bluuebunny/crossref_metadata_2025_split huggingface dataset:
Frequently discordant results from therapeutic drug monitoring for digoxin: clinical confusion for the prescriber
Authors: Rogers N. M. , Jones T. E. , Morris R. G. 
Published: November 2008

AbstractBackground: Digoxin remains a commonly prescribed medication for the treatment of congestive cardiac failure or atrial tachyarrhythmias. Its utility is offset by its narrow therapeutic index requiring regular blood concentration monitoring. Recent evidence suggests that a lower therapeutic range (0.5–0.8 µg/L, or 0.6–1.0 nmol/L) is associated with reduced mortality in patients with congestive cardiac failure. Therapeutic drug monitoring for digoxin is carried out by immunoassays that are well established in routine clinical practice. Laboratories using different immunoassays may be involved in monitoring individual patients throughout the protracted course of therapy. These results should be concordant to ensure consistent dose individualization and optimum clinical management. We have investigated the discordance in digoxin measurements involving five different laboratories across the Adelaide metropolitan area.Methods: Aliquots from routine digoxin samples (n= 261) were analysed by accredited laboratories using commercially available immunoassays.Results: The results showed that 119 (46%) of 261 samples were so varied that a different clinical outcome was indicated when reviewed by the treating physician. The differences between the highest and lowest readings from any one sample were also substantial, with 45% of the measurements exceeding 0.3 µg/L.Conclusions: Our study shows the considerable variation in the routine monitoring of digoxin. This makes therapeutic drug monitoring difficult to interpret and complicates clinical management when treating physicians are endeavouring to avoid toxicity and optimize dosing. These results raise a significant concern for the quality of therapeutic drug monitoring of digoxin and have direct repercussions on patient care.
Relationship between intensity of physical activity and health‐related quality of life in Portuguese institutionalized elderly
Authors: Lobo Alexandrina , Santos Paula , Carvalho Joana , Mota Jorge 
Published: November 2008

Aims:  Health‐related quality of life (HRQOL) is considered to be the key goal for health promotion in older people. This study explores the relationship between HRQOL and objectively measured intensity of physical activity (PA) in institutionalized older adults. The analysis of the PA patterns of the subjects in relation to recommended levels of PA was also performed.Methods:  One hundred and eighty‐five residents of long‐term care homes aged 65 years or more, volunteered for this study. The Medical Outcome Study Short Form 36‐Item health survey (MOS SF‐36) questionnaires and the uni‐axial MTI Actigraph were used to assess HRQOL and PA, respectively. Participants were classified as less active, reasonably active and more active by tertile of moderated physical activity (MPA).Results:  (i) The men represented a greater number of counts/h and min of MPA in all the tertile groups; (ii) men from the less active group had a significantly higher body mass index; (iii) women came third and exhibited less total activity even though they used this time in more intense activities; (iv) there was a higher significant correlation between MPA, physical function and negative association with body pain in relation to the time of institutionalization in both sexes but was more strongly visible in men; and (v) only men presented a significant positive association with physical health, mental health and vitality.Conclusion:  Any intensity of PA seems to be better than no activity for HRQOL, but MPA confers greater benefits for the perception of physical function and body pain in the case of institutionalized elderly persons.
Proposing indicators for the development of nursing care quality in Iran
Authors: Pazargadi M. , Tafreshi M.Z. , Abedsaeedi Z. , Majd H.A. , Lankshear A.J. 
Published: November 2008

