bluuebunny/crossref_metadata_2025_split huggingface dataset:
The assessment and implementation of mouth care in palliative care: a review
Authors: Gillam J L , Gillam David G 
Published: February 2006

Aim: From a review of the literature it is evident that the importance and maintenance of oral health for patients with cancer is recognised as an integral part of basic nursing care and yet from practical observation in the hospital environment together with reviewing the published literature it is clear that there appears to be limited evidence of regular assessment of the mouth or implementation of oral protocols on the ward. Furthermore there is a lack of adequate training in the assessment and implementation of mouth care by nurses during their general nurse training. The aim of the present study was to review existing literature published between 1995 and 1999 to determine whether mouth care was effectively assessed and implemented in the palliative care setting. Method and results: Relevant articles selected from the 1995–1999 period highlighted the lack of published research in this very important aspect of care. Results from these published articles raised concern about the lack of training and education among nurses in the assessment of mouth care as well as the need to rationalise the assessment tools used on the ward or hospice. Furthermore, while it was recognised in palliative care that a multiprofessional approach was beneficial, in practice this did not appear to apply to mouth care with a few notable exceptions. Conclusion: This review has highlighted a number of inconsistencies in both the knowledge of mouth care and its implementation by nursing staff. The importance of establishing protocols and setting standards of care was also indicated in this review. It is clear that without effective assessment of the mouth, the appropriate implementation of care will not be delivered. The implementation of mouth care should not be anecdotal in nature but based on research (evidence-based) and this in turn will enable nurses to embrace an evidence-based practice (which will benefit their patients) that can be effectively audited.
A survey of the physical health screening of all in-patients in a residential rehabilitation population
Authors: Panesar Narinder Pal 
Published: February 2006

Aim:It has been noted for many years that people with severe and enduring mental illness frequently have poor physical health. Their physical health needs often go unrecognised by the mental health team. This study aims to investigate the physical health status of all in-patients in a residential rehabilitation setting. Methods:All the clients in a rehabilitation centre in Doncaster, England, were included in the health screening survey. The physical health of patients was assessed following the guidelines from ‘Physical Health of the Severe and Enduring Mentally Ill. A Training Pack for GPEducators’.1 Results:Over one-third (35%) of the patients studied were found to be obese and more than one-half (53%) were heavy smokers. These compare with figures of 24% for obesity and 25% for smoking in the general population. Conclusions:The physical health needs of people residing in rehabilitation units should be a high priority for the mental health staff and regular surveys should be considered. If we are successful at encouraging the mental health team to be involved in annual physical health screening of patients with severe mental illness in the rehabilitation unit, we might improve their physical health and reduce mortality.
Senior Shirts
Authors: Stader David L. 
Published: February 2006

The final two months of the senior year in high school are an emotionally charged time that can be a significant challenge for both students and school personnel. School personnel often struggle to balance an emerging independence with the need to maintain order. This balance is difficult and issues that on the surface seem simple or mundane have the potential to become lighting rods for controversy. This case presents such issues. In this case a senior class challenges the problem solving, legal knowledge, and political savvy of the principal. Candidates are asked to consider the case and determine a legal, practical, and politically defensible solution. Students are then asked to develop a plan to implement the decision and to communicate the decision to the various publics involved. This case can be used in a course on the principalship, school and community relations, or school law.
The Ethics of Change
Authors: Wegner Scott , Moseman Gerald , Watson Robert 
Published: February 2006

This case is designed for use in courses that explore ethics or issues related to the change process. The superintendent in this case is faced with a decision that could facilitate the adoption of much needed reform in the district. This decision would not only assure better learning and brighter futures for thousands of students but avert his own firing. At risk is the self-respect of a single person. This case can be used as a springboard to a discussion of professional ethics as well as the consequences of the change process. The case was developed for the Missouri Professors of Educational Administration through a grant from the Missouri Department of Elementary and Secondary Education, 2003.
Rawls's Practical Conception of Justice: Opinion, Tradition and Objectivity in Political Liberalism
Authors: Kaufman Alexander 
Published: February 2006

