bluuebunny/crossref_metadata_2025_split huggingface dataset:
Infections associated with ventricular assist devices: epidemiology and effect on prognosis after transplantation
Authors: Monkowski D.H. , Axelrod P. , Fekete T. , Hollander T. , Furukawa S. , Samuel R. 
Published: February 2007

Abstract: Background. Ventricular assist devices (VADs) can be used as a bridge to orthotopic heart transplantation (OHT) in people with severe congestive heart failure. Although they can be inserted for an indefinite time period (unlike balloon pumps), they do carry a substantial risk of infection. We studied the epidemiology, microbiology, and consequences of infection in patients with VADs who ultimately had cardiac transplantation.Methods. Records of VAD‐supported patients at our institution between January 1995 and January 2005 were identified by ICD‐9 code. Infection was classified as driveline infection, pocket infection, mediastinitis, or VAD endocarditis in increasing severity of illness.Results. Of 73 patients identified by ICD‐9 code, 60 had charts available for review. Of these 60, 72% had a VAD infection: 13 had VAD endocarditis; 3, mediastinitis; 25, pocket infection; and 29, driveline infection. The only association of infection (43 patients, 72%) and demography or underlying disease was that of endocarditis with older age (median age 59 vs. 53 years; P=0.02) and diabetes mellitus (13 patients, 30%; risk ratio 3.4; P=0.01). The duration of VAD support was longer in infected patients (median 125 days) vs. uninfected ones (25 days). Median survival measured from the time of VAD placement (although also true from the time of transplantation) was shorter in patients with VAD endocarditis (120 days) and pocket infection (350 days) vs. no infection (>2400 days) with a significant P=0.017 for endocarditis. Four patients had infections after transplantation that were caused by the same organism as their VAD infection. The predominant pathogens in VAD infection were Staphylococcus and Enterococcus spp.Conclusion. VAD use as a bridge to cardiac transplantation is associated with a large number of device‐related infections. Patients with infected VADs, on average, wait longer for transplantation than patients with uninfected VADs, and patients with VAD endocarditis have a shorter survival than patients with no VAD infection or simple driveline infection.
Knowing the patient and the impact on patient participation: A grounded theory study
Authors: Henderson Saras 
Published: February 2007

Henderson S. International Journal of Nursing Practice 1997; 3: 111–118 Knowing the patient and the impact on patient participation: A grounded theory study Currently, there is an emphasis on patient participation. Studies have demonstrated that when patients participate in their care, they experience positive outcomes such as greater satisfaction with care and decreased vulnerability. Nurses are of the opinion that patients should participate in their care. Literature and research indicate, however, that there is an incongruence between nurses’ pro‐participatory attitudes and actual practice. Grounded theory was used to identify factors relevant to patient participation from the nurses’ and patients’ perspectives. Using purposive sampling from four hospitals in Western Australia, in‐depth interviews and participant observation were conducted. The constant comparative method of analysis was used. As this study is in progress, the core category and sub‐categories are still being refined. One category that has emerged strongly is ‘knowing the patient’ and the outcome on patient participation. This paper will discuss this category from the nurses and patients perspective including recommendations.
An exploration of the way in which the concept of patient advocacy is perceived by registered nurses working in an acute care hospital
Authors: Watt Elizabeth 
Published: February 2007

Watt E. International Journal of Nursing Practice 1997; 3: 119–127 An exploration of the way in which the concept of patient advocacy is perceived by registered nurses working in an acute care hospital The purpose of this study was to provide a beginning exploration of the way in which registered general nurses perceived the concept of patient advocacy. A qualitative approach was taken using the techniques of the grounded theory method. A volunteer sample of eight registered nurses working in an adult acute care ward of a major metropolitan hospital were interviewed using an semi‐structured format. Areas explored during the interviews included personal definitions of patient advocacy, elements of the advocate role, and the rationale for the nurse acting as patient advocate. Data analysis commenced during the data collection phase, where initial interviews were transcribed, coded and beginning categories were identified. The findings indicate that for the participants, advocacy is based on respect for the person, and acknowledgement of human rights. The quality of the relationship between the nurse and the patient appears to be the basis for the advocate role. Three initial categories emerged that describe the major elements of the participant’s conceptualization of patient advocacy. These are, informing, supporting and representing.
Role identity and job satisfaction of community health nurses
Authors: Cloutier Shirley , Dickenson Dena , Diem Elizabeth 
Published: February 2007

