bluuebunny/crossref_metadata_2025_split huggingface dataset:
Genetic background of pancreatitis
Authors: Hirota Masahiko , Ohmuraya Masaki , Baba Hideo 
Published: December 2006

Abstract
Trypsin activity is properly suppressed by pancreatic secretory trypsin inhibitor (PSTI), which is also known as serine protease inhibitor Kazal type 1 (SPINK1), thereby preventing damage to pancreatic acinar cells as a first line of defence. However, if trypsin activation exceeds the capacity of PSTI/SPINK1, a subsequent cascade of events leads to the activation of various proteases that damage cells. Five mutations (R122H, N29I, A16V, D22G and K23R) in cationic trypsinogen and two mutations (N34S and M1T) in the PSTI/SPINK1 gene have been found to correlate significantly with the onset of pancreatitis. From analyses of hereditary pancreatitis and the phenotype of PSTI/SPINK1 (Spink3) knockout mice, we showed that the imbalance of trypsin activation and its inhibition by PSTI/SPINK1 would lead to the development of pancreatitis.
The course of apraxia and ADL functioning in left hemisphere stroke patients treated in rehabilitation centres and nursing homes
Authors: Donkervoort Mireille , Dekker Joost , Deelman Betto 
Published: December 2006

Objective: To study the course of apraxia and daily life functioning (ADL) in left hemisphere stroke patients with apraxia. Design: Prospective cohort study. Setting: Rehabilitation centres and nursing homes. Subjects: One hundred and eight left hemisphere stroke patients with apraxia, hospitalized in rehabilitation centres and nursing homes. Measures: ADL-observations, Barthel ADL Index, Apraxia Test, Motricity Index. Results: During the study period of 20 weeks, patients showed small improvements in apraxia (standardized mean differences of 0.19 and 0.33) and medium-sized improvements in ADL functioning (standardized mean differences from 0.37 to 0.61). About 88% of the patients were still apraxic at week 20. Less improvement in apraxia was observed in initially less severe apraxic patients. Less improvement in ADL functioning was found to be associated with more severe apraxia, a more independent initial ADL score, higher age, impaired motor functioning and longer time between stroke and first assessment. Conclusions: Apraxia in stroke patients is a persistent disorder, which has an adverse influence on ADL recovery.
Limited dose response to Constraint-Induced Movement Therapy in patients with chronic stroke
Authors: Richards Lorie , Gonzalez Rothi Leslie J , Davis Sandra , Wu Samuel S , Nadeau Stephen E 
Published: December 2006

Objective: To compare outcomes in motor skill, perceived amount of use and ability of the paretic arm in daily activities between traditional Constraint-Induced Movement Therapy, consisting of 6 hours of in-clinic, therapist-guided task practice, and a shortened Constraint-Induced Movement Therapy, consisting of 1 hour of in clinic, therapist-guided task practice coupled with 5 hours of unsupervised practice at home. Design: A secondary analysis of two previous randomized, controlled, double-blind, parallel group studies. Setting: A research clinic. Participants: Thirty-nine individuals with hemiparesis from a chronic unilateral stroke who were able to extend the wrist 10° and the fingers and thumb 10° from a flexed position and were participants in one of the two studies examining the efficacy of adding neuroplasticity adjuvants to Constraint-Induced Movement Therapy. Main outcome measures: The Wolf Motor Function Test was used to assess motor skill and the Motor Activity Log amount of use and quality of movement scales were used to assess perceived amount of use and ability respectively. Interventions: Constraint-Induced Movement Therapy plus donepezil in the CIMT-6 study (the traditional 6 hours of in-clinic task practice) and Constraint-Induced Movement Therapy plus repetitive transcranial magnetic stimulation in the CIMT-1 study (1 hour of in-clinic task practice). Results: Motor skill gains after two weeks of therapy were equivalent for both groups (n=39; mean difference=2.81, P>0.22), but gains were not maintained six months later with either intervention protocol. Despite this, participants in the CIMT-6 group reported greater use (mean difference=1.52, P<0.001) and movement quality (mean difference=0.95, P<0.004) than those with less therapist-guided practice. Both groups had regressed somewhat in use and ability at the six-month follow-up. Conclusion: These results suggest that 6 hours of therapist-guided practice may not be necessary to facilitate motor skill gains, but may influence patterns of use.
A randomized controlled pilot study to obtain the best estimate of the size of the effect of a thermoplastic resting splint on spasticity in the stroke-affected wrist and fingers
Authors: Sheehan J L , Winzeler-Merçay U , Mudie M H 
Published: December 2006

