bluuebunny/crossref_metadata_2025_split huggingface dataset:
Comparison between direct humidification and nebulization of the respiratory tract at mechanical ventilation: distribution of saline solution studied by gamma camera
Authors: Klockare Maria , Dufva Ann , Danielsson Anne‐Marie , Hatherly Robert , Larsson Stig , Jacobsson Hans , Mure Margareta 
Published: February 2006

Aim.  To study the effectiveness of this procedure, an intra‐individual pilot study comparing the distribution of an instilled radiolabelled saline solution and an inhaled nebulized radiolabelled saline solution was performed using a scintigraphic technique.Background.  In patients treated with mechanical ventilation, we have routinely used instillation of saline solution in the endotracheal tube before suctioning with the aim of softening mucus and facilitating removal of secretions. In our experience, the effectiveness of this procedure is doubtful. It may also have adverse effects.Methods.  Nine patients on mechanical ventilation were examined with Single Photon Emission Computed Tomography on the same occasion using both humidification methods. The entire examination was carried out with the patient kept in a constant position in relation to the gamma camera, thereby allowing subtraction of the first registration from the second registration and subsequent evaluation and digital comparison of the two humidification methods.Results.  Most of the instilled fluid goes to the posterior portion of the right lower pulmonary lobe. Compared with direct instillation, nebulized solution is more uniformly distributed between and within the lungs. With nebulization, distribution is less influenced by gravitation than with instillation. The aerosol reaches the periphery of the lung to a larger extent.Conclusions.  Through the use of an aerosol with specific size characteristics, it may be possible to optimize the distribution of a fluid in the respiratory tract and achieve a more homogenous humidification. It is recommended to replicate the study using 25 subjects.Relevance to clinical practice.  Direct instillation of saline should not be used with mechanical ventilation.
Psychological approaches to chronic pain management: part 1
Authors: Adams Nicola , Poole Helen , Richardson Clifford 
Published: February 2006

Aims and objectives.  The aim of this paper is to provide an overview of the theoretical basis and application of psychological interventions used in the management of chronic pain. In doing this, psychological factors mediating pain and disability will also be reviewed.Background.  A biopsychosocial model of chronic pain is widely purported and pain management is often based upon cognitive–behavioural principles as psychological factors meditating pain and disability have been found to include emotional, cognitive and behavioural components.Conclusions.  This paper provides support for a biopsychosocial model of and for the effectiveness and efficacy of psychological interventions for the management of chronic pain conditions.Relevance to clinical practice.  The application of psychological approaches to chronic pain management is reviewed and discussed. The way in which psychological approaches may be integrated specifically into nursing management of chronic pain is discussed in a later paper.
The Acute Care Nurse Practitioner: challenging existing boundaries of emergency nurses in the United Kingdom
Authors: Norris Tracey , Melby Vidar 
Published: February 2006

Aim.  This study explored the opinions of nurses and doctors working in emergency departments towards the development of the Acute Care Nurse Practitioner service in the United Kingdom.Background.  Studies carried out in the United States and Canada suggest that the Acute Care Nurse Practitioner can have a positive impact on the critically ill or injured patients’ experiences in the emergency department. This role is well developed in the United States and Canada, but is still in its infancy in the United Kingdom.Design and methods.  A descriptive, exploratory design incorporating questionnaires (n = 98) and semi‐structured interviews (n = 6) was employed. The sample included nurses and doctors from seven emergency departments and minor injury units.Results.  Respondents felt it was important for the Acute Care Nurse Practitioner to have obtained a specialist nurse practitioner qualification and that the Acute Care Nurse Practitioner should retain a clinical remit. While participants seemed comfortable with nurses undertaking traditional advanced skills such as suturing, reluctance was displayed with other advanced skills such as needle thoracocentesis. Three main themes were identified from the interviews: inter‐professional conflict, autonomy and the need for the Acute Care Nurse Practitioner.Discussions.  Doctors were reluctant to allow nurses to practise certain additional advanced skills and difficulties appear to be centred on the autonomy and other associated inter‐professional conflicts with the role of the Acute Care Nurse Practitioner.Conclusion.  Nurses and doctors identified a need for the Acute Care Nurse Practitioner, but the blurring of boundaries between doctors and nurses can result in inter‐professional conflict unless this is addressed prior to the introduction of such advanced practitioners.Relevance to clinical practice.  As the role of the emergency nurse diversifies and expands, this study re‐affirms the importance of inter‐professional collaboration when seeking approval for role expansions in nursing.
Teamwork in the operating theatre: cohesion or confusion?
Authors: Undre Shabnam , Sevdalis Nick , Healey Andrew N. , Darzi Sir Ara , Vincent Charles A. 
Published: February 2006

