colposcopy Unit, King’s College Hospital, London, UK.Results:  We identified 524 patients of whom 375 patients with complete follow‐up data are included. The age range was 19–67 years with a median of 29 years. There were 207 patients aged 35 years or less (55%). At 6 months, 258 smears were performed and 47.8% of them were negative (95% CI: 41.6–54.0%). The total number of negative follow‐up smears in the first year was 198 out of a total of 397 smears performed (50%). This proportion has significantly increased between 1 and 4 years’ follow‐up to 67.5% (RR: 1.24; 95% CI: 1.14–1.35). Over the 4‐year period, 791 smears were performed and 477 were negative (60.3%; 95% CI: 56.9–63.7%). Of the 477 negative smears there were only 61 smears (12.8%; 95% CI: 10–16%), in 54 patients (14%; 95% CI: 11–18%) that reverted back to low‐grade cytological abnormality. In only one case the repeat smear showed high‐grade abnormality after initial negative follow‐up; however, on biopsy, histology showed CIN I. Out of the 375 patients, 70 required treatment with excisional biopsy (19%; 95% CI: 15.0–22.9%). Histology confirmed high‐grade CIN in only 41 cases giving a prevalence of 11% (95% CI: 8.1–14.5%). There were no cases of microinvasive or invasive cancer detected. Age (≤35 years versus >35 years) did not significantly affect either cytological or histological outcome.Conclusion:  Sixty per cent of follow‐up smears after initial mild dyskaryosis subsequently became negative; of them 87.2% remained negative over the 4 year follow‐up. Treatment was only required in 19% of patients, with 11% prevalence of high‐grade CIN. Age did not affect the outcome. These results are reassuring and indicate that colposcopic referral may not be necessary after only one mildly dyskaryotic smear.
Immunolocalization of androgen and oestrogen receptors in the ventral lobe of rat (Rattus norvegicus) prostate after long‐term treatment with ethanol and nicotine
Authors: Fávaro W. J. , Cagnon V. H. A. 
Published: October 2007

SummaryNicotine and alcohol adversely affect prostate gland function. In this work, immunohistochemistry was used to investigate the immunoreactivity and distribution of androgen and α, β‐oestrogen receptors following chronic treatment with alcohol, nicotine or a combination of both substances, as well as to relate these results to the development of possible prostatic pathologies. Forty male rats were divided into four groups: the Control group received tap water; the Alcoholic group received diluted 10%Gay Lussac ethanol; the Nicotine group received a 0.125 mg/100 g body weight dose of nicotine injected subcutaneously on a daily basis (Sigma Chemical Company, St. Louis, MO, USA); the Nicotine‐Alcohol group received simultaneous alcohol and nicotine treatment. After 90 days of treatment, samples of the ventral lobe of the prostate were collected and processed for immunohistochemistry, light microscopy and the quantification of serum hormonal concentrations. The results showed significantly decreased serum testosterone levels and increased serum oestrogen levels in the animals from the nicotine‐alcohol, the alcoholic and the nicotine groups, as well as their hormonal receptor levels. Then, it was concluded that ethanol and nicotine compromised the prostatic hormonal balance, which is a crucial factor to maintain the morphological and physiological features of this organ.
Impact level of dihydrotestosterone on the hypothalamic‐pituitary‐leydig cell axis in men
Authors: Cailleux‐Bounacer Anne , Rohmer Vincent , Lahlou Najiba , Lefebvre Hervé , Roger Marc , Kuhn Jean Marc 
Published: October 2007

SummaryDihydrotestosterone (DHT) the physiologically most potent androgen cannot be aromatised into oestrogen. DHT is used as a treatment for idiopathic gynaecomastia. In order to investigate the different sites of action of DHT on the hypothalamic‐pituitary‐testicular axis, two groups of adult men were studied. Group I included 10 gonadotropin‐releasing hormone (GnRH)‐deficient men who were evaluated before and during a pulsatile infusion of GnRH alone for 2 weeks and then in association with DHT given transdermally at doses used in the treatment of gynaecomastia for further two weeks. Luteinizing hormone (LH) pulsatility was assessed at the end of each step of the study. Plasma LH levels were measured every 15 min. Plasma testosterone (T), DHT, oestradiol (E2), free alpha‐subunit (FAS) of glycoproteic hormones and LH bioactivity were measured on pooled plasma samples. Group II included 12 healthy men in whom plasma T, DHT and E2 were measured before and then 24, 48 and 72 h after the injection of 5000 IU hCG alone or in combination with either DHT or the pure anti‐androgen nilutamide. Two weeks separated each of the 3 hCG testing. In group I, except for bioactive/immunoreactive (B/I) LH ratio which was unchanged, GnRH treatment induced significant rises (p < 0.01) in all plasma hormone levels, LH pulse amplitude and frequency. During treatment with GnRH+DHT, plasma DHT levels increased up to 16.8 ± 2.5 nm, while plasma hormone levels, B/I LH ratio, LH pulse amplitude and frequency were similar to those obtained with GnRH alone. In group II, the peak of hCG‐induced T rise was not modified by either DHT or nilutamide. In contrast, DHT reduced by 50% (p < 0.01) the E2 peak in response to hCG. These data show that DHT exerts no direct action on the pituitary to retroregulate LH secretion and to modify either B/I LH ratio or FAS secretion. Its reducing effect on LH secretion is likely mediated at the hypothalamic level. DHT does not appear to have a physiological influence on Leydig cells steroidogenesis. Administered at therapeutic doses, DHT directly reduces testicular aromatase activity that combined with its antigonadotropic effect leads to the gain in the symptomatic treatment of gynaecomastia.
Quality of life, postnatal depression and baby gender
Authors: De Tychey Claude , Briançon Serge , Lighezzolo Joëlle , Spitz Elisabeth , Kabuth Bernard , De Luigi Valerie , Messembourg Catherine , Girvan Françoise , Rosati Aurore , Thockler Audrey , Vincent Stephanie 
Published: October 2007

