bluuebunny/crossref_metadata_2025_split huggingface dataset:
Relationship between polypharmacy and underprescribing
Authors: Kuijpers Mascha A. J. , Van Marum Rob J. , Egberts Antoine C. G. , Jansen Paul A. F. ,   The OLDY (OLd people Drugs & dYsregulations) study group
Published: August 2008

WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT • Polypharmacy is common among the elderly.• Underprescribing is also frequent.• Optimizing polypharmacy includes avoiding underprescription. WHAT THIS STUDY ADDS • The probability of underprescription increases with the number of drugs used.• Forty‐three % of patients who used five or more medicines are undertreated.• In undertreated patients a mean of 1.4 medicines were lacking.AIMSUnderprescribing is increasingly recognized as an important problem. The aim of this study was to determine the relationship between polypharmacy and underprescribing.METHODSTreatment of current medical problems in geriatric patients was compared with general practitioner and national guidelines. Underprescription was defined as lack of an indicated drug, while no reason could be found for not prescribing it. Polypharmacy was defined as five or more drugs.RESULTSPolypharmacy was present in 61% of 150 patients. Underprescription was found in 47 (31%). Of patients with polypharmacy 42.9% were undertreated, in contrast to 13.5% of patients using four medicines or less (OR 4.8, 95% CI 2.0, 11.2). The estimated probability of underprescription increased significantly with the number of drugs.CONCLUSIONSWe found a clear relationship between polypharmacy and underprescribing.
Haemophilia A mutations in the UK: results of screening one‐third of the population
Authors: Green P. M. , Bagnall R. D. , Waseem N. H. , Giannelli F. 
Published: August 2008

SummaryOne‐third of the UK haemophilia A population was screened to establish a national database of mutations and pedigrees and advance knowledge of the disease. The following mutations were found: 131 intron 22‐ and 13 intron1‐breaking inversions; 11 gross deletions and an insertion; 65 frameshifts; three in‐frame deletions and one insertion; 46 nonsense; 30 intronic mutations affecting splice sites and four generating new sites; 469 non‐synonymous mutations due to 203 different base substitutions of which four affected, and nine were predicted to affect, splicing; three promoter mutations; two synonymous exon 14 mutations possibly affecting splicing; two VWF mutations. Of the above mutations, 176 are not listed in the Haemophilia A Mutation, Structure, Test and Resource Site (HAMSTeRS). Four gross deletions arose by non‐homologous end‐joining; we detected unexpected splicing in some mutations; substitution of amino acids conserved for less than 90 million years are rare; the risk of developing inhibitors for patients with nonsense mutations is greater when the stop codon is in the 3′ half of the mRNA; changes likely to generate splice sites causing frameshifts are over‐represented among non‐synonymous mutations associated with inhibitors; our data and those in HAMSTeRS enabled the size of the spectrum of specific mutations causing the disease to be estimated and to determine how much of it is known.
Cytotoxic T lymphocytes as immune‐therapy in haematological practice
Authors: Leen Ann M. , Heslop Helen E. 
Published: August 2008

SummaryViral infections are a significant cause of morbidity and mortality, particularly in pediatric allogeneic haematopoietic stem cell transplant recipients. Effective therapies are limited and often associated with significant side effects. Adoptive transfer of virus‐reactive T cells offers a means of reconstituting antiviral immunity and this approach has been successfully used to prevent and treat cytomegalovirus, Epstein‐Barr virus, and adenovirus infections in vivo. This review outlines the clinical trials that have been performed to date, and will describe future initiatives to (a) develop strategies that can increase the breadth of the viruses that can be targeted, and (b) simplify the process to extend this technology to more centers so that cellular therapy to reconstitute immunity can be more widely applied.
Clomiphene citrate, metformin or both as first‐step approach in treating anovulatory infertility in patients with polycystic ovary syndrome (PCOS): a systematic review of head‐to‐head randomized controlled studies and meta‐analysis
Authors: Palomba Stefano , Pasquali Renato , Orio Francesco , Nestler John E. 
Published: August 2008