Objective: To obtain the best estimate of the size of the effect of a thermoplasticresting splint on spasticity in the stroke-affected upper limb. Design: A randomized controlled intervention involving 14 adults affected by stroke,allocated to two groups. Setting: Inpatient and outpatient rehabilitation departments. Intervention: Following one week of baseline when neither group wore a splint, group 1 continued without a splint for week 2 and then wore a splint during week 3.Group 2 wore a splint during weeks 2 and 3. Both groups then wore a splint through weeks 4-7. Main measures: A computerized torque apparatus was used to measure resistance at the wrist in newtons at every one-degree angle through the range of extension.Amount and rate of change in resistance was compared between the groups to obtain the best estimate of the size of the effect of splinting. Results: Effect sizes were small and failed to reach the suggested smallest clinically worthwhile effect size for amount and rate of change in resistance in the short term. However, the average estimated size of the effect for rate of change with longer term splinting exceeded the smallest clinically worthwhile effect. Conclusions: These findings and the fact that confidence intervals overlapped the smallest clinically worthwhile size of the effect for amount and rate of change in both short and long term suggest that a study with a larger sample is warranted.
Studying communication in oncologist-patient encounters: The SCOPE Trial
Authors: Koropchak Celine M , Pollak Kathryn I , Arnold Robert M , Alexander Stewart C , Skinner Celette Sugg , Olsen Maren K , Jeffreys Amy S , Rodriguez Keri L , Abernethy Amy P , Tulsky James A 
Published: December 2006

Study objective: Most oncologists have not received adequate training in physician-patient communication, and existing effective courses tend to be time and resource intensive. We are developing and testing a tailored CD-ROM educational intervention that includes feedback on oncologists’ own audio-recorded conversations with their advanced cancer patients. In this report, we describe the study methods and identify challenges to implementation and how these were overcome. Study design: A three-phase, randomized, controlled trial. In Phase 1, we audio-recorded oncologist-patient clinic encounters. In Phase 2, oncologists were randomly assigned to a communication CD-ROM intervention or control. Phase 3 consisted of audio-recording all participating oncologists conversing with a new sample of patients, two to 12 months after the intervention, to assess its effectiveness. Setting: Oncology clinics at Duke University Medical Center (DUMC) and the Durham Veterans Affairs Medical Center (DVAMC) in Durham, NC, and the University of Pittsburgh Medical Center (UPMC) in Pittsburgh, PA. Participants: Medical, radiation and gynecological oncologists and their patients with advanced cancer. Intervention: A tailored CD-ROM that contains an interactive educational interface with reference materials and video-clips of model conversations, along with the oncologists’ own Phase 1 audio-recorded conversations. Conclusion: We present challenges and solutions to oncologist recruitment, identifying appropriate patients with advanced cancer, adapting to clinic flow, and developing a self-administered communications intervention.
Methodological and structural challenges in palliative care research: how have we fared in the last decades?
Authors: Kaasa Stein , Hjermstad Marianne Jensen , Loge Jon Ha°vard 
Published: December 2006