Aims and objective.  To study the impact of postnatal depression on the quality of life of young French mothers and to evaluate if the gender of their child influences this.Background.  Postnatal depression (PND) constitutes a major public health problem considering its high prevalence and consequences upon quality of life and parental skills.Design.  This research is a cross‐sectional study during the postnatal period.Methods.  This study was carried out during a two‐month period. Data were collected by interview and questionnaires. The authors compared the prevalence rate of PND and life quality in a cohort of 181 women and measured the short‐term impact of the child's birth.Results.  Postnatal depression strongly negatively influences all dimensions of life quality explored through the SF36, e.g. physical functioning (PF), physical Role (RP), bodily pain (BP), mental health (MH), emotional role (RE), social functioning (SF), vitality (VT), general health (GH), standardized physical component (PCS) and standardized mental component (MCS). The baby's gender (having a boy) also significantly reduces quality of life, irrespective of depressive state. There is a relationship between baby gender and PND.Conclusion.  This research is the first to show that the birth of a boy reduces several dimensions of the mothers’ quality of life.Relevance to clinical practice.  The importance of the impairment of quality of life in case of PND, as well as its effects on mother‐child interaction, could justify prevention programs and early psychotherapeutic care. Further research needs to explore the effectiveness of programmes targeting the construction of parenting skills as a preventative measure against PND, especially for parents of boys.
A comparison of emotional/behavioural problems between Taiwanese children with cancer and healthy controls
Authors: Liang Hwey‐Fang , Chiang Yi‐Chien , Chien Li‐Yin , Yeh Chao‐Hsing 
Published: October 2007

Aims.  The purpose of this study was to compare children, diagnosed with cancer, who were attending school, with their healthy peers on emotional and behavioural problems.Background.  Children who suffer from cancer experience severe side effects from their treatment protocols and from the uncertainty associated with their disease. We were seeking to find out if these children subsequently experienced more emotional and behavioural problems than their healthy peers.Methods.  Parents and teachers of paediatric oncology patients and their healthy schoolmates were recruited. The ratio was one patient to two schoolmates. The Child Behaviour Checklist (CBCL) was used to collect data from the parents and teachers of 23 paediatric cancer patients and 46 healthy controls. Children were matched on enrollment in the same grade and socioeconomic status of their families. Paired‐t tests were used to compare the differences between the emotional/behavioural scores of both groups of children.Results.  The findings of the study indicated that children with cancer had statistically higher scores on the following items of the CBCL: withdrawn/depressed, somatic complaints, social problems, thought problems, hyperactivity/impulsivity, rule‐breaking behaviours and aggressive behaviours.Conclusions.  School children with cancer in Taiwan did have more emotional/behavioural problems than their peers. Findings from this study suggest that Taiwanese paediatric oncology patients who are able to return to school and their families may need more psychosocial care.Relevance to clinical practice.  Healthcare professionals may need to extend their professional services to school settings to decrease long‐term emotional and behavioural problems in children with cancer.
Perspectives of patients with type 2 diabetes following a critical cardiac event – an interpretative approach
Authors: (Jo) Wu Chiung‐Jung , Chang Anne M , McDowell Jan 
Published: October 2007