Background:  Nursing has come a long way in developing frameworks for the delivery of high‐quality care; however, it is still grappling with identifying key performance indicators and defining the patient outcomes that are directly or indirectly affected by nurses.Objective:  The study aimed to determine performance quality indicators in nursing care based on the healthcare system in Iran.Methods:  A descriptive exploratory study was conducted and 220 nurses from seven provinces in Iran were selected by quota sampling. A questionnaire including 97 indicators in seven categories was developed to collect data and respondents were asked to rate each indicator for importance, scientific acceptability and feasibility of implementation.Results:  Of the initial 220 distributed questionnaires, 74% (n = 119) nurse managers and 26% (n = 42) expert nurses (total: n = 161) returned questionnaires (73% response rate). The mean scores for all categories showed that the most of the indicators were important and scientifically acceptable (mean > 2.40), but difficult to implement in hospitals (mean < 2.15). An analysis using ANOVA showed that there were no significant differences between seven categories for the ‘importance’ aspect, but there were significant differences between ‘time and quality of care’ and ‘job satisfaction’, for ‘scientific acceptability’ (P = 0.004) and significant differences between most of categories for ‘feasibility of implication’(P = 0.000).Conclusion:  The researchers have proposed the most significant nursing quality indicators for the clinical setting in Iran. These indicators would be useful for nurse managers as a first step to assess the quality of nursing care in hospitals.
An unending challenge: How official decisions have influenced the teaching of nursing in Norway
Authors: Mathisen J. , Bastoe L‐K. H. 
Published: November 2008

Background:  Over a period of more than 50 years, there have been huge changes in nursing education in Norway owing to large numbers of political and other official resolutions.Aim:  To evaluate how these decisions have had influence upon the role of the nurse teacher.Methods:  The contents of political documents, government‐sponsored curricula and articles in The Norwegian Nurse Organization's journal Sykepleien were analysed.Findings:  The main findings are structured into two periods. During the period from 1950 to 1979, nurse education was strongly bound by official detailed terms for the curriculum, and the role of the teacher was ruled by these regulations. In the next period, from 1980 to the present, the situation in nursing education changed. From now on, the teachers had to develop the curricula based on more general plans and regulations. During these years, the numbers of students increased dramatically, and there also was tremendous pressure on nurse teachers to undertake further qualifications and to do scientific work. At the same time, the teachers had to fulfil their duties in teaching and supervising the students, and support their supervisors in clinical practice.Conclusion:  The role of the nurse teachers in Norway has, in many ways, been driven by many different interests and they are still struggling to meet the different demands made upon them.
Nutritional patterns of Korean diabetic patients: an exploratory study
Authors: Lee H. , Kim M. , Daly B.J. 
Published: November 2008

Background:  Although much is known about the relationship of dietary intake to glycemic and lipid control in persons with diabetes, most previous studies have been conducted with patients in Western countries. Koreans have quite different dietary patterns to Westerners.Purpose:  To analyse nutritional intake in relation to serum glucose and lipids among Koreans with diabetes.Methods:  A descriptive correlational design was used. A total of 154 patients with type 2 diabetes mellitus were recruited from 10 outpatient clinics in Korea. Actual dietary intake was measured by 24‐hour dietary recall in a face‐to‐face interview. Glucose and lipid profiles were measured by serum analysis.Results:  Most Korean diabetic patients reported inappropriate levels of total energy and insufficient calcium intake. low‐protein intake was related to high serum glucose and high‐fat intake was related to serum high‐density lipoprotein.Conclusion:  This study revealed a significant deviation from recommended daily allowances in the nutritional intake of Korean diabetic patients and emphasizes that dietary teaching and counselling must be tailored to clients' specific cultures and ethnic backgrounds.
Barriers to, and facilitators of post‐operative pain management in Iranian nursing: a qualitative research study
Authors: Rejeh N. , Ahmadi F. , Mohammadi E. , Anoosheh M. , Kazemnejad A. 
Published: November 2008

Background:  Unrelieved post‐operative pain continues to be a major clinical challenge, despite advances in management. Although nurses have embraced a crucial role in pain management, its extent is often limited in Iranian nursing practice.Aim:  To determine Iranian nurses' perceptions of the barriers and facilitators influencing their management of post‐operative pain.Methods:  This study was qualitative with 26 participant nurses. Data were obtained through semi‐structured serial interviews and analysed using the content analysis method.Findings:  Several themes emerged to describe the factors that hindered or facilitated post‐operative pain management. These were grouped into two main themes: (1) barriers to pain management after surgery with subgroups such as powerlessness, policies and rules of organization, physicians leading practice, time constraints, limited communication, interruption of activities relating to pain, and (2) factors that facilitated post‐operative pain management that included the nurse–patient relationship, nurses' responsibility, the physician as a colleague, and nurses' knowledge and skills.Conclusion:  Postoperative pain management in Iran is contextually complex, and may be controversial. Participants believed that in this context accurate pain management is difficult for nurses due to the barriers mentioned. Therefore, nurses make decisions and act as a patient comforter for pain after surgery because of the barriers to effective pain management.
Symptoms and strategies in heart failure in Turkey
Authors: Oguz S. , Enç N. 
Published: November 2008