The heterogeneity of the palliative care population represents challenges to research methodology, including study design, informed consent (and ethical issues in general), assessment and classification of symptoms and signs, as well as practical issues in the clinic. The aim of this report is to describe and examine the status of palliative care research in Europe by means of a survey and a literature review. Only one European country, the UK, has taken a national initiative to stimulate and promote palliative care research through the supportive and palliative care collaboratives (SUPAC) in 2005. There are few European research groups in palliative care reaching a critical size, several countries do not have academic chairs in palliative care, and there is no clear trend that chairs are emerging in general. There is little public funding for palliative care research. Palliative care researchers need to compete on the ‘open market’ or rely on private foundations. There has been a steady increase in the number of abstracts for presentation at the EAPC Research Forums, from 200 in 2000, to 480 in 2006. The literature review indicated that the majority of publications are surveys and descriptive/observational studies, and few randomised, controlled, studies were published. In conclusion, the quantity of research seems to be steadily increasing. There may be a need for larger multi-centre studies, and in order to perform such studies, national and international structures, encompassing research above the critical size, with a multi-disciplinary background including both basic scientists and clinicians is required.
Renal safety of 1-hour pamidronate infusion for breast cancer and multiple myeloma patients: comparison between clinical trials and population-based database
Authors: de Lemos Mário L , Taylor Suzanne C , Barnett Jeff B , Hu Francis , Levin Adeera , Moravan Veronika , O'Reilly Susan E 
Published: December 2006

Purpose. The American Society of Clinical Oncology recommends infusion of pamidronate over 2 hours to avoid renal deterioration, although there are data to suggest that 1-hour infusions may be safe. Methods, Prevalence of renal deterioration with 1-hour pamidronate infusions from a population database was compared to renal deterioration with 2-hour pamidronate infusions, in randomised, controlled, trials. A cost-minimisation analysis, comparing the 1-and 2-hour pamidronate infusions, and the 15-minute infusion of zoledronic acid, was performed with a sensitivity analysis that varied the opportunity cost of time in the treatment room. Results. Renal deterioration occurred in 7.7% of 169 patients with multiple myeloma and metastatic breast cancer. There is no evidence that this differs from the 10% reported in randomised, controlled, trials (one-tailed binomial test, P=0.3874). A subgroup analysis showed that renal deterioration occurred in 15 and 1.1% of patients with multiple myeloma and metastatic breast cancer, respectively. The median increase in serum creatinine was 13 and 7% in the multiple myeloma and breast cancer groups, respectively. The respective costs/dose (drug/ labour/supplies) of pamidronate and zoledronic acid are $325 and $610. Cost neutrality occurs if the opportunity cost of chair time is $6.33/ minute for pamidronate 1-hour versus zoledronic acid, and $2.71/minute for pamidronate 2-hour versus zoledronic acid. If a median $4/minute is used, the respective costs of pamidronate 1-hour, 2-hour, and zoledronic acid infusions are $685, $925, and $790/cycle. Conclusions. Prevalence of renal deterioration with 1-hour pamidronate infusions from a population database was not significantly different to 2-hour pamidronate infusions in clinical trials. Our findings suggest further support for the safety of 1-hour pamidronate infusions. Pamidronate via 1-hour infusion is less expensive than zoledronic acid.
Physical and chemical stability of paclitaxel infusions in different container types
Authors: Donyai Parastou , Sewell Graham J 
Published: December 2006

