bluuebunny/crossref_metadata_2025_split huggingface dataset:
A brief history of processing approaches to SLA: reply to Mellow
Authors: Pienemann Manfred , Johnston Malcolm 
Published: November 2007

In his article Mellow claims that the 'predictive model' is based on a transformational analysis of word formation. We will show that this is incorrect and that instead, the model is based on the psychological concept of exchange of linguistic information. Therefore, Mellow's evaluation of various types of transformational analyses is quite irrelevant for the model. To demonstrate our point we will reproduce the full text of the original description of the 'predictive model'. We will show that the transformational connection should properly be traced to Clahsen's strategies which apply to syntax only. The strategies approach will then be described in contrast to the 'predictive model' in order to characterize the two approaches and their historical context. This will provide the background to a brief critique of the strategies approach. Theory formation in later processing approaches to SLA will then be sketched out briefly before addressing several points of detail in Mellow's article.
Comparison study of the Hepcon System Four and the Hemostasis Management System
Authors: Harloff Michael , Taraskiewicz John , Fotouhi Carol 
Published: November 2007

Milwaukee Heart Surgery Associates, in affiliation with St Mary's Medical Center, were asked to be clinical investigators for a comparison study of the current Hepcon System Four (HSF) and the next generation Hemostasis Management System (HMS) manufactured by HemoTec, Inc. The HSF has been in place at St Mary's Medical Center for the past three years in a programme that performs approximately 900-1100 cardiac procedures a year. Heparin assays and high range activated clotting times (HR-ACTs) are performed routinely on all patients placed on cardiopulmonary bypass (CPB). This study will evaluate the results based upon the two systems run in tandom on a series of patients undergoing cardiac surgery with no exclusions, i.e. valve repair or replacement and myocardial revascularization. The study sets out to determine whether or not the new generation HMS has any distinct advantages over the HSF and whether it is or is not suitable for this clinical setting.
Heparin surface treatment does not impair gas and heat transfer of an extracorporeal circuit
Authors: Boonstra PW , Akkerman C. , Tigchelaar I. , Gu YJ , Huyzen R. , Eijgelaar A. 
Published: November 2007

Surface treatment of a cardiopulmonary bypass circuit with heparin improves its haemocompatibility. However, potential side effects of this layer of heparin are impairment of O2 transfer and CO2 transfer in the oxygenator and heat transfer in the heat exchanger. Therefore we studied these side effects during extracorporeal circulation with moderate hypothermia in 30 patients who underwent elective coronary artery bypass grafting surgery. All patients were heparinized systemically. In 15 patients (Duraflo II-group) we used an extracorporeal circuit (including a Bentley Bos-CM50 membrane oxygenator) which was treated with heparin. The results of this group were compared with those obtained from another group of 15 patients (control-group), who were operated upon with an identical extracorporeal circuit but without heparin surface treatment. We found no significant differences between the two groups in O2 transfer, CO2 transfer or heat transfer during normothermia or hypothermia. We concluded that neither O2 transfer and CO2 transfer of the oxygenator nor heat transfer of the heat exchanger were impaired by Duraflo II heparin surface treatment during clinical cardiopulmonary bypass with moderate hypothermia.
Cold or warm start of cardiopulmonary bypass- influence on microcirculatory blood flow
Authors: Boldt J. , Knothe Ch. , Hammermann H. , Stertmann W.A. , Hempelmann G. 
Published: November 2007

