bluuebunny/crossref_metadata_2025_split huggingface dataset:
Making sure the residents get their tablets: medication administration in care homes for older people
Authors: Barnes Lynne , Cheek Julianne , Nation Roger L. , Gilbert Andrew , Paradiso Lisa , Ballantyne Alison 
Published: October 2006

Aim.  This paper reports an exploratory study of issues concerning the nursing practice of altering medication dose forms prior to administration of medicines to residents in homes for older people.Background.  Medication use and administration is a major issue in residential homes for older people. Research suggests that the alteration of medication dose forms in these homes is a widespread practice. Despite its prevalence, there is limited nursing or pharmaceutical literature exploring the decision‐making processes surrounding this practice, the methods by which medicines are altered, or the types of medicines which are modified.Method.  Semi‐structured interviews were carried out with 11 Registered Nurses working in a purposive sample of 10 residential homes for older people drawn from each of the six regions of South Australia. The data were collected in 2000.Findings.  Nurses felt constrained to ensure that prescribed medication was administered to residents, despite their concern that this was not without risk. Nurses were concerned that they were working in an information vacuum, due to limited information resources and informal communication with other healthcare professionals such as speech pathologists, pharmacists and general practitioners. There was also concern about the difficulty of coordinating information and policies about altering medications and of implementing appropriate procedures in individual facilities.Conclusion.  Clinical guidelines for the processes surrounding the alteration of medication dose forms and relevant pharmaceutical information are needed in all residential homes for older people. Ongoing education for nurses in this area is also required.
Cranial and peripheral neuropathy in rheumatoid arthritis with special emphasis to II, V, VII, VIII and XI cranial nerves
Authors: HAMED Sherifa A. , HAMED Eman A. , ELATTAR Amal M. , RAHMAN Mohamed S. AbdeL , AMINE Nabila F. 
Published: October 2006

AbstractBackground:  Cranial neuropathy in rheumatoid arthritis (RA) is relatively rare compared to the frequently reported peripheral neuropathy.Methods:  We investigated the occurrence of subclinical cranial and peripheral nerve involvement in 55 patients with RA.Results:  Patients had a mean age of 43.1 years and a mean duration of illness of 6.4 years. All patients presented with electrophysiological findings suggestive of peripheral neuropathy. In addition, 69.1% of them had entrapment neuropathies, in which carpal tunnel syndrome was the most common (54.6%). Sensorimotor neuropathy at sites other than usual entrapment sites was diagnosed in 70.9%, while bilateral distal sensory neuropathy in lower limbs was identified in 29.1%. Among cranial nerves examined, optic and vestibulocochlear neuropathies were common (29.1% of eyes and 40% of ears examined). Spinal accessory neuropathy was reported in 21.8% of records. Neither facial nor trigeminal nerves were affected. Electrophysiological characteristics of neuropathies were indicative of axon loss. Significant association was identified between neuropathy and patients’ ages (P < 0.01), duration of the illness (P < 0.001), presence of rheumatoid nodules (P < 0.001) and disease stages (P < 0.001).Conclusions:  Our results indicate that cranial and non‐compressive neuropathies are not uncommon in RA. This extends the pathologic disease spectrum. We do not confirm, but suggest the contribution of chronic immune‐mediated vasculitis and/or neurotoxicity in RA neuropathies. Of clinical importance, subclinical neuropathy may never progress and/or be of clinical significance, which contradicts that of comparable diseases, such as systemic lupus erythematosus. Advances in genetics implicate a complex immune genetics which controls susceptibilities and adaptive molecular mechanisms as a culprit of phenotypical heterogenicity among related diseases.
Clinical manifestations of Behcet's disease in Chinese patients
Authors: ZHANG Zhuoli , PENG Jinmin , HOU Xiaomeng , DONG Yi 
Published: October 2006