Objectives. To determine the physicochemical stability of generic (Teva Pharmaceuticals) paclitaxel infusions (0.3 and 1.2 mg/mL) in 0.9% sodium chloride or 5% glucose in polyolefin (Viaflo®), low-density polyethylene (Ecoflac®), and glass containers at 2-8 and 25°C. Methods. Paclitaxel infusions of various concentration/diluent/container combinations were prepared. Containers were light-protected and incubated at test temperatures with further analysis at predetermined intervals of 1-3 days for up to 30 days. Infusions were monitored for pH, weight loss, precipitation, colour change, and subvisual particulates as indicators of physical stability, and assayed for drug concentration to determine chemical stability. Results. Precipitation was the limiting factor. Infusions of paclitaxel (0.3 mg/mL) in 0.9% sodium chloride remained stable for 13, 16 and 13 days at 2-8°C in polyolefin, low-density polyethylene and glass containers, respectively; in 5% glucose for 13, 18, and 20 days, respectively. At 25°C, paclitaxel infusions (0.3 mg/mL) remained stable for 3 days in all diluent/container combinations with the exception of 5% glucose in glass, where stability reached 7 days. Paclitaxel infusions (1.2 mg/mL) in 0.9% sodium chloride remained stable for 9, 12, and 8 days at 2-8°C in polyolefin, low-density polyethylene and glass containers, respectively; in 5% glucose for 10, 12, and 10 days, respectively. At 25°C, paclitaxel 1.2 mg/mL remained stable for 3 days in all diluent/container combinations with the exception of glass, where stability reached 5 days in 0.9% sodium chloride diluent, and 7 days in 5% glucose. Conclusion. Paclitaxel stability was influenced by storage temperature, with longer shelf-life at 2-8°C, and also by drug concentration, where 0.3 mg/mL infusions were more stable than 1.2 mg/mL for all diluent/container combinations. Physical stability (precipitation) was the limiting parameter in each case.
Cognitive slowing in multiple sclerosis is strongly associated with brain volume reduction
Authors: Lazeron R HC , de Sonneville L MJ , Scheltens P , Polman C H , Barkhof F 
Published: December 2006

Introduction In this study, we investigated the influence of in vivo disease pathology (measured as magnetic resonance imaging (MRI) lesion load and brain volume reduction) on cognitive functioning, especially the speed of processing, in multiple sclerosis (MS) patients. Since MS is characterized by cognitive slowing rather than impaired accuracy, we used the Amsterdam Neuropsychological Tasks (ANT) program, a computerized test proven to be very sensitive to cognitive slowing in MS patients. Methods Thirty-two patients performed the ANT and underwent MRI scanning. Using the ANT computerized tests, we investigated focused, divided, sustained attention, executive function and psychomotor function, and examined associations of speed, speed fluctuation and accuracy of performance of these tests with MRI lesion load and brain volume parameters. Results A decrease in the speed of processing and response speed stability, and a decrease in psychomotor accuracy and stability were clearly associated with less brain volume, and with higher lesion loads, in particular at frontal and occipital areas. Correlations with brain volume reduction were found for all domains, except for visuo-spatial processing. In particular, speed and speed fluctuation scores correlated with brain volume reduction, while accuracy of performance, in general, did not correlate. Only some test speed scores and speed fluctuation scores correlated with lesion load measurements. Conclusion This study shows that, in MS patients, accuracy of processing is not compromised unless high working memory demands are involved. Problems in neurocognitive functioning in MS are mainly modulated by speed and stability of speed processing, in particular when attention-demanding controlled information processing is required. Abnormalities in these domains are most strongly associated with brain volume loss, confirming that pathology beyond focal lesions is important in MS.
How similar are commonly combined criteria for EDSS progression in multiple sclerosis?
Authors: Kragt J J , Nielsen J M , van der Linden F AH , Uitdehaag B MJ , Polman C H 
Published: December 2006

Introduction Measuring disease progression is an important aspect of multiple sclerosis (MS) clinical trials. Commonly applied disability endpoints include time to clinically meaningful Expanded Disability Status Scale (EDSS) change, or the number of patients in whom such a change has occurred. Typically, clinically meaningful EDSS change has been defined as a change of 1.0 point on Kurtzke’s EDSS in patients with an entry EDSS score of 5.5 or lower, or 0.5 point in patients with a higher EDSS score. Our goal was to evaluate whether these changes can be considered as similar. Therefore, we compared EDSS changes to corresponding changes in the Guy’s Neurological Disability Scale (GNDS), which is a measure of patient perceived disability, and the Multiple Sclerosis Functional Composite (MSFC), which is an examination-based quantitative scoring of neurological impairment. Methods From a large longitudinal database, we selected two groups of patients with a clinically meaningful change in EDSS score according to the usual criteria: patients with EDSS change]/1.0 for baseline EDSS 5/5.5 and patients with EDSS change]/0.5 for baseline EDSS]/6.0. We compared changes in GNDS sum score and in MSFC score between both groups. Results In the group with baseline EDSS]/6.0, GNDS and MSFC changes were higher than in patients with baseline EDSS 5/5.5. The difference in change was 1.00 (95% confidence interval (CI): / 0.35 to 2.36) for the GNDS and 0.412 (95% CI: 0.300-0.525) for the MSFC. Conclusion Our results indicate that a 0.5 point EDSS change in patients with baseline EDSS / 6.0 cannot be considered equal to a 1.0 point change in patients with baseline EDSS 5/5.5.
Thinking Professional Social Work
Authors: Fargion Silvia 
Published: December 2006