In a randomized study of 30 patients undergoing elective aortocoronary bypass grafting, either cold start of cardiopulmonary bypass (CPB) (prime: room temperature [approximately 20°C], n = 15) or normothermic start of CPB (prime: warmed up to the patients' blood temperature, n = 15) were performed. After warm start, CPB was continued using almost normothermia (lowest nasopharyngeal temperature: 35.8 ± 0.4°C), after cold start hypothermia was used (lowest nasopharyngeal temperature: 28.8 ± 0.2°C). Changes in microcirculatory perfusion were assessed by measuring skin capillary blood flow at the patient's forearm and forehead using laser Doppler technique. Laser Doppler flow (LDF) was continuously monitored before onset of CPB (=baseline values), 30 seconds, one, five, 10, 15 and 20 minutes after start of CPB. Mean arterial blood pressure (MAP) and systemic vascular resistance (SVR) were reduced by CPB in both groups, with the more pronounced reduction in the normothermic patients. Haemoglobin and plasma viscosity were without differences between the groups. The lowest blood temperature in the hypothermic patients was 21.0 ± 0.3°C, and the lowest rectal temperature in these patients was 29.0 ± 0.3°C (20 minutes after start of CPB). Forehead- and forearm-LDF increased significantly in both groups by start of CPB. In the hypothermic patients, this increase was significantly lower, and LDFs were already reduced below baseline values five to 10 minutes after onset of CPB (LDF-forehead -18%, LDF-forearm -72%). In the normothermic patients, LDFs remained elevated during the first 20 minutes after the beginning of bypass (LDF- forehead +38%; LDF-forearm +35%) and were significantly higher than baseline ' even after CPB (hypothermia: LDF-forehead -34%; LDF-forearm -31%). Except for the blood temperature, none of the measured haemodynamic and laboratory values could be related significantly to changes of LDFs (analyses of covariance). It is concluded that skin microcirculatory perfusion as assessed by laser Doppler flowmetry was less altered when using warm start and maintenance of perfusion than after cold start and hypothermic CPB. Whether this improvement in microperfusion after warm start of CPB takes place also in other (more vital) organs has to be elucidated in further studies.
Clinical significance of heparin in the residual pump oxygenator blood, reinfused postoperatively after cardiopulmonary bypass
Authors: Singh G. , Gayler M. , Wyatt R. , Spyt TJ 
Published: November 2007

Postcardiopulmonary bypass (CPB) heparin levels and thrombin time were measured in 20 patients following routine open cardiac operations. There was a statistically significant increase in heparin concentration and thrombin time ratio on completion of transfusion of the residual pump oxygenator blood. An hour after the end of the transfusion there was no statistically significant difference in the heparin concentration and thrombin time ratio compared to values before and immediately after transfusion. We also observed a significant decrease in the chest drainage over a period of four hours which was unrelated to plasma heparin level. Measurements of thrombin time in the post bypass period closely follow plasma heparin levels. If postoperative bleeding arose it was due to inadequate surgical haemostasis or coagulation defect other than residual heparinization. Thus this confirms further that heparin is not the sole aetiological factor in postoperative bleeding post-CPB.
The acute phase response to cardiopulmonary bypass in children
Authors: Mitchell IM , Brady L. , Black J. , Jamieson Mpg , Pollock Jcs , Logan RW 
Published: November 2007

The endocrine phase of the stress response to cardiopulmonary bypass in children is known to be subtly different from that seen in adults. The aim of this investigation was to determine whether there are similar differences in the acute phase response. Thirteen children were studied (mean age 2.65 years). Each child had congenital heart disease and underwent corrective cardiac surgery. Blood samples taken two days prior to operation and at 6, 9, 12, 24, 48 and 120 hours after were analysed for C-reactive protein, albumin, caeruloplasmin, zinc and copper concentrations. Metal:carrier protein molar ratios were also calculated. Results demonstrate changes which, although similar to those seen in adults, differed both quantitatively and qualitatively. This is explained by the concept of immaturity leading to a generally poor capacity for protein synthesis and a relative inability to respond to altered circumstances.
Use of midazolam in palliative care
Authors: McNamara Paul , Minton Michael , Twycross Robert G 
Published: November 2007

Objective: To review the use of midazolam (a water-soluble benzodiazepine) in terminally ill patients. Design: A retrospective study of 104 patients. Results: Midazolam was used intravenously as sedation before minor procedures in three patients. Because of prolonged sedation in two patients, the following regimen is now used: 1 mg intravenously stat, followed by 1 mg/min, or 0.5mg/min in those over 65. In other situations, midazolam was used subcutaneously (SC), usually via a syringe driver. For muscle relaxation the median dose was 30mg SC/24h (27 patients; range 10-60mg). When treating terminal agitated delirium the median dose was 35mg SC/24h (61 patients; range 10-240mg). For multifocal myoclonus or as prophylaxis against fits the median dose was 30mg SC/24h (12 patients; range 15-80mg).
Training for palliative medicine. II: How should palliative physicians be trained? An observational study of the clinical skills needed by senior palliative physicians
Authors: Daley Andrew G , Lennard Rosemary F 
Published: November 2007