AbstractIn Political Liberalism, Rawls emphasizes the practical character and aims of his conception of justice. Justice as fairness is to provide the basis of a reasoned, informed and willing political agreement by locating grounds for consensus in the fundamental ideas and values of the political culture. Critics urge, however, that such a politically liberal conception of justice will be designed merely to ensure the stability of political institutions by appealing to the currently-held opinions of actual citizens. In order to evaluate this concern, I suggest, it is necessary to focus on the normative character of Rawls's analysis. Rawls argues that justice as fairness is the conception of justice that citizens of modern democratic cultures should choose in reflective equilibrium, after reflecting fully upon their considered judgments regarding justice. Since judgments in reflective equilibrium are grounded in considered judgment, rather than situated opinions, I argue that the criticism fails.
Standards, Advice, and Practical Reason
Authors: Andreou Chrisoula 
Published: February 2006

AbstractIs there a mode of sincere advice in which the standards of the adviser are put aside in favor of the standards of the advisee? I consider two sorts of cases that appear to be such that the adviser is evaluating things from within the advisee's system of standards even though this system conflicts with her own; and I argue that these cases are best interpreted in ways that dissolve this appearance. I then argue that the nature of sincere advice precludes an adviser's putting aside her own system of standards in favor of a competing system of standards. It follows that, contrary to what some have suggested, it cannot be that practical reason judgments– which are concerned with what an agent has reason to do or not to do and which can figure as advice–evaluate actions from within the agent's (as opposed to the judger's) system of standards.
Low-dose inhaled and nasal corticosteroid use and the risk of cataracts
Authors: Ernst P. , Baltzan M. , Deschênes J. , Suissa S. 
Published: February 2006

Orally inhaled corticosteroid use has been convincingly linked to an increase in the risk of cataracts, although the risk at lower doses in common use remains uncertain. The potential risk of cataracts with the use of nasal corticosteroids is unknown.A matched nested case–control analysis was performed in a population-based cohort of elderly people who had been dispensed medications for airway disease, as identified through a universal drug benefit plan.Inhaled corticosteroid use was associated with a dose-related increase in both the risk of all cataracts and severe cataracts requiring extraction, and the increase in risk of severe cataracts was apparent even at daily doses of ≤500 μg. An excess risk with nasal corticosteroids was not apparent for severe cataracts.It is concluded that, among the elderly, even low doses of inhaled corticosteroids are associated with a small but significant excess risk of cataracts requiring extraction. Such an excess risk was not observed with nasal corticosteroids.
Characteristics and outcome of patients with active pulmonary tuberculosis requiring intensive care
Authors: Erbes R. , Oettel K. , Raffenberg M. , Mauch H. , Schmidt-Ioanas M. , Lode H. 
Published: February 2006

Severe tuberculosis (TB) requiring intensive care unit (ICU) care is rare but commonly known to be of markedly bad prognosis. The present study aimed to describe this condition and to determine the mortality rate and risk factors associated with mortality.Patients with confirmed TB admitted to ICU between 1990 and 2001 were retrospectively identified and enrolled. Clinical, radiological and bacteriological data at admission and during hospital stay were recorded. A multivariate analysis was performed to identify the predictive factors for mortality.A total of 58 TB patients (12 females, mean age 48 yrs) admitted to ICU were included. Mean Acute Physiology and Chronic Health Evaluation (APACHE) II score at admission was 13.1±5.6 and 22 of 58 (37.9%) patients required mechanical ventilation. The in-hospital mortality was 15 of 58 (25.9%); 13 (22.4%) patients died in the ICU. The mean survival of patients who died was 53.6 days (range 1–229), with 50% of the patients dying within the first 32 days. The factors independently associated with mortality were: acute renal failure, need for mechanical ventilation, chronic pancreatitis, sepsis, acute respiratory distress syndrome, and nosocomial pneumonia.These data indicate a high mortality of patients with tuberculosis requiring intensive care unit care and identifies new independently associated risk factors.
Cost–utility analysis of chemotherapy in symptomatic advanced nonsmall cell lung cancer
Authors: Dooms C. A. , Lievens Y. N. , Vansteenkiste J. F. 
Published: February 2006