Summary: Two different frameworks are identified with respect to social work practice and views of professional powers. Findings: Accounts of social work practice, gathered in Italy, illustrate two styles of narrating and constructing the work experience. These are analysed following Mannheim’s seminal work on romantic and enlightenment styles of thought. Practitioners’ accounts differ in how sequences are constructed, in the meaning attributed to crucial aspects such as the understanding of the situation, and in the place attributed to theory. Two conceptions emerge of the relationship of professional social workers with clients, and of their power. Applications: The article contributes to the debate on the relation between theory and practice in social work. Theoretical models are not viewed as potential sources of practical suggestions, but as whole perspectives with which to engage. They are ways of seeing and doing ‘things’ which stimulate critical reflection on one’s own work. The two ways of conceiving professional powers that emerge from this study appear embedded in different cognitive orders. This invites those seeking to identify new ways of conceiving professional powers to look at the whole social work culture, without trying to isolate single aspects or elements of it.
Skills and Knowledge Needed to Practise as a Care Manager
Authors: Dustin Donna 
Published: December 2006

Summary: This article presents findings of qualitative research carried out to explore the impact of care management on social work practice in statutory Social Services Departments. Interviews were carried out with front line care managers and their team managers working with a range of service user groups to gain their perspective on the skills and knowledge needed to practice as a care manager. Findings: A central finding was that care management requires a range of complex skills. Some pre-Griffiths casework skills are still necessary to practice as a care manager, such interpersonal skills, negotiation skills and organisational skills. However, new skills are required, such as risk management, the ability to construct a case and use IT, management of other professional input and use of accounting and budgetary systems. Knowledge needed to be a care manager was divided into practical knowledge, such as knowledge of resources and procedures, and theoretical knowledge, such as hierarchies of need and human development. Pre-Griffiths casework skills and knowledge are necessary but not sufficient to care mangement practice. Applications: This research rasises issues as to where care managers should acquire the specialised skills needed to practice as a care manager. Implications for social work education and training are addressed.
What Can We Learn about Social Work Assessment from the Textbooks?
Authors: Crisp Beth R. , Anderson Mark R. , Orme Joan , Lister Pam Green 
Published: December 2006

Summary: Although often criticized for inadequacies, textbooks are both highly influential and a readily available source of information about contemporary thinking in social work theory and practice. As part of a series of studies about facilitating learning and teaching about assessment in social work, the authors have been conducting a review of how this professional task is presented in textbooks which are currently known to be used in programmes of social work education in the UK. Relevant chapters of each of the selected textbooks were subjected to an in-depth analysis in order to determine how assessment was understood, assessment processes, relevance to the UK practice context and evidence bases. Findings: What are considered the key issues in, and skills required for, social work assessment are contested, with considerable variety between textbooks as to the extent of detail and topics covered in relation to assessment. Some issues which are prominent in the policy context, such as the need to ensure the involvement of service user and carer perspectives, and multidisciplinary assessment, were hardly mentioned. Changes in emphasis over time and differences in emphasis between textbooks published in the UK and North America were found. Applications: Given the many differences in emphasis and depth of content between textbooks ostensibly outlining the same aspects of practice, it is essential that educators have a clear rationale for recommending particular textbooks.