Summary
Background  To date, no systematic review or meta‐analysis has been published of direct head‐to‐head studies comparing clomiphene citrate (CC) vs. metformin, or the combination of both drugs as first‐line therapy in anovulatory polycystic ovary syndrome (PCOS) patients seeking pregnancy. The aim of the current paper was to define, if possible, the best evidence‐based recommendations regarding the use of CC and/or metformin as the initial treatment of PCOS women with anovulatory infertility.
Design  Systematic review and meta‐analysis of the head‐to‐head randomized controlled trials (RCTs) available in the literature.
Methods  A bibliographic search was performed using the following bibliographic databases: Medline, EMBASE, Biological Abstracts, Cochrane Controlled Trials Register and Cochrane Database of Systematic Reviews. Reference lists of included studies, other relevant review articles and textbooks were checked for additional citations of interest.
Results  Four head‐to‐head RCTs were identified and qualified for inclusion in the analysis. No difference in fertility improvement was observed comparing CC with metformin (OR = 1·22, 95% CI 0·23–6·55, P = 0·815), whereas a significant (P < 0·0001) heterogeneity was observed. Homogeneous data showed no difference in fertility improvement between the combination treatment and CC monotherapy (OR = 0·99, 95% CI 0·70–1·40, P = 0·982), but a significant difference in comparison with metformin monotherapy (OR = 0·23, 95% CI 0·14–0·37, P < 0·0001).
Conclusions  In PCOS patients with anovulatory infertility and not previously treated, the administration of metformin plus CC is not better than monotherapy (metformin alone or CC alone), whereas to date no specific recommendation can be given regarding the use of CC or metformin as first‐step drug.
Prevalence of low male testosterone levels in primary care in Germany: cross‐sectional results from the DETECT study
Authors: Schneider Harald Jörn , Sievers Caroline , Klotsche Jens , Böhler Steffen , Pittrow David , Lehnert Hendrik , Wittchen Hans‐Ulrich , Stalla Günter Karl 
Published: August 2008

SummaryObjective  Low testosterone levels in men occur with increasing age and are associated with increased morbidity, particularly metabolic syndrome, and mortality. As the prevalence of hypogonadal testosterone levels has not been assessed in the primary care setting in Europe, we aimed to investigate the prevalence of low testosterone levels in this setting, and the patient characteristics and comorbidities associated with this finding.Design  A cross‐sectional, epidemiological study (the Diabetes Cardiovascular Risk‐Evaluation: Targets and Essential Data for Commitment of Treatment (DETECT) study).Patients  A total of 2719 male primary care patients (age 58·7 ± 13·4 years) were included.Measurements  Testosterone was measured in all patients. Information on diseases, risk conditions and treatments was documented by the primary care physicians. A large set of laboratory parameters was measured in a central laboratory. We calculated univariate and multivariate logistic regression models to assess the associations of low testosterone levels with different health and life style factors.Results  A total of 19·3% of all men had hypogonadism as defined by testosterone levels < 3·0 ng/ml. Stepwise logistic regression analysis revealed that obesity, metabolic syndrome, cancer, intake of six or more drugs, acute inflammation and nonsmoking were associated with hypogonadal testosterone levels. Higher age, liver diseases, and cancer were associated with very low testosterone levels (< 1·0 ng/ml).Conclusions  Hypogonadal testosterone levels are common in primary care, particularly in patients with the above conditions.
Forest succession and prey availability influence the strength and scale of terrestrial‐aquatic linkages in a headwater salamander system
Authors: GREENE BRIAN T. , LOWE WINSOR H. , LIKENS GENE E. 
Published: August 2008