Cloutier Laffrey S, Dickenson D, Diem E. International Journal of Nursing Practice 1997; 3: 178–187 Role identity and job satisfaction of community health nurses Although many efforts have been made to articulate the nature of community health nursing practice, there continues to be a great deal of confusion about the roles and functions of community health nurses. This article reports a descriptive research study of the role identity and job satisfaction of 43 staff community health nurses practicing in home health care, generalized public health nursing, combined public health/home health care (PH/HHC), and specialized programmes. Although differences were found, the home health, generalized public health, and PH/HHC nurses shared a similar core identity. The major differences were seen for the nurses working in specialized programmes. No significant differences were found in job satisfaction among the four groups.
Ethical dilemmas concerning sexuality of elderly patients suffering from dementia
Authors: Ehrenfeld Mally , Tabak Nili , Bronner Gila , Bergman Rebecca 
Published: February 2007

Ehrenfeld M, Tabak N, Bronner G, Bergman R. International Journal of Nursing Practice 1997; 3: 255–259 Ethical dilemmas concerning sexuality of elderly patients suffering from dementia This study endeavoured to clarify the ethical dilemmas concerning sexuality encountered by nurses caring for elderly patients suffering from dementia, and to assist the decision‐making process of the nurses and staff who handle dilemmas of this nature. Many of the staff in geriatric institutions report difficulties, confusion, embarrassment and helplessness as well as negative responses and rejection when encountering sexual situations between patients of the same or different sex, patients and staff members or between patients and visitors. Embarrassment over sexuality is felt by staff members, visitors and family. This embarrassment may result in elderly patients being treated like children, and being separated from their partners. A response of this nature can provoke anger in the patients, sometimes leading to violence. The central dilemma on the subject of sexuality in a geriatric institution is the fact that staff are in conflict between the desire to protect the elderly patients and maintain their dignity and the patients’ desire to fulfil their sexual needs. Since no single, definitive prescription can be provided for conduct acceptable to the staff, the patients and their families, it was decided to work with the staff on the basis of case studies to help them in selecting ways of coping.
Fungal keratitis in Melbourne
Authors: Bhartiya Prashant , Daniell Mark , Constantinou Marios , Islam FM Amirul , Taylor Hugh R 
Published: February 2007

AbstractBackground:  Description of the clinical and microbiological spectrum of fungal keratitis at a tertiary eye care hospital in Melbourne, Australia.Methods:  Retrospective review of all patients with keratitis with positive fungal cultures from corneal or associated samples presenting to the Royal Victorian Eye and Ear Hospital, Melbourne, Australia from July 1996 to May 2004. Demographic data, predisposing factors, features on presentation, management, outcomes and microbiological data were collected and analysed.Results:  The study included 56 eyes of 56 patients. Thirty‐five patients were treated as ‘typical’ fungal keratitis and used for description and analysis, with a mean follow up of 18 months. Ocular trauma (37.1%), chronic steroid use (31.4%) and poor ocular surface (25.7%) were the major predisposing factors. Perforation was seen in 25.7% of patients, penetrating keratoplasty was required in 9 (25.7%) patients and evisceration was performed in 2 (5.7%) patients. Candida albicans (13 patients, 37.2%) was the most common fungal isolate accounting for more than one‐third of all organisms followed by Aspergillus fumigatus (six patients, 17.1%) and Fusarium sp. (five patients, 14.3%).Conclusions:  The present study describes the clinical patterns of fungal keratitis in Melbourne, Australia and contrasts them with reports from other areas of the world. A high incidence of C. albicans infection and the prior use of steroids in high proportion of the patients are highlighted in this study.
Seropositivity rates for Bartonella henselae, Toxocara canis and Toxoplasma gondii in New Zealand blood donors
Authors: Zarkovic Andrea , MacMurray Catherine , Deva Narme , Ghosh Susanta , Whitley David , Guest Stephen 
Published: February 2007