When using chemotherapy in patients with a short life expectancy, outcomes such as symptom improvement or clinical benefit receive increasing attention. Outcomes of subjective benefit to the patient can be rated as a utility in order to perform health economic analyses and comparisons with other treatment conditions. A cost–utility analysis has been performed alongside a prospective randomised clinical trial comparing single agent gemcitabine to cisplatin-based chemotherapy in symptomatic advanced nonsmall cell lung cancer patients.Global quality of life as well as resource utilisation data were collected during first-line chemotherapy for both treatment arms. Incremental costs, utilities and cost–utility ratio were calculated.Per patient, an incremental cost of \#8364;1,522 was obtained for gemcitabine compared to cisplatin–vindesine, mainly as a consequence of the direct cost of the cytotoxic drugs. When combined with utilities, this resulted in an incremental cost–utility ratio for gemcitabine of \#8364;13,836 per quality-adjusted life year gained.In conclusion, although the least expensive strategy is cisplatin–vindesine, the greater clinical benefit of gemcitabine, resulting in an acceptable incremental cost–utility ratio as compared with other healthcare interventions, balances its higher cost. The gains in subjective outcome achieved with palliative chemotherapy are critical from both a clinical and a health economic point of view.
High diagnostic accuracy of NT-proBNP for cardiac origin of pleural effusions
Authors: Kolditz M. , Halank M. , Schiemanck C. S. , Schmeisser A. , Höffken G. 
Published: February 2006

A prospective study was performed to evaluate the diagnostic accuracy of N-terminal-pro-B-type natriuretic peptide (NT-proBNP) levels, measured simultaneously in serum and pleural fluid, in identifying pleural effusions due to heart failure.Pleural fluid and serum samples from all patients presenting for thoracentesis between April 2004 and May 2005 were simultaneously collected. The discriminative properties of NT-proBNP levels in identifying pleural effusions due to heart failure were determined by receiver operating characteristic curve analysis and compared to the diagnostic value of finding a transudate by Light's criteria.Ninety-three patients were evaluated, 27% with cardiac effusion and 73% with exudative effusions of various cause. Levels of NT-proBNP in pleural fluid and serum correlated closely. Serum and pleural fluid NT-proBNP levels were significantly elevated in patients with cardiac effusion. With a cut-off value of 4,000 ng·L−1, NT-proBNP levels in pleural fluid and serum displayed comparably high diagnostic accuracies of 92 and 91%, respectively. All patients misclassified by Light's criteria were correctly identified by measuring NT-proBNP levels.N-terminal-pro-B-type natriuretic peptide levels in either pleural fluid or serum showed a high diagnostic accuracy compared to traditional criteria. Thus measuring N-terminal-pro-B-type natriuretic peptide is a valuable additional diagnostic tool for the detection or exclusion of cardiac origin of pleural effusions.
Predictors of success and failure in pulmonary rehabilitation
Authors: Garrod R. , Marshall J. , Barley E. , Jones P. W. 
Published: February 2006