Summary1. Trophic linkages between terrestrial and aquatic ecosystems are common and sensitive to disruption. However, there is little information on what causes variation in the strength and spatial scale of these linkages.2. In the highly aquatic adults of the headwater salamander Gyrinophilus porphyriticus (family Plethodontidae), use of terrestrial prey decreases along a gradient from early‐ to late‐successional riparian forests. To understand the cause of this relationship, we tested the predictions that (i) terrestrial prey abundance is lower in late‐successional forests, and (ii) G. porphyriticus adults cannot move as far from the stream to forage in late‐successional forests, thus limiting access to terrestrial prey.3. We established 100‐m long study reaches on six headwater streams in the Hubbard Brook Experimental Forest, New Hampshire. Three reaches were in early‐successional forests and three were in late‐successional forests. We conducted pitfall trapping for invertebrate prey in June and July of 2005, with three traps at 0, 2, 5 and 10 m from the stream at each reach. In June, July and August of 2004 and 2005, nighttime salamander surveys were conducted at each reach along ten, 10‐m long by 2.5‐m wide transects perpendicular to the stream.4. Abundance of terrestrial prey was consistently lower in late‐successional forests, suggesting that consumption of terrestrial prey by G. porphyriticus is affected by prey abundance. Contrary to our prediction, G. porphyriticus adults moved farther from the stream in late‐successional forests, suggesting that habitat conditions in late‐successional forests do not limit movement away from the stream, and that lower abundances of terrestrial prey in these forests may cause salamanders to move farther from streams.5. Our results provide novel insight on the extent of terrestrial habitat use by G. porphyriticus. More broadly, these results indicate that major habitat gradients, such as forest succession, can affect the strength and scale of terrestrial‐aquatic linkages. Application of this insight to the design of vegetation buffers along headwater streams would have widespread benefits to freshwater ecosystems.
Inducible‐ and constitutive‐type transcript variants of kakusei, a novel non‐coding immediate early gene, in the honeybee brain
Authors: Kiya Taketoshi , Kunieda Takekazu , Kubo Takeo 
Published: August 2008

AbstractWe previously identified a novel non‐coding immediate early gene, termed kakusei, from the honeybee (Apis mellifera) and used it as a marker to detect neural activity in the brains of foraging workers (Kiya et al., 2007). Here, we investigated the detailed kakusei gene structure. Expression analysis revealed that, in addition to the neural activity‐inducible transcript variant, multiple neural activity‐independent transcript variants were constitutively expressed from the same kakusei locus. In situ hybridization revealed that constitutive‐type kakusei variants were detected in the whole brain and the RNA was localized predominantly in the neural nuclei, like the inducible‐type variant, suggesting the concerted action of inducible‐ and constitutive‐types of kakusei transcript variants on nuclear function.
Preconditions needed for establishing a trusting relationship during health counselling – an interview study
Authors: Eriksson Irene , Nilsson Kerstin 
Published: August 2008

Aim. To examine the preconditions needed by district nurses to build a trusting relationship during health counselling of patients with hypertension.Background. Trust has been found to be an important aspect of the patient–nurse relationship. Little research has focused on how trust is formed in patient–nurse relationships or the conditions the development process requires when working with health counselling; in particular not in relation to hypertension.Design. Qualitative study.Method. Qualitative data were collected through open‐ended interviews with all (10) district nurses from three primary health care districts of western Sweden. All interviewees work with the health counselling of patients with hypertension. A latent content analysis was performed with thematic coding of the content of the interviews.Results. The first theme that emerged from the analysis, the nurses’ competence, describes the nurses’ consciousness of their method of expression, both oral and non‐verbal, as well as their pedagogical competence and their ability to be reliable in their profession. The second theme, the patient meeting, describes the continuity in the patient meeting and creating respectful communication.Conclusion. The results show an awareness of preconditions influencing building a trusting relationship. When creating a trusting relationship the communication and pedagogical competences of district nurses have considerable importance. Despite this awareness they state that it is easy to fall into a routinised way of working.Relevance to clinical practice. The implications of this study might be used as support and guidance for district nurses when developing their competence in health counselling in relations to patients with hypertension. This knowledge is also important when planning for nurse‐led clinics for this patient group.
Medium‐term post‐Katrina health sequelae among New Orleans residents: predictors of poor mental and physical health
Authors: Kim Son Chae , Plumb Ruth , Gredig Quynh‐Nga , Rankin Larry , Taylor Barbara 
Published: August 2008