AbstractRationale  The aim of the research that we report here was to empirically assess the cohesiveness of the multidisciplinary operating theatre (OT) team.Method  We used concepts from the team performance and team mental models literature to assess OT professionals’ perceptions of their teamwork, the structure of their teams and their respective roles within them and their teams’ performance.Results  Team structure: OT professionals would welcome a change from the current structure of the team, although there was no agreement on what that structure is. Nurses perceived the team as unitary, surgeons and anaesthetists perceived it as comprising multiple subteams. Team roles: OT professionals tended to overrate their own understanding of their colleagues’ role in the OT relative to the role understanding that the colleagues attributed to them. This tendency was especially marked for the surgeons. Team communication and team performance: OT professionals agreed on the relative importance of the various communicating pairs in the OT. Moreover, they were satisfied with the quality of communication among them, except for the communication between the surgeon and the anaesthetist, which received lower ratings. Finally, the quality of the teamwork in the OT was deemed acceptable, although there is room for improvement.Conclusions  The OT environment need not be as cohesive as previously assumed – a finding that carries implications for the effectiveness of team training interventions. Further research is needed in order to fully comprehend the dynamics of the OT as a working environment and, most importantly, their relation to patient safety.
Evaluating disease management programme effectiveness: an introduction to instrumental variables
Authors: Linden Ariel , Adams John L. 
Published: February 2006

AbstractThis paper introduces the concept of instrumental variables (IVs) as a means of providing an unbiased estimate of treatment effects in evaluating disease management (DM) programme effectiveness. Model development is described using zip codes as the IV. Three diabetes DM outcomes were evaluated: annual diabetes costs, emergency department (ED) visits and hospital days. Both ordinary least squares (OLS) and IV estimates showed a significant treatment effect for diabetes costs (P = 0.011) but neither model produced a significant treatment effect for ED visits. However, the IV estimate showed a significant treatment effect for hospital days (P = 0.006) whereas the OLS model did not. These results illustrate the utility of IV estimation when the OLS model is sensitive to the confounding effect of hidden bias.
The impact of implantable cardiac defibrillators for primary prophylaxis in the community: baseline risk and clinically meaningful benefits
Authors: Jolly S. , Dorian P. , Alter D. A. 
Published: February 2006

AbstractObjective  To estimate the baseline risk of arrhythmic death required for prophylactic implantable cardiac defibrillators (ICDs) to result in clinically meaningful survival benefits in the population.Background  While proven efficacious, the absolute survival impact of ICDs for the primary prevention of sudden cardiac death among patients with left ventricular (LV) dysfunction is highly dependent upon patient's baseline risk of arrhythmic death.Methods  Using echocardiographic data from a random sample of patients identified from community echocardiographic laboratories, patients with moderate or severe LV dysfunction (ejection fraction < 35%) were linked to administrative databases to characterize baseline mortality risk (median follow‐up duration of 4.85 years). Relative efficacy was ascertained from meta‐analysis and clinical trial data. The baseline annual risk of arrhythmic death required for prophylactic ICDs to result in clinically meaningful survival benefits in the population was estimated at different ranges of relative efficacy and numbers needed to treat (NNTs) thresholds.Results  LV dysfunction was a significant independent predictor of adverse outcomes. In total, 35.4% of the patients with moderate to severe LV dysfunction died during the follow‐up period. Assuming a base‐case relative efficacy of 66%, we estimated that the baseline risk for arrhythmic death required to exert a clinically meaningful NNT threshold of 50 in order to prevent one death (from any cause) was 3% per year or higher.Conclusions  The survival impact and cost‐effectiveness of prophylactic ICDs in the population will depend upon the ability to risk‐stratify and identify patients whose baseline risk for sudden cardiac death exceed 3% per year.
Compliance to surgical and radiation treatment guidelines in relation to patient outcome in early stage endometrial cancer
Authors: Lankveld Marieke AL van , Koot Nicole CM , Peeters Petra HM , Schagen van Leeuwen Jules , Jürgenliemk‐Schulz Ina M , Eijkeren Marion A van 
Published: February 2006