Aim.  This study aimed to gain in‐depth understanding of the actual hospital and home experience of patients with diabetes and a critical cardiac event to assist in developing a pertinent diabetes self‐management programme.Background.  Type 2 diabetes can lead to cardiac complications requiring critical nursing care. Patients with diabetes and a history of cardiac disease are at greater risk of a further cardiac event. Greater self‐efficacy or confidence in regulating diabetes and reducing the risk of a further cardiac event can be achieved through self‐management programmes. However, the start of such a programme within the critical care environment presents challenges to critical care staff. It is important to understand patients’ experiences and needs to improve quality of care.Design.  An interpretive approach comprising open‐ended interviews was used to collect data from patients with type 2 diabetes experiencing a cardiac event who had a coronary care unit admission in 2002–2003.Findings.  The findings revealed that patients with diabetes who had a critical cardiac event experienced considerable feelings of hopelessness and fatigue. Patients also had concerns in the areas of self‐confidence and confidence in health professionals. Patients indicated that greater self‐confidence and confidence in health professionals would help their ability to manage their daily lives.Conclusion.  This paper provides in‐depth understanding of the perspectives of patients with type 2 diabetes who have also been hospitalized for a critical cardiac event. This study concluded that further research is needed to fully explore whether enhancing self‐confidence for these patients will lead to improved diabetes management, reduced negative feelings and more positive health outcomes.Relevance to clinical practice.  The themes identified in this study provide direction and strategies for nursing staff to improve patients’ confidence levels and reduce their feelings of hopelessness and fatigue.
A study on the effect of the duration of subcutaneous heparin injection on bruising and pain
Authors: Zaybak Ayten , Khorshid Leyla 
Published: October 2007

Aim.  This study was carried out to determine the effect of injection duration on bruising and pain following the administration of the subcutaneous injection of heparin.Background.  Although different methods to prevent bruising and pain following the subcutaneous injection of heparin have been widely studied and described, the effect of injection duration on the occurrence of bruising and pain is little documented.Design.  This study was designed as within‐subject, quasi‐experimental research.Method.  The sample for the study consisted of 50 patients to whom subcutaneous heparin was administered. Heparin was injected over 10 seconds on the right abdominal site and 30 seconds on the left abdominal site. Injections areas were assessed for the presence of bruising at 48 and 72 hours after each injection. Dimensions of the bruising on the heparin applied areas were measured using transparent millimetric measuring paper. The visual analog scale (VAS) was used to measure pain intensity and a stop‐watch was used to time the pain period. Data were analysed using chi‐square test, Mann–Whitney U, Wilcoxon signed ranks tests and correlation.Results.  The percentage of bruising occurrence was 64% with the injection of 10 seconds duration and 42% in the 30‐second injection. It was determined that the size of the bruising was smaller in the 30‐second injection. Pain intensity and pain period were statistically significantly lower for the 30‐second injection than for the 10‐second injection.Conclusions.  It was determined that injection duration had an effect on bruising and pain following the subcutaneous administration of heparin. This study should be repeated on a larger sample.Relevance to clinical practice.  When administering subcutaneous heparin injections, it is important to extend the duration of the injection.
Maternal birthweight and outcome of twin pregnancy
Authors: Morley Ruth , Moore Vivienne M. , Dwyer Terence , Owens Julie A. , Umstad Mark P. , Carlin John B. 
Published: October 2007

SummaryThere is evidence from singletons that maternal birthweight is positively related to offspring gestational length and birthweight, and some evidence of an inverse relationship with preterm birth. Among twins very preterm birth is the major cause of neonatal mortality and of immediate and later morbidity, including neurodevelopmental impairment. We hypothesised that the relationship between maternal birthweight and gestational length would be more evident in twin than in singleton pregnancies, as there is more variation in gestation in the former.Among 131 singleton mothers carrying twins, there was weak evidence of a positive relationship between maternal birthweight and twin gestational length (+0.6 weeks [95% CI −0.05, +1.3] per kg increase in maternal birthweight, but stronger evidence among 56 of these who went into labour spontaneously (+1.9 weeks [+0.7, +3.1], P = 0.003 for interaction). In the latter group we estimated that the odds of very preterm birth (at <32 weeks) were reduced by 50% [95% CI 10%, 82%] per 250 g increase in maternal birthweight. In the whole cohort, and in this subgroup, maternal birthweight was strongly positively related to both twin offspring total birthweight and total placental weight. Our data, consistent with intergenerational programming of early development, suggest the possibility of a stronger and more clinically relevant association among twins than among singletons. Nevertheless, our sample size was modest and this finding needs to be confirmed in a larger cohort.
Construction and characterisation of a longitudinal clinical blood pressure database for epidemiological studies of hypertension in pregnancy
Authors: Thompson Mary Lou , Miller Raymond S. , Williams Michelle A. 
Published: October 2007

SummaryBlood pressure measurement plays a central role in the screening and management of hypertension during pregnancy. Although descriptions of changes in blood pressure patterns of normotensive and hypertensive pregnancies are plentiful, relatively little is known about how modifiable environmental and lifestyle characteristics, including maternal diet and physical activity, influence blood pressure levels in pregnancy. In this paper we provide a detailed description of the first 2000 subjects enrolled in the Omega Prospective Cohort Study. Our intention is to characterise the cohort and to establish a rigorous data framework that will form the basis for future analyses of the association between blood pressure patterns in pregnancy and modifiable risk factors. We describe the construction of a representative longitudinal blood pressure analysis database drawn from routinely collected measurements. In doing this, we explore possible over‐ and under‐representation of patients and evaluate ways of modifying the database to address areas of possible bias. In addition, we consider questions of data quality which are specific to blood pressure measurements. In an accompanying paper, we use this database to explore the influence of maternal pre‐pregnancy adiposity on blood pressure levels across gestation.