AbstractAim and method:  The data of 1996 patients from 46 medical centres were meta‐analysed for the purpose of determining the type and frequency of clinical features of Behcet's disease in Chinese patients. The age at onset was 33.8 ± 12.2 years with 1144 male and 852 female patients. The duration of follow‐up at study entry was 8.9 ± 5.2 years.Results:  The common manifestations observed throughout the disease course were oral aphthae (98.4%), genital aphthae (76.3%), various cutaneous lesions including erythema nodosum and pseudo‐folliculitis (69.0%), inflammatory ocular disease (34.8%) and arthralgia/arthritis (30.0%). Other systems, such as gastrointestines, vessels, nerves, heart, lungs, kidneys and blood, were also involved in Chinese Behcet's disease patients at the prevalence of 8.8%, 7.7%, 6.5%, 4.0%, 2.2%, 1.9% and 0.8%, respectively. Ophthalmologic presentation occurred earlier than the involvement of major vessels, gastrointestines, the nervous system and the haematological system. Vascular involvement as well as ocular, heart and nervous system involvement were more common in men than women (11.8%vs. 2.2%, P < 0.001, OR = 5.947; 39.9%vs. 27.9%, P < 0.001, OR = 1.715; 5.4%vs. 2.1%, P < 0.005, OR = 2.661; 8.0%vs. 4.5%, P < 0.05, OR = 1.845, respectively); while haematological involvement occurred more frequently in women than men (0.4%vs. 1.3%, P < 0.05, OR = 0.305) and gastrointestinal involvement was equally common in both sexes (8.3%vs. 9.4%, P > 0.05). Positive pathergy test was present in 57.9% of all patients and most of these were male (70%vs. 41.7%, P < 0.001).Conclusions:  Behcet's disease starts frequently around the beginning of the third decade and has a male predominance. The disease is usually more severe in men than women in Chinese populations.
Beyond Substituted Judgment: How Surrogates Navigate End‐of‐Life Decision‐Making
Authors: Vig Elizabeth K. , Taylor Janelle S. , Starks Helene , Hopley Elizabeth K. , Fryer‐Edwards Kelly 
Published: October 2006

OBJECTIVES: To characterize how surrogates plan to make medical decisions for others.DESIGN: Descriptive study using semistructured qualitative interviews.SETTING: Surrogates were interviewed by telephone from their homes.PARTICIPANTS: Fifty experienced surrogate decision‐makers identified to make decisions for older, chronically ill veterans.MEASUREMENTS: Surrogates were asked to describe advance care planning conversations with loved ones and how they planned to make future medical decisions. Thematic content analysis was used to identify bases for decision‐making.RESULTS: Surrogates described the motivators and the content of advance care planning conversations with loved ones. Surrogates described five bases for decision‐making: (1) conversations (making decisions based on their knowledge of their loved ones' preferences), (2) relying on documents (referring to their loved ones' advance care directives), (3) shared experience (believing an “inner sense” would guide decisions because of shared lived experience with loved ones), (4) surrogates' own values and preferences about life, and (5) surrogates' network (enlisting the help of others).CONCLUSION: Although ethicists and clinicians expect surrogates to use substituted judgment or patients' best interests when making decisions, these data indicate that many surrogates rely on other factors such as their own best interests or mutual interests of themselves and the patient or intend to base substituted judgments on documents with which they have little familiarity.
Cognitive Correlates of Financial Abilities in Mild Cognitive Impairment
Authors: Okonkwo Ozioma C. , Wadley Virginia G. , Griffith H. Randall , Ball Karlene , Marson Daniel C. 
Published: October 2006

OBJECTIVES: To investigate the cognitive correlates of financial abilities in mild cognitive impairment (MCI).DESIGN: Controlled, matched‐sample, cross‐sectional analysis regressing five cognitive composites on financial performance measures.SETTING: University medical and research centers.PARTICIPANTS: Forty‐three persons with MCI and 43 normal controls.MEASUREMENTS: The Financial Capacity Instrument (FCI) and a comprehensive neurocognitive battery.RESULTS: Patients with MCI performed significantly worse than controls on cognitive domains of executive function, memory, and language and on FCI domains of financial conceptual knowledge, bank statement management, and bill payment. Patients with MCI also needed significantly more time to complete a multistep financial task and were significantly more likely than controls to make errors on this task. Stepwise regression models revealed that, within the MCI group, attention and executive function were significant correlates of FCI performance.CONCLUSION: Although impaired memory is the cardinal deficit in MCI, the neurocognitive basis of lower functional performance in MCI appears to be emergent declines in abilities to selectively attend, self‐monitor, and temporally integrate information. Compromised performance on cognitive measures of attention and executive function may constitute clinical markers of lower financial abilities and should be evaluated for its relationship to functional ability in general. These cognitive domains may be appropriate targets of future intervention studies aimed at preservation of functional independence in people with MCI.
Hypoalbuminemia is an important risk factor of hypotension during hemodialysis
Authors: NAKAMOTO Hidetomo , HONDA Nobuko , MIMURA Taku , SUZUKI Hiromichi 
Published: October 2006