AbstractBackground:  Bartonella henselae, Toxocara canis and Toxoplasma gondii organisms can all cause vision‐threatening posterior segment disease. Diagnosis relies heavily on clinical findings, but detection of antibodies in the patient’s serum may be helpful in some cases. The significance of a positive serology result depends on the seroprevalence in the general population. Seroprevalence rates for these organisms vary widely around the world and this study aimed to determine the rates for a New Zealand population.Methods:  One hundred and forty healthy blood donors from the Waikato region in the North Island of New Zealand had their serum tested using an indirect latex agglutination test for detection of T. gondii antibodies, an indirect immunofluorescent assay for B. henselae antibodies and an enzyme‐linked immunosorbent assay test for T. canis antibodies.Results:  Seropositivity rates for T. canis, T. gondii and B. henselae in this New Zealand population were 0.7 ± 1.65%, 42.9 ± 8.12% and 5 ± 3.61%, respectively.Conclusion:  Seropositivity rates for T. gondii and B. henselae in New Zealand are similar to rates reported in some other countries; however, T. canis seroprevalence may be lower than reported elsewhere in the world.
Anaesthesia for children with osteogenesis imperfecta – a review covering 30 years and 266 anaesthetics
Authors: HALL R.M.O. , HENNING R.D. , BROWN T.C.K. , COLE W.G. 
Published: February 2007

SummaryOsteogenesis imperfecta is an uncommon condition which presents in a variety of forms which are reviewed. Many of the problems, particularly in the more severe cases, are related to fractures and deformities which require anaesthesia for correction. This paper reviews 266 anaesthetics for 63 patients. The concept that malignant hyperpyrexia is an associated condition is refuted although these patients may have an increased metabolic rate and a tendency to pyrexia. The care of these patients during anaesthesia is discussed particularly in relation to transfer, positioning, temperature and airway problems.
Propofol infusions for radiotherapy
Authors: ALDRIDGE L.M. , GORDON N.H. 
Published: February 2007

SummaryThe use of an intravenous propofol infusion as the sole anaesthetic agent for radiotherapy or isotope bone scan in young children is described. Six children received a total of 127 anaesthetics. In one case both ketamine and propofol were used and the recovery patterns compared. The advantages of smooth induction, good airway maintenance in both the supine or prone position, and rapid recovery following procedures of varying duration are discussed.
Pancuronium dose‐response revisited
Authors: BLINN A. , WOELFEL S.K. , COOK D.R. , BRANDOM B.W. , COHEN I.T. 
Published: February 2007

SummaryWe were interested in determining the cumulative dose‐response relationship of pancuronium in infants and children during nitrous oxide–halothane anaesthesia. Neuromuscular blockade was monitored by recording the electromyographic activity of the adductor pollicis muscle from supramaximal stimulation of the ulnar nerve at 2 Hz for 2 s at 10 s intervals. Forty patients were divided into four equal groups according to age: 3–6 months, 7–12 months, 13–47 months and 48–83 months. The effective dose, ED50 (mean ± SEM), of pancuronium in these age groups was 24 ± 2, 30 ± 2, 34 ± 3, 29 ± 2 μgμkg‐1, respectively; the ED95 (mean ± SEM) was 45 ± 2, 52 ± 3, 62 ± 6, 62 ± 4 μgμkg‐1, respectively. The ED95 of pancuronium was significantly less (P < 0.05) for infants from 3 to 6 months of age than for children from 13 to 83 months of age. Infants thus appear to be more sensitive than children to the neuromuscular blocking effects of pancuronium during halothane anaesthesia.
Legal and ethical considerations of organ donation in children: implications for anaesthetists
Authors: PACE N.A. 
Published: February 2007