AbstractRationale, aims and objectives  We evaluated the adherence to treatment guidelines in early stage endometrial cancer and the influence of adherence to guidelines on overall survival.Method  Patients were identified in the central region in the Netherlands from 1990 till 1995. Patient and tumour characteristics, surgical findings, radiation and follow‐up data were abstracted from medical records. Endpoint was overall survival. Kaplan‐Meier method was used to perform time‐to‐event analysis. Hazard ratios for overall survival were estimated with a Cox Proportional Hazards model.Results  359 patients were eligible for analysis. 335 patients presented with a clinical stage I cancer. 333 patients underwent a Total Abdominal Hysterectomy with Bilateral Salpingo Oophorectomy (TAH/BSO), of which 301 were staged as International Federation of Gynaecology and Obstetrics (FIGO) stage I, whereas 34 (10.2%) as FIGO stage II. Of the 24 patients with a clinical stage II cancer, 12 underwent a Radical Hysterectomy with Pelvic Lymph Node Dissection (RH/PLND), of which seven were diagnosed with FIGO stage II. In 72.1% of the patients adjuvant radiation was given or not in adherence to the guidelines. Whether treatment was given according to the guidelines or not did not affect 5 years overall survival.Conclusion  This suggests that extensive surgical procedures are redundant in the treatment of occult stage II endometrial cancer.
Evaluation of a national quality use of medicines service in Australia: an evolving model
Authors: Beilby Justin , Wutzke Sonia E. , Bowman Jenny , Mackson Judith M , Weekes Lynn M. 
Published: February 2006

AbstractRationale  To describe the first phase of a global evaluation framework for the National Prescribing Service (NPS), with a focus on services for health professionals, and in particular highlight the lessons learnt from evaluation around the establishment and implementation of this national pragram.Methods  The agreed evaluation framework used mixed methods focused around a series of evaluation questions, aimed at measuring the overall effect of this new organization as well as the individual pragrams within it. The evaluation questions were determined a priori and were based on the objectives established by the organization in its first year of operation. A detailed analyses has been completed of: the process, scope and reach of pragram delivery using both quantitative and qualitative measures; changes in attitudes and knowledge measured through key informant interviews and surveys of professional groups and consumers; and changes in prescribing behaviour and savings to the Pharmaceutical Benefits Scheme (PBS) through analysis of prescription data. The evaluation period for this report was mid‐1998 to mid‐2004.Results  The NPS has successfully implemented a complex, multi‐facted pragram across Australia. From 1998 to 2004, in addition to print material provided to all general practitioners (GPs) and pharmacists, 90% of all GPs have been actively involved in one or more educational activity; 116 of 120 divisions of general practice have coordinated local NPS pragrams; and 9% of pharmacists have actively participated in at least one educational activity. Sixty per cent of GPs and pharmacists rated the printed educational materials as good or very good. In the last three years, the NPS activities have generated savings in the range of $121–163 million to the PBS, owing to changes in prescribing practices.Conclusion  The national evaluation framework has informed pragram delivery and ongoing design and development. Continued refinement of existing evaluation methods and further exploration of new techniques will remain a priority for the organization.
Professional approaches to stroke treatment in Japan: a relationship‐centred model
Authors: Slingsby Brian Taylor 
Published: February 2006