Background:  Patients with heart failure can live longer and achieve a better quality of life by learning about the symptoms and management of the disease and about associated changes required in the lifestyle and by controlling symptoms.Objectives:  The objective of this study was to determine the symptoms experienced by patients with heart failure and to identify the strategies they use in the management of the disease.Methods:  The study was carried out with 64 (53.3%) of patients diagnosed with chronic heart failure [functional class (II–III)] who had been admitted to the cardiology polyclinic. The patients had to be literate and conscious, and had to voluntarily accept to participate in the study. Data were gathered by a questionnaire. The patients were interviewed face to face with the researcher in the polyclinic. Data were evaluated by percentage values, averages and chi‐square.Results:  Symptoms identified in the subjects were fatigue in 67.2%, dyspnoea in 60.9% and palpitation in 59.4% of respondents. A statistically significant difference was noted between men and women in the case of fatigue (P = 0.039), with this symptom having a stronger restricting effect on the daily activities of men compared with women. A significant difference between men and women was also observed for the management of dyspnoea (P = 0.004), preferred approach for avoiding this symptom being resting for men, while using medication and oxygen for women.Conclusion:  Fatigue was found to be the most common symptom experienced by the subjects, followed by dyspnoea, palpitation and oedema, respectively. A significant difference between men and women was noted in approaches for reducing symptoms.
The Pragmatics of Legal Language
Authors: MARMOR ANDREI 
Published: November 2008

AbstractThe purpose of this essay is to explore some of the main pragmatic aspects of communication within the legal context. It will be argued that in some crucial respects, the pragmatics of legal language is unique, involving considerations that are not typically present in ordinary conversational contexts. In particular, certain normative considerations that are typically settled in a regular conversational context are unresolved and potentially contentious in the legal case. On the other hand, the essay also argues that a careful distinction between various pragmatic aspects of language use enables us to offer some generalizations about types of pragmatic enrichment that could be taken to form, or not to form, part of what is actually determined by legal expressions.
The Pluralistic Universe of Law: Towards a Neo‐Classical Legal Pragmatism*
Authors: HAACK SUSAN 
Published: November 2008

AbstractAfter a brief sketch of the history of philosophical pragmatism generally, and of legal pragmatism specifically (section 1), this paper develops a new, neo‐classical legal pragmatism: a theory of law drawing in part on Holmes, but also on ideas from the classical pragmatist tradition in philosophy. Main themes are the “pluralistic universe” of law (section 2); the evolution of legal systems (section 3); the place of logic in the law (section 4); and the relation of law and morality (section 5).
Virtues and Vices of Relativism
Authors: Schofer Jonathan Wyn 
Published: November 2008

comment▪ Subject:“Judging Others: History, Ethics, and the Purposes of Comparison”Aaron Stalnaker Journal of Religious Ethics 36.3 (September 2008)▪ From:Jonathan Wyn SchoferHarvard Divinity School45 Francis AvenueCambridge, MA 02138
Association between HIV infection and attenuated diurnal blood pressure rhythm in untreated hypertensive individuals*
Authors: Baekken M , Os I , Stenehjem A , Sandvik L , Oektedalen O 
Published: November 2008