Palliative medicine is a new specialty in the UK. Formal training schemes are slowly evolving but some debate exists as to what precise experience such schemes provide. Five senior palliative physicians were observed in their clinical work in order to obtain information about the nature of the clinical problems that they were routinely managing and hence about where emphases in training should lie. The doctors were observed dealing with 262 problems in 112 patients. The results demonstrate the wide range of problems in symptom control that palliative physicians manage, highlight the significant incidence of nonmalignant problems which require a broad knowledge of medicine, and show the large number of psychosocial problems for which communication skills, knowledge of psychiatry and awareness of community services are needed. The authors suggest seven areas which higher training must cover. They note that no other higher specialist training will provide the skills needed, and that no one background or qualification emerges as the 'best' prior to higher specialist training.
Questioning diagnosis disclosure in terminal cancer patients: a prospective study evaluating patients' responses
Authors: Centeno-Cortés Carlos , Núñez-Olarte Juan M 
Published: November 2007

This study attempted to assess the degree of knowledge of the diagnosis, and the attitude towards that information, in a group of terminally ill cancer patients. We also tried to determine the influence of the knowledge of the diagnosis on other patient psychosocial needs. We assessed 97 patients (64 in an oncology service, 33 in a palliative care unit) by means of a semistructured personal interview, and a psychosocial needs questionnaire. Data collected showed that 68% of patients had not been informed of their diagnosis; 60% of this group had a high degree of suspicion of their diagnosis,but 42% of noninformed patients did not want to receive more information. Information on diagnosis appears to be beneficial in establishing satisfactory relationships and communication between patients and relatives and staff. We have tried to answer the most relevant issues related to diagnosis disclosure in our clinical setting, questioning the feasibility of truth telling within our cultural boundaries.
Radiotherapy for painful bone metastases
Authors: Needham PR , Hoskin PJ 
Published: November 2007

Bone metastases are a frequent cause of morbidity in patients with malignant disease. Pain is the commonest symptom; it can be treated successfully in the majority of patients by local external beam irradiation. Controversy exists over which regimen should be used, with a single dose necessitating only one treatment visit to the radiotherapy department, or a fractionated course requiring several visits. Many radiotherapists continue to use fractionated regimens despite the current evidence that single fractions are as effective. Many reasons exist for this, including departmental policy and training, fears of recurrence, problems with retreatment of previously treated areas, fears of increased early and late morbidity, and attempts at promoting recalcification. The majority of these reasons are theoretical and have yet to be substantiated. In many patients, symptomatic bone metastases are widespread, and hemibody irradiation, although more toxic, should be considered in order to avoid the need for repeated courses of local treatment.
Anticipatory grief: a theoretical challenge
Authors: Evans Alison J 
Published: November 2007

The theories of loss and grief described by Freud and Bowlby have provided considerable interest in anticipatory grief. Anticipatory grief is assumed to be akin to post-death grief, but commencing prior to the loss of the loved one. 'Grief work' completed during the anticipatory period is purported to mitigate against abnormal grief reactions after death and enhance adjustment to loss. Research conducted to investigate the link between anticipatory grief and postbereavement adjustment has not, however, yielded conclusive findings. It is argued that the intellectual vision of researchers has been obscured by the traditional view of grief leading to conceptual confusion in the theoretical literature and equivocal findings of the empirical investigations. The limited view of the 'death event' as the only loss incurred fails to consider the past, present and future losses that may occur as a result of terminal disease. The physiological, psychological, interpersonal and sociocultural factors evident in the terminal situation serve to highlight the existence of many previously unconsidered variables which may determine the anticipatory grief experience. Until the influence of these determining variables is acknowledged and researchers learn to look beyond the parameters of the traditional models of grief, the costs and/or benefits of the anticipatory period will remain largely undefined. A good starting point may be the adoption of the alternative label, 'terminal response'.
The impact on community palliative care services of a hospital palliative care team
Authors: Bennett Michael , Corcoran Gerard 
Published: November 2007