AbstractRationale  To examine how stroke professionals in Japan approach rehabilitation therapy.Methods  This qualitative study was based on Grounded Theory. Data collection included (1) non‐participatory observation, (2) non‐structured interviews, and (3) semi‐structured interviews. A national hospital located in an urban area of the prefecture of Kanagawa in Japan specializing in the treatment of stroke and other neurological disorders. Stroke professionals (doctors, nurses, clinical psychologists, physiotherapists, occupational therapists and speech therapists), patients and patients’ families.Results  (1) Professionals recognized patient motivation as a factor related to rehabilitation outcome, but believed it to be a direct product of fostered fiduciary relationships and effective patient interaction. (2) Professionals regarded fiduciary relationships as the most important determinant of rehabilitation outcome. (3) Professionals adapted their behaviour and communication style in aims of fostering fiduciary relationships. These findings informed a three‐component model of care: the Relationship‐centred Model.Conclusions  The Relationship‐centred Model describes how stroke professionals in Japan approach rehabilitative therapy. This model of care may be preferred by patients in other countries who also favour a family‐centred approach to decision making.
A microbial world within us
Authors: Zoetendal Erwin G. , Vaughan Elaine E. , De Vos Willem M. 
Published: February 2006

SummaryThe microbial world within us includes a vast array of gastrointestinal (GI) tract communities that play an important role in health and disease. Significant progress has been made in recent years in describing the intestinal microbial composition based on the application of 16S ribosomal RNA (rRNA)‐based approaches. These were not only instrumental in providing a phylogenetic framework of the more than 1000 different intestinal species but also illustrated the temporal and spatial diversity of the microbial GI tract composition that is host‐specific and affected by the genotype. However, our knowledge of the molecular and cellular bases of host–microbe interactions in the GI tract is still very limited. Here an overview is presented of the most recent developments and applications of novel culture‐independent approaches that promise to unravel the mechanisms of GI tract functionality and subsequent possibilities to exploit specifically these mechanisms in order to improve gut health.
The Exeter Family Study of Childhood Health (EFSOCH): study protocol and methodology
Authors: Knight Bridget , Shields Beverley M. , Hattersley Andrew T. 
Published: February 2006

SummaryThe Exeter Family Study of Childhood Health is a prospective study, set up to test the fetal insulin hypothesis, and to identify genetic polymorphisms that play a role in determining birthweight and early postnatal growth. We recruited 1017 families from a postcode‐defined area in central Exeter. Specific inclusion criteria were established to obtain a homogeneous, non‐diabetic, UK Caucasian cohort. Detailed anthropometric measurements were taken from both parents at 28 weeks’ gestation, and from their children at birth, 12 weeks, 1 year and 2 years of age. Insulin and other biochemical analysis were measured in fasting parental samples and an umbilical cord blood sample taken at delivery. Parental and offspring DNA were extracted to allow molecular genetic analysis of candidate genes implicated in fetal growth. This comprehensive data set is available on a disease‐free cohort, and detailed preparatory work has ensured high levels of quality control. The study would welcome collaboration within strict confidentiality rules.
Early life predictors of childhood intelligence: findings from the Mater‐University study of pregnancy and its outcomes
Authors: Lawlor Debbie A. , Najman Jake M. , Batty G. David , O'Callaghan Michael J. , Williams Gail M. , Bor William 
Published: February 2006

SummaryLawlor DA, Najman JM, Batty GD, O’Callaghan MJ, Williams GM, Bor W. Early life predictors of childhood intelligence: findings from the Mater‐University study of pregnancy and its outcomes. Paediatric and Perinatal Epidemiology 2006; 20: 148–162.Growing evidence linking childhood intelligence with adult health outcomes suggests a need to identify predictors of this psychological characteristic. In this study, we have examined the early life determinants of childhood intelligence in a population‐based birth cohort of individuals born in Brisbane, Australia between 1981 and 1984. In univariable analyses, family income in the year of birth, maternal and paternal education, maternal age at birth, maternal ethnicity, maternal smoking during pregnancy, duration of labour, birthweight, breast feeding and childhood height, and body mass index were all associated with intelligence at age 14. In multivariable analyses, the strongest and most robust predictors of intelligence were family income, parental education and breast feeding, with these three variables explaining 7.5% of the variation in intelligence at age 14. Addition of other variables added little further explanatory power. Our results demonstrate the importance of indicators of socio‐economic position as predictors of intelligence, and illustrate the need to consider the role of such factors in generating the association of childhood intelligence with adult disease risk.
The influence of maternal cigarette smoking, snuff use and passive smoking on pregnancy outcomes: the Birth To Ten Study
Authors: Steyn Krisela , De Wet Thea , Saloojee Yussuf , Nel Hannelie , Yach Derek 
Published: February 2006