AbstractHypotension during hemodialysis (HD) is an important problem in patients on HD. To investigate the risk factors that contribute to the hypotension during HD, we compared background factors of hypotensive (HP) patients during HD. Among 58 patients undergoing HD in Tamura Memorial Hospital, 12 patients could not continue full HD because of hypotension. We compared the data of ultrafiltration volume, cardiothoracic ratio (CTR), total protein (TP), serum albumin, blood urea nitrogen (BUN), serum creatinine, total cholesterol (TC), hemoglobin (Hb), blood glucose (BS), brain natriuretic peptide (BNP), and cardiac function between HP patients (HP group; n=12) and sex‐ and age‐matched control patients (NP group; n=12). There were no significant differences of age, sex, and duration of HD between the 2 groups. Cardiothoracic ratio is bigger and BNP is higher in the HP group compared with the NP group (CTR: HP 55.8±2.9% vs. NP 47.7±1.1%, p=0.0165; BNP: HP 602±171 vs. NP 147±38, p=0.0167). Serum albumin in the HP group is significantly lower compared with the NP group (HP 3.2±0.1 g/dL vs. NP 3.5±0.1 g/dL, p=0.0130). However, there were no significant differences of ultrafiltration rate (UFR), BS, TC, Hb, and cardiac function between the 2 groups. There is a significant negative correlation between changes of systolic blood pressure (delta systolic blood pressure) and serum albumin in these patients (r=−0.598, p=0.0016). From these data, we conclude that hypoalbuminemia is a major risk factor of hypotension during HD.
Comparison of survival between short‐daily hemodialysis and conventional hemodialysis using the standardized mortality ratio
Authors: BLAGG Christopher R. , KJELLSTRAND Carl M. , TING George O. , YOUNG Bessie A. 
Published: October 2006

AbstractMore frequent hemodialysis (5 or more times weekly, both short during the day and long overnight) has been shown to improve patient well‐being, reduce symptoms during and between treatments, and have beneficial effects on clinical outcomes. Because of the relatively small patient sample sizes, there are little or no data on mortality from any single study at this time. This study compares survival in 117 U.S. patients treated by short‐daily hemodialysis in 2003 and 2004, with patients reported in the 2003 data from the United States Renal Data System (USRDS). Expected mortality was calculated from the USRDS and compared with observed actual mortality. The standardized mortality ratio (SMR) was used to adjust for differences in patient age, sex, race, and cause of renal failure. The SMR for the short‐daily hemodialysis patients was 0.39, statistically significantly better (p<0.005) than data from the overall U.S. population of hemodialysis patients and indicating that daily hemodialysis patients had a 61% better survival. Patients treated by short‐daily hemodialysis have a better survival rate than comparable populations treated by conventional hemodialysis.
Flow distribution analysis by helical scanning in polysulfone hemodialyzers: Effects of fiber structure and design on flow patterns and solute clearances
Authors: RONCO Claudio , LEVIN Nathan , BRENDOLAN Alessandra , NALESSO Federico , CRUZ Dinna , OCAMPO Catalina , KUANG Dingway , BONELLO Monica , De CAL Massimo , CORRADI Valentina , RICCI Zaccaria 
Published: October 2006