SummaryIt is essential, when transplantation is considered, firstly to distinguish between regenerative and non‐regenerative tissue or organs, and secondly to assess the amount of risk created. A framework of ethical guidelines could then be set up. There are still many unanswered questions regarding the legality of organ transplantation in minors and legal guidelines are urgently required in many parts of the world.
Modern paediatric day case anaesthesia: a review
Authors: N.S. MORTON MB, ChB, FFARCS  
Published: February 2007

SummaryThe economic and psychological benefits of reducing the in‐patient hospital stay are obvious advantages of day case surgery for children. Careful selection, pre‐operative assessment and preparation of children and their parents for day case surgery are vitally important for success. Staffing levels, equipment and facilities must be clearly defined and costed. The implications for waiting lists and the alternative use of in‐patient beds must be taken into account. New anaesthetic, analgesic and monitoring techniques have made intraoperative care for a wide range of paediatric surgical procedures safe and straightforward. Recovery is rapid, uncomplicated and comfortable for the majority of children. Post‐operative care is simple, allowing early mobilization, oral intake and return home. Follow‐up care at home is important and assists audit of the day surgery service. In certain cases, in‐patient admission may be required and facilities for this should be immediately available.
Bone marrow harvesting from a 13‐week‐old baby
Authors: CAMPKIN N.T.A. , BLAKENEY C. 
Published: February 2007

SummaryA 13‐week‐old baby weighing 5.7 kg donated bone marrow for transplantation to his 4‐year‐old brother with metachromatic leucodystrophy. This required aspiration of 260 ml of marrow, 60% of estimated blood volume. The procedure was successfully managed with non‐invasive blood pressure monitoring and continuous replacement of blood against measured losses, combined with temperature and arterial blood gas measurement per‐operatively. No complications occurred with the donor and the recipient was successfully engrafted.
Repeated rectal methohexitone as the sole anaesthetic agent for radiotherapy
Authors: FOESEL T.E.H. , SCHIRMER U. , WICK C. 
Published: February 2007

SummaryA 2‐year‐old boy underwent 22 consecutive anaesthetics with rectal methohexitone for radiation of a recurrent craniopharyngioma. In 21 instances rectal methohexitone, as the sole agent provided adequate anaesthesia, while on one occasion, due to early defaecation of methohexitone, anaesthesia had to be supplemented with ketamine intravenously. Onset time of rectal methohexitone was between 3 and 9 min, duration varied between 30 and 180 min. No complications were observed.
Christmas disease and pyloromyotomy
Authors: GALLAGHER T.M. , DARLING R. , POTTS S.R. , DEMPSEY S. , CREAN P.M. 
Published: February 2007

SummaryA 4‐week‐old infant developed a life‐threatening haemorrhage following pyloromyotomy. Subsequent investigations revealed unsuspected Christmas disease (Haemophilia B). This case emphasises the importance of considering a diagnosis of haemophilia in a child with unexplained bleeding, even in the absence of a positive family history.
Post‐operative apnoea in the former preterm infant: a review
Authors: WELBORN L. G. 
Published: February 2007

SummaryFormer preterm infants are known to be at increased risk for apnoea, periodic breathing, and bradycardia. When surgery cannot be postponed until respiratory function is more mature, speical peri‐operative considerations and measures are essential. In this article, the literature concerning this subject is reviewed, summarizing prospective and retrospective studies of risks associated with surgery in former preterm infants during the first year of life. This work is placed within the context of our ongoing studies of peri‐operative risk in former preterm infants undergoing surgery at the Children's National Medical Center (CNMC), which have focused on three particular areas: (1) the effects of spinal versus general anaesthesia on the incidence of post‐operative apnoea and bradycardia; (2) the possible contribution of anaemia of prematurity to surgical risk; and (3) the effect of peri‐operative caffeine in preventing post‐operative apnoea. Recommendations are made concerning surgical and anaesthetic management of infants who undergo surgery at < 44 weeks' post‐conceptual age.
Type IV laryngotracheoesophageal cleft in a neonate
Authors: LOW J. , ROBINSON S. J. , BROWN T. C. K. 
Published: February 2007