SummarySteyn K, de Wet T, Saloojee Y, Nel H, Yach D. The influence of maternal cigarette smoking, snuff use and passive smoking on pregnancy outcomes: the Birth To Ten Study. Paediatric and Perinatal Epidemiology 2006; 20: 90–99.This article describes the patterns and effects of maternal snuff use, cigarette smoking and exposure to environmental tobacco smoke during pregnancy on birthweight and gestational age, in women living in Johannesburg and Soweto in 1990. A cohort of 1593 women with singleton live births provided information about their own and household members’ usage of tobacco products during pregnancy. The women completed a questionnaire while attending antenatal services. Data on gestational age and birthweight were obtained from birth records. Women who smoked cigarettes or used snuff during pregnancy accounted for 6.1% and 7.5% of the study population respectively.The mean birthweight of non‐tobacco users was 3148 g [95% CI 3123, 3173] and that of the smokers 2982 g [95% CI 2875, 3090], resulting in a significantly lower mean birthweight of 165 g for babies of smoking mothers (P = 0.005). In contrast, women using snuff gave birth to infants with a mean birthweight of 3118 g [95% CI 3043, 3192], which is a non‐significant (P = 0.52) decrease (29.4 g) in their infants’ birthweights compared with those not using tobacco. A linear regression analysis identified short gestational age, female infant, a mother without hypertension during pregnancy, coloured (mixed racial ancestry), and Asian infants compared with black infants, lower parity, less than 12 years of education and smoking cigarettes as significant predictors of low birthweight, while the use of snuff during pregnancy was not associated with low birthweight. The snuff users, however, had a significant shorter gestational age than the other two groups of women. The birthweight reduction adjusted for possible confounders was 137 g [95% CI 26.6, 247.3 (P = 0.015)] for cigarette smokers and 17.1 g [95% CI −69.5, −102.7, P = 0.69] for snuff users respectively, compared with the birthweight of non‐tobacco users. Among women who did not smoke cigarettes or use snuff, exposure to environmental tobacco smoke did not result in significant effects on the birthweight of their infants.In conclusion, infants of cigarette smokers had significantly lower birthweights than those of non‐tobacco users or snuff users who are exposed to nicotine during pregnancy. Passive smoking did not affect birthweight significantly in this population.
Immunopathologic study of erythema dyschromicum perstans (ashy dermatosis)
Authors: Luz A. Vásquez‐Ochoa , Diana M. Isaza‐Guzmán , Orozco‐Mora Beatriz , Restrepo‐Molina Rodrigo , Trujillo‐Perez Judith , Félix J. Tapia 
Published: February 2006

AbstractErythema dyschromicum perstans (EDP) is a pigmentary disease of unknown etiology in which damage to basal cells is thought to be mediated by adhesion molecules. The aim of this study was to characterize the histopathology and immunopathology of EDP. Forty‐three patients from Medellín, Colombia, with the diagnosis of EDP were evaluated. Skin biopsy specimens were obtained for histopathology and immunohistochemistry, using monoclonal antibodies directed against the following markers: CD4, CD8, CD56, CD1a, CD68, CLA, HLA–DR, ICAM‐1 and LFA‐1α.A dermal lymphocytic infiltrate was observed in all cases, with a perivascular location in 86%. Other histologic features included melanophages in all specimens, vacuolization of the basement membrane zone (BMZ) 58% and exocytosis of lymphocytes (53.5%). The mean number of total leukocytes was 1510 cells mm−2 of tissue. There was a predominance of CD8+ T lymphocytes in the dermis and HLA–DR+, ICAM‐1+ keratinocytes in the epidermis. Exocytosis of cutaneous lymphocyte antigen (CLA) + cells was observed in areas of BMZ damage, suggesting that response to antigenic stimulation may play a role in the development of EDP.