AbstractThe efficiency of a hemodialyzer is largely dependent on its ability to facilitate diffusion, as this is the main mechanism by which small solutes are removed. The diffusion process can be impaired if there is a mismatch between blood and dialysate flow distribution in the dialyzer. The objective of the paper was to study the impact of different fiber bundle configurations on blood and dialysate flow distribution and urea clearances. The Optiflux 200 NR hemodialyzer was studied and the standard F 80 A hemodialyzer was used as a control for the study. Six dialyzers of each type were studied in vitro in the radiology department utilizing a new generation of helical computed tomography (CT) scan following contrast medium injection into the blood and dialysate compartment. Dynamic sequential imaging of longitudinal sections of the dialyzer was undertaken to detect flow distribution, average and peak velocities, and calculate wall shear rates. Six patients were dialyzed with 2 different dialyzers in random consecutive sequence. In these patients, 2 consecutive dialyses were carried out with identical operational parameters (Qb=300 mL/min, Qd=500 mL/min). In each session, blood and dialysate side urea clearances were measured at 30 and 150 min of treatment. Macroscopic and densitometrical analysis revealed that flow distribution was most homogeneous in the dialyzer with a new bundle configuration. Significantly increased urea clearances (p<0.001) were seen with the Optiflux dialyzer compared with the standard dialyzer. In conclusion, more homogeneous dialysate blood and dialysate flow distribution and improved small solute clearances can be achieved by modifying the configuration of the filter bundle. These effects are achieved probably as a result of reduced blood to dialysate mismatch with reduction of flow channeling. The used radiological technique allows detailed flow distribution analysis and has the potential for testing future modifications to dialyzer design.
Daily dialyses decrease plasma levels of brain natriuretic peptide (BNP), a biomarker of left ventricular dysfunction
Authors: ODAR‐CEDERLÖF Ingegerd , BJELLERUP Per , WILLIAMS Amy , BLAGG Christopher R. , TWARDOWSKI Zbylut , TING George , KJELLSTRAND Carl M. 
Published: October 2006

AbstractBrain natriuretic peptide or B‐type natriuretic peptide (BNP) is a sensitive marker of heart disease. Plasma levels of BNP increase in left ventricular failure and determination of plasma BNP has become a useful tool in the diagnosis of heart failure. Hemodialysis (HD) patients may have elevated plasma levels of BNP, particularly predialysis, that correlate with echocardiographic signs of left ventricular dysfunction. High BNP levels are also a strong predictor of mortality in both nonrenal and HD patients. We studied plasma BNP levels in patients who changed from conventional thrice‐weekly dialysis to daily dialysis 6 times a week while maintaining a total weekly time on dialysis of 12 hr. Twelve HD patients, mean age 55 years, had 4 hr of conventional thrice‐weekly treatment for 4 weeks. Predialysis and postdialysis blood samples were obtained at the last dialysis. Patients were then dialyzed for 2 hr, 6 times weekly, for 4 weeks (daily dialysis). Again, predialysis and postdialysis blood samples were collected at the last HD. Brain natriuretic peptide plasma concentrations were determined by immunoradiometric assay. Predialysis BNP levels decreased from 194±51 ng/L (68±19 pmol/L; mean+SE) during thrice‐weekly HD to 113±45 ng/L (41±18 pmol/L; p=0.001) after 4 weeks on daily dialysis. With thrice‐weekly HD, predialysis BNP levels were higher than postdialysis levels: 120±26 ng/L (39±8 pmol/L; p=0.059). With daily dialysis, predialysis BNP levels did not differ significantly from postdialysis levels. Elevated predialysis plasma levels of BNP, considered sensitive and early markers of left ventricular dysfunction, decreased when patients were changed from conventional thrice‐weekly HD to daily dialysis maintaining total hours of dialysis per week constant. Given the accumulated evidence that BNP is a biomarker of left ventricular dysfunction and can be used for risk stratification and guidance in pharmacotherapy of heart failure, daily dialysis appears to lead to less cardiac distress.
Social and Emotional Impacts of Farmwork Injuries: An Exploratory Study
Authors: Robertson S. M. , Murphy Dennis J. , Davis Lisa A. 
Published: October 2006

ABSTRACT:
Context: The physical hazards of farming have been extensively studied and reported upon. Far less studied are the social and emotional impacts of farmwork injuries and deaths. Purpose: To investigate and document broad but targeted issues regarding the impact on individuals, families, and communities of farmwork injuries and fatalities of farmer leaders. Methods: Ten incidents of farmwork injuries with disabilities or fatalities in Pennsylvania were used for a collective case study. Data were collected through a total of 47 interview sessions with 66 individuals including next of kin, other family members, injured persons, and community members. Thematic analysis was used to identify themes and issues in this descriptive study. Findings: Community members missed the rich, broad, and comprehensive skills, abilities, and perspectives that farmers brought to community service. Participants expressed that the community assistance and support provided to injured persons and families benefited not only the injured persons and their families and farms but also the community members. Participants reported emotional anguish and loss as well as positive transformations and consequences. As expressed by participants, God and religion play an important role in their beliefs regarding the occurrence and outcome of farmwork injury incidents. Conclusions: Social and emotional impacts on individuals, families, and communities are varied and multileveled. The role that religion and storytelling play in the process of dealing with serious injury incidents raises questions regarding agricultural injury prevention.
Classifying undetermined poisoning deaths
Authors: Donaldson A E , Larsen G Y , Fullerton-Gleason L , Olson L M 
Published: October 2006