Aims.  To assess the medium‐term post‐Katrina mental and physical health of New Orleans residents and to determine demographic, social and environmental factors that predict poor mental and physical health.Background.  Major disasters can have a negative impact on the health of survivors for prolonged periods. Although the initial and short‐term impacts of Hurricane Katrina have been well described, the medium‐term impacts have not been studied as thoroughly.Design.  Cross‐sectional survey.Methods.  A convenience sample (n = 222) of residents in Gentilly area of New Orleans completed questionnaires between 16 and 18 December 2006. Multivariate logistic regression and multiple regression models were employed to determine predictors of poor mental and physical health.Results.  Poor mental health was reported by 52% of the respondents. Pre‐Katrina depression [odds ratio (OR) = 19·1], post‐Katrina depression (OR = 7·2), poor physical health (OR = 5·6), feeling unsafe from crime (OR = 4·3) and female gender (OR = 2·6) were significant predictor variables of poor mental health. Twenty‐four percent of the variance in number of days of poor mental health was explained by the independent variables (R2 = 0·24; p < 0·001). Poor physical health was reported by 48% of the respondents. Poor mental health (OR = 3·9), lack of money to buy food (OR = 2·7) and pre‐Katrina arthritis (OR = 2·6) were significant predictor variables of poor physical health. Twenty‐three percent of the variance in number of days of poor physical health was explained by the independent variables (R2 = 0·23; p < 0·001).Conclusions.  Approximately half of the New Orleans residents continue to experience poor mental and physical health 15 months after Katrina. The results support focusing post‐Katrina efforts to protect residents from crime, improve mental health services to the depressed and improve food supply to the poor.Relevance to clinical practice.  Identifying predictors of poor mental and physical health may help clinicians and policy makers to focus their efforts in ameliorating the post‐disaster health sequelae.
Existential aspects of living with addiction – Part II: caring needs. A hermeneutic expansion of qualitative findings
Authors: Wiklund Lena 
Published: August 2008

Aim.  This paper aims to describe caring needs associated with existential aspects of living with addiction.Background.  Spirituality is considered a driving force within and the concept relates to self, others and God and the relationships between them. The spiritual dimension is of great importance in both the addiction itself as well as in recovery and addressing caring needs relating to spirituality is important in nursing.Design.  Hermeneutic inquiry was used to explore caring needs related to peoples experiences of living with addiction.Method.  This paper is a hermeneutic expansion of findings presented in Part I. Existential themes in the form of spiritual challenges and caring needs are reflected upon as a process between figure and background.Results.  The themes presented are: meaning – meaninglessness, connectedness – loneliness, life – death, freedom – adjustment, responsibility – guilt, control – chaos. Caring needs associated with them are identified as; the need to create a new frame of reference for interpreting of life, the need to experience coherence in life, a restored dignity as well as the need for a sense of community and attachment, confirmation and acceptance. The caring need for forgiveness and reconciliation is also identified as well as the need for continuity, comprehensibility and manageability.Conclusions.  When caring for patients suffering from addiction nurses should address patients’ spirituality. The caring communion is vital, as it is the foundation for meeting the patients’ needs. Intervention by nurses should focus on aspects that will help patients feel alive and in communion with others.Relevance to clinical practice.  Understanding and being able to identify patients’ caring needs associated with existential aspects of living with addiction will enable nurses to provide professional care and promote patient’s recovery.
A systematic review of nursing administration of medication via enteral tubes in adults
Authors: Phillips Nicole M , Nay Rhonda 
Published: August 2008