This retrospective study examined the influence of a hospital palliative care team on the activity of a local hospice home care team over a four-year period from May 1989 to April 1993 in East Leeds. The increasing referral to death interval observed in home care patients over this period appears to be due to the presence of the hospital team. The increasing work-load of the home care team generated by the hospital team is discussed with reference to solutions to meet this increasing demand. A district or regional planning strategy is recommended to co-ordinate existing and potential palliative care services.
Continuing education and short courses
Authors: Smith Anthony M 
Published: November 2007

Requirements for healthcare professionals in the United Kingdom to undertake continuing education are discussed. For nurses, midwives and many career- grade doctors, formal arrangements are in place; for other professionals, continuing education is recommended but not yet a formal requirement. In order to explore what is available, courses, conferences and seminars advertised in the Hospice Information Service's publication Choices for the academic year September 1994 to July 1995 are reviewed in terms of number, intended audience, participants and duration. Comment is offered on size of events and their financing. Issues of approval, quality assurance and evaluation are addressed. Suggestions are offered with regard to future financing of courses, and co- ordination of planning and provision. It is suggested that the National Council for Hospice and Specialist Palliative Care might encourage increasing co operation between units in the provision of education.
Is Moral Education of Nurses Still Possible?
Authors: Wrońska Irena , Baajer Małgorzata 
Published: November 2007

A decline in work and study of nursing students in a school of nursing became increas ingly obvious. A lack of ambition, anxiety and discouragement seemed to be due to prospective unemployment. This led to a research study concerning the problems of moral education in a school of nursing. Findings show that students should be taught a certain sensibility of conscience, the ability to think independently, to choose the right career, and to take responsibility for themselves. Le travail et les études des étudiants infirmiers/ères dans une école d'infirmiers/ères ont perdu l'importance toujours plus visiblement. Un manque d'ambition, peur et découragement semblaient être dus à la possibilité du chômage. Ceci poussait à une étude de recherches concernant les problèmes d'éducation morale dans une école d'infirmiers/ères. Les conclusions montrent que les étudiants devraient être enseignés une certaine sensibilité de conscience, la compétence de penser indépendement, choisir la bonne carrière, et prendre la responsabilité pour eux-mêmes. Ein Rückgang in der Arbeit und der Studien der Schüler/innen einer Kranken pflegeschule wurde mehr und mehr offensichtlich. Ein Mangel an Bestrebung, Furcht und Mutlosigkeit schienen auf eine zukünftige Arbeitslosigkeit zu deuten. Dies führte zu einem Forschungsstudium über die Probleme der Moralbildung einer Krankenpflegeschule. Die Ergebnisse zeigten dass die Schüler/innen eine gewisse Sensibilität des Gewissens, die Möglichkeit, selbstständig zu denken, die gute Karriere zu wählen, und die Eigensverantwortung gelehrt sein sollten.
Moral Rights and the Ethics of Nursing
Authors: Sim Julius 
Published: November 2007