ObjectiveHypertensive cardiovascular complications are more closely associated with ambulatory blood pressure (ABP), particularly the attenuated diurnal blood pressure (BP) rhythm (i.e. a fall in systolic blood pressure <10% during the night compared with the day), than with casual BP. The aim of the study was to assess the ABP pattern in an HIV‐infected cohort in which hypertension was newly diagnosed.MethodsABP over 24 h was compared between 77 newly diagnosed, untreated hypertensive HIV‐positive individuals and 76 HIV‐uninfected untreated hypertensive controls.ResultsMore HIV‐infected subjects had an attenuated ABP rhythm with a reduced nocturnal fall than HIV‐negative hypertensive control subjects (60 vs. 33%, respectively; P=0.001). The dipping pattern was observed despite newly diagnosed hypertension, a low prevalence of microalbuminuria, and the absence of signs of overt kidney disease. Furthermore, the prevalence of nondipping in the HIV‐infected subjects was independent of combination antiretroviral treatment. Multiple logistic regression analysis with dipping pattern as the dependent variable showed that HIV status was an independent predictor of nondipping BP [P=0.002; odds ratio (OR) 0.33; 95% confidence interval (CI) 0.17–0.66]; casual SBP (P=0.37; OR 1.001; 95% CI 0.99–1.04) and microalbuminuria (P=0.39; OR 1.56; 95% CI 0.57–4.28) were not associated with dipping pattern.ConclusionsThe prevalence of a nondipping BP pattern in HIV‐infected subjects with newly diagnosed hypertension who had not received antihypertensive treatment was high and significantly greater than in hypertensive control subjects.
MISSING THE WOOD FOR THE TREES A CRITIQUE OF PROUDFOOT'S EXPLANATORY REDUCTION OF RELIGIOUS EXPERIENCE
Authors: KARUVELIL GEORGE 
Published: November 2008

It is common for scholars sympathetic to religion – from Friedrich Schleiermacher to the present – to describe the modern critics of religious experience as reductionist. By this they mean these critics do not respect religion for what it is; they rather ‘attempt to assimilate religion to nonreligious phenomena’,1 say, primitive science or metaphysics. Needless to say, these scholars consider this incorrect.Into this scene strides Wayne Proudfoot. In his award‐winning book Religious Experience2 he sets out to scrutinize this accusation and rehabilitate the modern critics. He dismisses this accusation as a protective strategy to render religious claims immune to rational critique. His rehabilitation program is based on a distinction he draws between two kinds of reduction – descriptive and explanatory. This distinction has so caught the imagination of philosophers that it has found its way into textbooks.3 On the other hand, the book is also controversial; needless to say, its claims are problematic for believers.The purpose of my paper is not to offer a comprehensive critique of his book, but only of his methodology, or the lack thereof, where methodology is understood as an integrated set of tools used for inquiry. I argue that although he proposes description and explanation as appropriate instruments for the study of religious experience, the two do not constitute a methodology, because his descriptions play no role in his explanations; rather, both go their separate ways. I argue that explanation must be guided by description. Moreover, I distinguish three kinds of inquiry, each calling for a different kind of description. The kind of description Proudfoot recommends is appropriate for genetic inquiry into how particular experiences came about, but not for a conceptual inquiry into the constitutive elements of religious experience. He knows lots of trees (particular experiences), but misses the wood (the nature of religious experience). Thus my title.The paper is divided into three parts. First is a brief presentation of Proudfoot's thesis. A second part analyses three different kinds of inquiry; it shows that genetic and epistemic explanations are logically independent and irreducible one to another. These different types of inquiry call for distinct types of description, and these descriptions in turn guide the explanation that will be considered satisfactory. The context‐sensitivity of descriptions, and their relation to explanation is dealt with in the final part. Let us start with Proudfoot's contention.
Health and Psychiatric Disparities in Children with Cognitive and Developmental Delays: Implications for Health Policy in Quebec
Authors: Nachshen Jennifer S. , Martin‐Storey Alexa , Campisi Lisa , Stack Dale , Schwartzman Alex , Serbin Lisa 
Published: November 2008