The purpose of the present study was to identify prognostic features of chronic obstructive pulmonary disease (COPD) associated with success or failure in pulmonary rehabilitation. Patients were stratified according to the Medical Research Council (MRC) dyspnoea score.A total of 74 stable COPD patients (mean±sdage 68±10 yrs), 21 MRC dyspnoea score grade 1/2, 29 grade 3/4 and 24 grade 5, with a mean forced expiratory volume in one second of 1.1±0.6 L, attended for rehabilitation. Assessments consisted of the following: quadriceps torque, 6-minute walking distance (6MWD), Brief Assessment Depression Cards and St George's Respiratory Questionnaire (SGRQ). Predictors of drop-out and of response (a change in SGRQ of four points or 6MWD of 54 m) were tested using binary logistic regression.In total, 51 patients completed the study. Of these, 39 (77%) showed a clinically significant benefit in either 6MWD or SGRQ. Baseline variables were poor predictors of response in each case. Significant differences were seen between MRC dyspnoea score groups for change in 6MWD and SGRQ Score. Only grade 1/2 and 3/4 patients improved. Depression was a risk factor for subject drop-out compared with nondepressed patients.Baseline state is a poor predictor of response to rehabilitation, although Medical Research Council dyspnoea score grade 5 patients showed smaller magnitudes of improvement than patients with less severe Medical Research Council dyspnoea score grades. Risk of drop-out is significantly greater in depressed compared with nondepressed patients.
Identification in Administrative Databases of Women Dying of Breast Cancer
Authors: Gagnon Bruno , Mayo Nancy E. , Laurin Carroll , Hanley James A. , McDonald Neil 
Published: February 2006

Purpose Palliative care is an essential component of cancer care, and population-based research is needed to monitor its impact. Administrative databases are the cornerstone of health services research. Their limitation is that cause of death is not sufficient to readily classify decedents as terminally ill for the study of the health services they received at the end of life. The study purpose is to develop and test the validity of an algorithm allowing the classification of the decedents as dying of breast cancer (BC), using administrative data. Methods Validation was carried out through a chart review of 119 BC decedents extracted from hospital-based databases. This algorithm was applied to 3,384 deceased women with BC representative of the whole population. The effect of the classification by the algorithm was illustrated by the shift in the distributions of age and place of death. Results The validation showed a sensitivity of 95%, a specificity of 89%, a positive predictive value of 98%, and negative predictive value of 77% for the classification of women dying of BC. Of the 3,384 decedents, 2,293 were classified as dying of, and 1,091 as not dying of BC. Women dying of BC were younger, died less often at home (6.9% v 17.9%), and in chronic care institutions (4.1% v 14.8%), and more often in acute-care beds (69.9% v 57.1%). Conclusion This novel way to classify decedents is conceptually based and empirically validated through chart review and impact on distribution of age and place of death.
White Matter Anisotropy in Post-Treatment Childhood Cancer Survivors: Preliminary Evidence of Association With Neurocognitive Function
Authors: Khong Pek-Lan , Leung Lucullus H.T. , Fung Amy S.M. , Fong Daniel Y.T. , Qiu Deqiang , Kwong Dora L.W. , Ooi Gaik-Cheng , McAlanon Grainne , Cao Guang , Chan Godfrey C.F. 
Published: February 2006

Purpose We aim to determine if the loss of white matter fractional anisotropy (FA), measured by diffusion tensor magnetic resonance imaging (DTI), in post-treatment childhood medulloblastoma (MED) and acute lymphoblastic leukemia (ALL) survivors correlate with intelligence quotient (IQ) scores. Materials and Methods MED and ALL survivors (n = 30; 20 male, 10 female; age range, 6.0 to 22.1 years; mean, 13.1 years) were recruited for DTI and IQ tests. In this cross-sectional study, age-matched normal control (n = 55; 32 male, 23 female; age range, 6.0 to 23 years; mean, 12.1 years) DTI was obtained to compute percentage difference in white matter FA (ΔFA%) for each patient compared with the age-matched control group. Multivariate regression analysis was performed to determine the relationships between ΔFA%, age at treatment, irradiation dose, time interval from treatment, and full-scale IQ (FSIQ), verbal IQ (VIQ), and performance IQ (PIQ). Receiver operating characteristics curves were used to determine the best ΔFA% cutoffs for predicting FSIQ, VIQ, and PIQ of less than 85. Results ΔFA% had a significant effect on FSIQ (adjusted r2 = 0.439; P < .001), VIQ (adjusted r2 = 0.237; P = .028), and PIQ (adjusted r2 = 0.491; P < .001) after adjusting for the effects of age at treatment, irradiation dose, and time interval from treatment. The best ΔFA% value to predict less than 85 scores in FSIQ, VIQ, and PIQ was −3.3% with specificities of 100% and sensitivities ranging from 77.8% to 87.5%. Conclusion Our preliminary findings suggest that white matter FA may be a clinically useful biomarker for the assessment of treatment-related neurotoxicity in post-treatment childhood cancer survivors.
Stability of Parental Understanding of Random Assignment in Childhood Leukemia Trials: An Empirical Examination of Informed Consent
Authors: Greenley Rachel Neff , Drotar Dennis , Zyzanski Stephen J. , Kodish Eric 
Published: February 2006