This paper explores the nature of rights, and their implications for the ethics of nursing. A right is seen as an entitlement which is justified on moral and/or legal grounds, and which may take the form of a right of action or a right of recipience, or both; in either case, correlative duties are generally imposed on others. Some of the conflicts which can occur among two or more conflicting rights are examined through three hypothetical scenarios, and approaches to their resolution are suggested. The question of whether nurses, as nurses, possess rights is then considered, and it is suggested that they do not. In conclusion, it is argued that, if rights are to be a helpful concept, they must be carefully defined and analysed, and their relationship to one another, and to duties, must be clarified. Cet article étudie la nature des droits et leur implications pour l'éthique des soins infirmiers. Un droit reste sur des bases morales et légales et peut prendre la forme d'un droit d'action ou d'un droit de récipience ou des deux formes ensembles. En chaque instant, des devoirs corrélatifs sont normalement imposés à d'autres personnes. Quelques uns des conflits qui peuvent arriver entre deux (ou plusieurs) droits opposés sont considérés ici par trois possibilités hypothétiques et des possibilités de résoudre les problèmes sont proposées. Enfin, la question est considérée si les infirmiers/ères possèdent des droits en tels qu'infirmiers/ères, et il est proposé qu'ils/elles ne les possèdent pas. En conclusion, il est proposé que pour les droits d'être utiles, ils doivent être bien définis et analysés et les relations entre eux et envers les devoirs doivent être bien claires. Dieser Artikel erforscht des Wesen der Rechte und deren Auswirkungen in der Krankenpflegeethik. Ein Recht hat moralische oder legale Gründe und nimmt die Form entweder eines Rechtes der Aktion oder eines Rechtes des Empfanges, oder beider Arten. In allen Fällen sind entsprechende Pflichten anderen aufgelegt. Einige Konflikte, die unter zwei (oder mehreren) Rechten entstehen können, sind hier untersucht an Hilfe von drei hypothetischen Szenarien. Möglichkeiten für die Lösung der Probleme sind vorgeschlagen. Anschliessend wird die Frage, ob das Krankenpflegepersonal Rechte hat - als Personal - betrachtet, und es ist vorgeschlagen, dass solche Rechte nicht bestehen. Zum Abschluss wird vorgeschlagen dass Rechte hilfreich sind wenn sie sorgfältig analysiert und festgelegt sind und wenn deren Beziehung zu einander und zu Pflechten klar ist.
Quality assurance questionnaire for professionals fails to improve the quality of informed consent
Authors: Lavori Philip W. , Wilt Timothy J. , Sugarman Jeremy 
Published: November 2007

Background The informed consent process for research warrants improvement but approaches designed to enhance informed consent need testing in the context of actual clinical research. Purpose Test the cumulative effect of a retrospective quality assurance questionnaire intended to enhance awareness in the person obtaining informed consent on the quality of the informed consent in clinical trials. Methods In the Veterans Affairs Cooperative Study `Enhancing the Quality of Informed Consent- Self Monitoring', 30 study sites are randomly assigned from five clinical trials to either use a new quality assurance questionnaire after each informed consent encounter or the standard process of obtaining informed consent. The quality of informed consent is evaluated using independent telephone interviews of 836 subjects who had given consent to participate in the clinical trials and the authors' study. The main outcome measures are two previously validated scores derived from an independent telephone interview, measuring the overall quality of consent as well as the degree of `therapeutic misapprehension'. Patients and assessors are blind to the study arm assignment. Results Subjects report complete (93%) or some (6%) satisfaction with the consent process of the `parent' clinical trial, and 91% recognize no consequences to non-participation. Concerning the `primary purpose' of the parent trial, 67% indicate understanding of the research purpose, 41% that the research is to benefit others, while 14% think the research is directed to their own benefit; 60% report no risk to participation and 65% report at least one expects direct benefit. Interviewers assess 77% of subjects as showing full appreciation of the `voluntariness' of participation. The quality assurance questionnaire do not provide an appreciable effect on the quality of informed consent. Using mixed model methods to account for the group randomization, near zero, non-significant effects have been found for the overall assessment score (-0.034 on a 0—10 point scale, standard error 0.099, P = 0.73) and for the score measuring `therapeutic misconception' (-0.005 on a 0—5 point scale, standard error 0.137, P = 0.97). Permutation methods yield similar results. Confidence intervals are narrow enough to exclude any clinically important effect. Limitations The intervention may work in a more homogeneous patient population, or one that is not sampled. The outcome measurement relies on a short, anonymous, telephone interview (to minimize burden and eliminate bias), but a longer, face-to-face interview may be more sensitive to differences. A `checklist' tied directly to the outcome measures may show an effect. Clinical Trials 2007; 4: 638—649. http://ctj.sagepub.com Conclusions Despite prior beliefs, a standardized quality assurance tool do not enhance informed consent in actual clinical trials. Future research is needed to rigorously evaluate proposed methods to enhance informed consent prior to widespread introduction.