Background  Previous research on psychiatric and health disparities according to level of cognitive functioning has focused on adults within an American healthcare context. The current study compares children with and without cognitive and developmental delays in Quebec, Canada, using physician billing data from a longitudinal study of low‐income, francophone families. Canada is an ideal context for studying medical billing data as its equal access healthcare system removes many socioeconomic biases.Methods  A large sample (n = 1050) of children is used to describe psychiatric and health disparities, as well as differences in Ambulatory Care Sensitive (ACS) conditions and primary healthcare, between children with (n = 107) and without (n = 943) diagnoses in their billing history indicative of delays.Results  The findings demonstrated a relatively high level of psychiatric diagnoses for children with delays. However, no difference was found between children with and without delays in regard to emergency room visits and hospitalizations for ACS conditions and primary healthcare.Conclusions  The findings suggest that, within a universal healthcare system, disparities in primary healthcare may not emerge until adulthood in individuals with delay status.
Tricalcaria Han gen. nov., a remarkable new genus with three hind‐tibial spurs belonging to the tribe Trichopterygini, with description of a new species from China (Lepidoptera: Geometridae: Larentiinae)
Authors: XUE Dayong , WU Chunguang , HAN Hongxiang 
Published: November 2008

Abstract Tricalcaria Han gen. nov. and its type species Tricalcaria stueningi Han sp. nov. are described from China. Morphological characters, including those of the male and female genitalia, are figured. The main diagnostic characters of Tricalcaria are: hind tibia with three spurs in both male and female; ventral margin of costal protrusion bearing a series of long, hook‐like, sclerotized setae in the male genitalia; female papilla analis modified and bearing over part of its surface broad blade‐like sclerotized setae. The wing pattern, venation, and genitalia of this genus are compared with those of the most closely related genera, Tristeirometa Holloway, 1997, Hypocometa Warren, 1896, and Phthonoloba Warren, 1893. Tribal placement is discussed, with the conclusion that the new genus should be placed in the tribe Trichopterygini.
Clarithromycin Resistance of Helicobacter pylori Strains Isolated from Children’ Gastric Antrum and Fundus as Assessed by Fluorescent In‐situ Hybridization and Culture on Four‐Sector Agar Plates
Authors: Caristo Elisa , Parola Andrea , Rapa Anna , Vivenza Daniela , Raselli Barbara , Dondi Elena , Boldorini Renzo , Oderda Giuseppina 
Published: November 2008

AbstractAim:  To assess validity of culture on four‐sector agar plates and fluorescent in‐situ hybridization (FISH) test, and clarithromycin resistance rate in Helicobacter pylori strains isolated from children in the last 10 years.Methods:  In the last 5 years, gastric biopsy specimens from antrum and fundus were taken from 89 consecutive children (median age 9 years) with H. pylori gastritis and from 21 controls. Culture was performed on 176 gastric biopsies (89 from antrum, 87 from fundus) on four‐sector agar plates, and FISH test with DNA ProbeMix®. After its validity was evaluated, FISH test was applied on additional 119 biopsies from 68 children (68 from the antrum, 51 from the fundus) stored in the Pathology archive in the previous 5 years.Results:  Culture was positive in 157 of 176 biopsies (sensitivity: 89.2%, 95% confidence interval (CI) 85–94). In 33 of 89 children (37%) resistant strains were found in one or both gastric sites. FISH test was positive in 148 of 176 biopsies from infected children (sensitivity 84.1%, 95%CI 79–89) and in none of 42 biopsies from controls (specificity 100%). When applied on archive biopsies, FISH test was positive in 96 of 119 (80.7%, 95%CI 74–88). Total children harboring resistant strains in the last 10 years, as assessed by FISH test, were 66 of 157 (42%). Mixed infection with both sensitive and resistant strains were found in 40 children (25%) and in 12 of them resistant strains were in the fundus only.Conclusions:  Culture on four‐sector agar plates and FISH test had a high sensitivity and specificity and showed co‐presence of sensitive and resistant strains. In one‐third of children with mixed infection, the resistant strains were in the fundus only. Clarithromycin resistance should be assessed in biopsies both from the antrum and the fundus, utilizing antral biopsies only can underestimate its prevalence.