Aim.  This systematic review aimed to determine the best available evidence regarding the effectiveness of nursing interventions in minimising the complications associated with administering medication via enteral tubes in adults.Background.  Giving enteral medication is a fairly common nursing intervention entailing several skills: verifying tube position, preparing medication, flushing the tube and assessing for potential complications. If not carried out effectively harmful consequences may result leading to increased morbidity and even mortality. Until now, what was considered to be best practice in this area was unknown.Design.  Systematic review.Methods.  CINAHL, MEDLINE, The Cochrane Library, Current Contents/All Editions, EMBASE, Australasian Medical Index and PsychINFO databases were searched up to September 2005. Reference lists of included studies were appraised. Two reviewers independently assessed study eligibility for inclusion. There were no comparable randomised‐controlled trials; data were presented in a narrative summary.Results.  Identified evidence included using 30 ml of water for irrigation when giving medication or flushing small‐diameter nasoenteral tubes may reduce tube occlusion. Using liquid medication should be considered as there may be less tube occlusions than with solid forms in nasoenteral tubes and silicone percutaneous endoscopic gastrostomy tubes. In addition, nurses may need to consider the sorbitol content of some liquid medications, for example elixirs, as diarrhoea has been attributed to the sorbitol content of the elixir, not the drug itself.Conclusion.  The evidence was limited. There was a lack of high‐quality research on many important issues relating to giving enteral medication.Relevance to clinical practice.  Nurses have the primary responsibility for giving medication through enteral tubes and need knowledge of the best available evidence. Some of the nursing considerations and interventions relating to this skill have been researched in the clinical area and have implications for practice. There is a need for further studies to strengthen these findings.
Brief report: Aggressive challenging behaviour in adults with intellectual disability following community resettlement
Authors: Bhaumik S. , Watson J. M. , Devapriam J. , Raju L. B. , Tin N. N. , Kiani R. , Talbott L. , Parker R. , Moore L. , Majumdar S. K. , Ganghadaran S. K. , Dixon K. , Das Gupta A. , Barrett M. , Tyrer F. 
Published: August 2008

AbstractBackground  Aggressive challenging behaviour is common in adults with intellectual disability (ID) in long‐term care facilities. The government's commitment to the closure of all facilities in England has led to concerns over how to manage this behaviour in the community. The aim of this study was to assess changes in aggressive challenging behaviour and psychotropic drug use in adults with ID following resettlement using a person‐centred approach.Method  The Modified Overt Aggression Scale was administered to carers of 49 adults with ID prior to discharge from a long‐stay hospital and 6 months and 1 year after community resettlement.Results  All areas of aggressive challenging behaviour reduced significantly between baseline and 6 months following resettlement (P < 0.001). This reduction remained (but did not decrease further) at 1‐year follow‐up.Conclusions  Further work is needed to evaluate the role of environmental setting on aggressive challenging behaviour in adults with ID.
Genetically monomorphic invasive populations of the rapa whelk, Rapana venosa
Authors: CHANDLER E. A , McDOWELL J. R , GRAVES J. E 
Published: August 2008

Abstract Rapana venosa is a predatory marine gastropod native to the coastal waters of China, Korea, and Japan. Since the 1940s, R. venosa has been transported around the globe and introduced populations now exist in the Black Sea, the Mediterranean Sea, the Adriatic and Aegean seas, off the coasts of France and the Netherlands, in Chesapeake Bay, Virginia, USA, and in the Rio de la Plata between Uruguay and Argentina. This study surveyed variation in two mitochondrial gene regions to investigate the invasion pathways of R. venosa, identify likely sources for introduced populations, and evaluate current hypotheses of potential transportation vectors. Sequence data were obtained for the mitochondrial cytochrome c oxidase I and NADH dehydrogenase subunit 2 gene regions of 178 individuals from eight native locations and 106 individuals from 12 introduced locations. Collections from within the native range displayed very high levels of genetic variation while collections from all introduced populations showed a complete lack of genetic diversity; a single haplotype was common to all introduced individuals. This finding is consistent with the hypothesis that R. venosa was initially introduced into the Black Sea, and this Black Sea population then served as a source for the other secondary invasions by various introduction vectors including ballast water transport. Although non‐native R. venosa populations currently appear to be thriving in their new environments, the lack of genetic variability raises questions regarding the evolutionary persistence of these populations.