Objective:To classify poisoning deaths of undetermined intent as either suicide or unintentional and to estimate the extent of underreported poisoning suicides.Methods:Based on 2002 statewide death certificate and medical examiner data in Utah, the authors randomly selected one half of undetermined and unintentional poisoning deaths for data abstraction and included all suicides. Bivariate analyses assessed differences in demographics, death characteristics, forensic toxicology results, mental health history, and other potentially contributing factors. Classification and regression tree (CART) analysis used information from unintentional and suicide poisoning deaths to create a classification tree that was applied to undetermined poisoning deaths.Results:The authors analyzed 41 unintentional, 87 suicide, and 84 undetermined poisonings. Undetermined and unintentional decedents were similar in the presence of opiates, physical health problems, and drug abuse. Although none of the undetermined decedents left a suicide note, previous attempt or intent to commit suicide was reported for 11 (13%) of these cases. CART analysis identified suicidal behavior, drug abuse, physical health problems, depressed mood, and age as discriminating between suicide and unintentional poisoning. It is estimated that suicide rates related to poisoning are underreported by approximately 30% and overall suicide rates by 10%. Unintentional poisoning death rates were underreported by 61%.Conclusions:This study suggests that manner of death determination relies on circumstance dependent variables that may not be consistently captured by medical examiners. Underreporting of suicide rates has important implications in policy development, research funding, and evaluation of prevention programs.
The influence of local politicians on pedestrian safety
Authors: Lyons R A , Jones S J , Newcombe R G , Palmer S R 
Published: October 2006

Aim:To determine whether local politicians influence the distribution of traffic calming measures.Methods:Longitudinal ecological study in two UK cities. Local political constituencies were categorized by representation by members of the cabinet structure as a marker of influence. The density of traffic calming features per political area, adjusted for the historical pattern of road injuries, was compared between cabinet represented and non-represented areas.Results:Traffic calming density was significantly associated with cabinet representation status, adjusted for historical collision risk (risk ratio 2.77, 95% confidence interval 1.37 to 5.61).Conclusion:These results support the hypothesis that senior local politicians are effective advocates for enhancing safety in their areas.
Critical Roles for Non-pRb Targets of Human Papillomavirus Type 16 E7 in Cervical Carcinogenesis
Authors: Balsitis Scott , Dick Fred , Dyson Nicholas , Lambert Paul F. 
Published: October 2006

Abstract
High-risk human papillomaviruses (HPV) encode two oncogenes, E6 and E7, expressed in nearly all cervical cancers. In vivo, HPV-16 E7 has been shown to induce multiple phenotypes in the context of transgenic mice, including cervical cancer. E7 is a multifunctional protein known best for its ability to inactivate the tumor suppressor pRb. To determine the importance of pRb inactivation by E7 in cervical cancer, we pursued studies with genetically engineered mice. E7 expression in estrogen-treated murine cervix induced dysplasia and invasive cancers as reported previously, but targeted Rb inactivation in cervical epithelium was not sufficient to induce any cervical dysplasia or neoplasia. Furthermore, E7 induced cervical cancer formation even when the E7-pRb interaction was disrupted by the use of a knock-in mouse carrying an E7-resistant mutant Rb allele. pRb inactivation was necessary but not sufficient for E7 to overcome differentiation-induced or DNA damage–induced cell cycle arrest, and expression patterns of the E2F-responsive genes Mcm7 and cyclin E indicate that other E2F regulators besides pRb are important targets of E7. Together, these data indicate that non-pRb targets of E7 play critical roles in cervical carcinogenesis. (Cancer Res 2006; 12(18): 9393-400)