SummaryThe peri‐operative management of a neonate with type IV laryngotracheoesophageal cleft, microgastria and pulmonary hypoplasia is described. Bronchoscopy was necessary to delineate the extent of the defect and was useful for performing selective endobronchial intubation. Chronic aspiration and atelectasis complicated the post‐operative management. Endobronchial intubation is compared with the use of a double lumen tube and tracheostomy for intra‐operative ventilation.
Assessment of an angulated laryngoscope for difficult paediatric intubation
Authors: COOPER M.G. , DONNELLY J. , OVERTON J.H. 
Published: February 2007

SummaryAngulated laryngoscopes with mirrors and prisms have been previously described for difficult tracheal intubation in adults, but not in children. We assessed the use of a recently described adult angulated laryngoscope (BelscopeTM) with or without prism, for difficult tracheal intubation in children. We use this laryngoscope as part of our difficult tracheal intubation regime before proceeding to other methods such as fibreoptic tracheal intubation. Children included were anticipated to be a difficult tracheal intubation from physical examination or previously had been difficult to intubate. Laryngoscopy was initially performed with a straight (Miller) or curved (Macintosh) laryngoscope. This was then repeated using the angulated laryngoscope, with prism if necessary. Degree of visualization of the larynx was scored with both methods. There was improvement in visualization in children with micrognathia, prominent maxillae or with an apparent ‘anterior larynx'. In children where there was no improvement, this laryngoscope did not actually cause a deterioration in grade of laryngoscopy.
A prospective survey of axillary artery cannulation in paediatric intensive care
Authors: MOYLAN S.L. , MURDOCH L.J. 
Published: February 2007

SummaryA prospective survey of 65 axillary artery cannulations in paediatric intensive care admissions at The Hospital for Sick Children, Great Ormond Street, London, was carried out over a period of six months, to assess the incidence of serious vascular or other complications. These arterial lines were used for direct blood pressure measurement and blood gas sampling on intensive care and in the operating theatre. Records were kept of the ease of arterial cannulation and all previous attempts in that arm, axillary or distally, all vaso‐active drugs administered and the general condition of the child. The number of days the cannula remained in situ and the reason for its removal were also recorded. In this study we had no significant vascular or neurological complications and there were no pneumothoraces. In only two cases was the line removed due to local tissue infection. We conclude that the axillary artery provides a valuable alternative site for cannulation in sick and small babies and in long standing intensive care admissions with multiple previous arterial cannulations.
Neuroleptic malignant syndrome in a child
Authors: LEVINE M.F. , LERMAN J. 
Published: February 2007

SummaryNeuroleptic malignant syndrome (NMS) is an uncommon condition, characterized by the insidious onset of fever, muscle rigidity, elevated creatine kinase, tachycardia, haemodynamic instability, altered level of consciousness, tachypnoea, diaphoresis and leucocytosis over a period of days to weeks. This condition occurs almost exclusively in patients receiving antipsychotic medications. We present a case of an eight‐year‐old boy who developed a condition that was suggestive of neuroleptic malignant syndrome after receiving oral haloperidol for control of athetoid movements. NMS is of particular importance to the anaesthetist since its clinical presentation may be confused with malignant hyperthermia (MH). Patients who had been treated for NMS have been reported as having a muscle biopsy positive for MH.
Paediatric microvascular surgery: anaesthetic experience of 27 toe to hand transfers
Authors: WILSON R.C. , YATES A.P.B. 
Published: February 2007

SummaryFree vascularized compound toe transfer to the hand offers the best possibility of restoring maximal function in the treatment of children afflicted by congenital or traumatic deformities of the hand. The surgery often involves multistaged operations and protracted periods of hospitalization in otherwise healthy children. We describe our experience in the first 20 children who underwent 27 free toe to hand transfers for a variety of conditions with a 100% successful transfer survival. The perioperative technique was directed towards controlling fear, pain, temperature and circulating volume in the child, as these were thought clinically to be the most important vasospastic stimuli. Continuous brachial plexus anaesthesia was used in all cases. The use of preoperative psychological counselling and of a dedicated high dependency unit for continuing postoperative care is emphasized. Complications resulting from prolonged tourniquet times are also discussed.