Purpose To examine stability versus change in parental understanding of random assignment in randomized clinical trials (RCTs) for pediatric leukemia and to identify factors associated with changes in understanding. Methods Eighty-four parents of children diagnosed with acute lymphoblastic leukemia or acute myeloid leukemia who were enrolled onto a pediatric leukemia RCT at one of six US children's hospitals participated. Parents were interviewed twice, once within 48 hours after the Informed Consent Conference (ICC; time 1 [T1]) and again 6 months later (time 2 [T2]). Interviews focused on parental understanding of key components of the RCT, including random assignment. Interviews were audiotaped, transcribed, and later analyzed. Results Changes in understanding of random assignment occurred in 19% of parents, with 17% of parents deteriorating in understanding from T1 to T2. Forty-nine percent of parents failed to understand random assignment at both times. Factors associated with understanding at both times included majority ethnicity, high socioeconomic status, parental reading of consent document, and presence of a nurse during the ICC. Physician discussion of specific components of the RCT was also associated with understanding at both times. Female caregivers and parents of low socioeconomic status were overrepresented among those who showed decay in understanding from T1 to T2. Conclusion Parents showed little gain in understanding over time. Factors that predicted understanding at diagnosis as well as sustained understanding over time may be important intervention targets. Attention to both modifiable and nonmodifiable barriers is important for clinical practice.
Racial Differences in Trust and Lung Cancer Patients' Perceptions of Physician Communication
Authors: Gordon Howard S. , Street Richard L. , Sharf Barbara F. , Kelly P. Adam , Souchek Julianne 
Published: February 2006

Purpose Black patients report lower trust in physicians than white patients, but this difference is poorly studied. We examined whether racial differences in patient trust are associated with physician-patient communication about lung cancer treatment. Patients and Methods Data were obtained for 103 patients (22% black and 78% white) visiting thoracic surgery or oncology clinics in a large Southern Veterans Affairs hospital for initial treatment recommendation for suspicious pulmonary nodules or lung cancer. Questionnaires were used to determine patients' perceptions of the quality of the physicians' communication and were used to assess patients' previsit and postvisit trust in physician and trust in health care system. Patients responded on a 10-point scale. Results Previsit trust in physician was statistically similar in black and white patients (mean score, 8.2 v 8.3, respectively; P = .80), but black patients had lower postvisit trust in physician than white patients (8.0 v 9.3, respectively; P = .02). Black patients, compared with white patients, judged the physicians' communication as less informative (7.3 v 8.5, respectively; P = .03), less supportive (8.1 v 9.3, respectively; P = .03), and less partnering (6.4 v 8.2, respectively; P = .001). In mixed linear regression analysis, controlling for clustering of patients by physician, patients' perceptions of physicians' communication were statistically significant (P < .005) predictors of postvisit trust, although patient race, previsit trust, and patient and visit characteristics were not significant (P > .05) predictors. Conclusion Perceptions that physician communication was less supportive, less partnering, and less informative accounted for black patients' lower trust in physicians. Our findings raise concern that black patients may have lower trust in their physicians in part because of poorer physician-patient communication.