bluuebunny/crossref_metadata_2025_split huggingface dataset:
Workforce profile, organisation structure and role responsibility for ventilation and weaning practices in Australia and New Zealand intensive care units
Authors: Rose Louise , Nelson Sioban , Johnston Linda , Presneill Jeffrey J 
Published: March 2008

Aims and objectives.  To provide an analysis of the scope of nursing practice and inter‐professional role responsibility for ventilatory decision‐making in Australian and New Zealand (ANZ) intensive care units (ICU).Background.  Currently, little empirical data describe nurses’ role in decision‐making for ventilation and its weaning. Delineation of roles and responsibilities for ventilatory practices vary according to unit structure, staffing and skill‐mix, patient case‐mix and unit leadership models.Methods.  Self‐administered questionnaire sent to nurse managers of eligible ICUs within ANZ.Results.  Survey responses were available from 54/180 ICUs. The majority (71%) of responding ICUs were located within metropolitan areas and categorised as a tertiary level ICU (50%). The mean number of nurses employed per ICU bed was 4·7 in Australia and 4·2 in NZ, with 69% (IQR: 47–80%) of nurses holding a postgraduate specialty qualification. All units reported a 1:1 nurse‐to‐patient ratio for ventilated patients with 71% reporting a 1:2 nurse‐to‐patient ratio for non‐ ventilated patients. Key ventilator decisions, including assessment of weaning and extubation readiness, were reported as predominantly made by nurses and doctors in collaboration. Overall, nurses described high levels of autonomy and influence in ventilator decision‐making. Decisions to change ventilator settings, including FiO2 (91%, 95% CI: 80–97), ventilator rate (65%, 95% CI: 51–77) and pressure support adjustment (57%, 95% CI: 43–71), were made independently by nurses.Conclusions.  The results of this survey suggest, within the ANZ context, nurses participate actively in ventilation and weaning decisions. In addition, the results support an association between the education profile and skill‐mix of nurses and the level of collaborative practice in ICU.Relevance to clinical practice.  Mechanical ventilation may result in significant complications if not applied appropriately. Collaborative practice that encourages nursing input into decision‐making may improve patient outcomes and reduce complications.
Impact of quality circles for improvement of asthma care: results of a randomized controlled trial
Authors: Schneider Antonius , Wensing Michel , Biessecker Kathrin , Quinzler Renate , Kaufmann‐Kolle Petra , Szecsenyi Joachim 
Published: March 2008

AbstractRationale and aims  Quality circles (QCs) are well established as a means of aiding doctors. New quality improvement strategies include benchmarking activities. The aim of this paper was to evaluate the efficacy of QCs for asthma care working either with general feedback or with an open benchmark.Methods  Twelve QCs, involving 96 general practitioners, were organized in a randomized controlled trial. Six worked with traditional anonymous feedback and six with an open benchmark; both had guided discussion from a trained moderator. Forty‐three primary care practices agreed to give out questionnaires to patients to evaluate the efficacy of QCs.Results  A total of 256 patients participated in the survey, of whom 185 (72.3%) responded to the follow‐up 1 year later. Use of inhaled steroids at baseline was high (69%) and self‐management low (asthma education 27%, individual emergency plan 8%, and peak flow meter at home 21%). Guideline adherence in drug treatment increased (P = 0.19), and asthma steps improved (P = 0.02). Delivery of individual emergency plans increased (P = 0.008), and unscheduled emergency visits decreased (P = 0.064). There was no change in asthma education and peak flow meter usage. High medication guideline adherence was associated with reduced emergency visits (OR 0.24; 95% CI 0.07–0.89). Use of theophylline was associated with hospitalization (OR 7.1; 95% CI 1.5–34.3) and emergency visits (OR 4.9; 95% CI 1.6–14.7). There was no difference between traditional and benchmarking QCs.Conclusions  Quality circles working with individualized feedback are effective at improving asthma care. The trial may have been underpowered to detect specific benchmarking effects. Further research is necessary to evaluate strategies for improving the self‐management of asthma patients.
The validity and reliability of the Turkish version of the MacNew Heart Disease Questionnaire in patients with angina
Authors: Daskapan Arzu , Höfer Stefan , Oldridge Neil , Alkan Neslihan , Muderrisoglu Haldun , Tuzun Emine Handan 
Published: March 2008

AbstractAims and objectives  Health‐related quality of life (HRQL) is an important patient‐reported outcome when identifying the effects of the angina and evaluating the efficacy of treatment. The aim of this study was to determine the reliability and validity of the Turkish version of the MacNew Heart Disease HRQL Questionnaire (MacNew) in patients with angina.Method  The Short Form SF‐36, the MacNew, and the Hospital Anxiety and Depression Scale were completed by the 125 patients in first 2–3 days after admission to the coronary care unit. Internal consistency reliability (Cronbach’s α) and reproducibility (intraclass correlation coefficients, ICC) of the MacNew were assessed, and test–retest reproducibility was evaluated over a 2‐month period in 25 clinically stable patients.Results  The original three‐factor structure for the Turkish MacNew was confirmed, with construct validity only partially confirmed; reliability statistics show that Cronbach’s α exceeded 0.80 and the ICC exceeded 0.60 for all MacNew scales. Discriminative validity of the MacNew was confirmed.Conclusion  The MacNew appears to be reliable and valid in Turkish patients with angina.
Impact of an educational intervention on internal medicine residents’ physical activity counselling: the Pressure System Model
Authors: Katz David L. , Shuval Kerem , Comerford Beth P. , Faridi Zubaida , Njike Valentine Y. 
Published: March 2008

AbstractRationale, aims and objectives  Systematic reviews point to inconclusive evidence that counselling patients in a primary care setting is effective in increasing adults’ physical activity (PA) levels. This study evaluates the impact of an innovative physician counselling programme on physicians’ PA counselling behaviour and their patients’ PA levels.Methods  A controlled educational study conducted at six Yale School of Medicine hospitals. Sixty‐five internal medicine residents and 316 primary care patients were randomized to intervention or control groups. Intervention physicians participated in five interactive sessions outlining details of the Pressure System Model, while control physicians received usual residency training. Intervention and control patients’ PA levels and residents counselling behaviour were assessed using a validated questionnaire and compared pre‐ and post intervention. Data analysis was performed using paired t‐tests and repeated measures anova.Results  At 6‐month follow‐up intervention, patients’ PA levels increased significantly from baseline (1.77 ± 0.84; P = 0.0376). A similar pattern was observed after 12 months (1.94 ± 0.98; P = 0.0486). Control patients’ PA did not change significantly from baseline at 6 or 12 months (0.35 ± 1.00; P = 0.7224 and 0.99 ± 1.52; P = 0.5160, respectively). At 12 months, intervention residents provided PA counselling 1.5 times more than they did at baseline (P < 0.05) compared with no significant changes in the control group.Conclusions  The present study has shown that providing residents with a practical tool, enabling them to deal with patients’ barriers and previous failure in behavioural change, is efficacious in increasing PA levels of adult patients.
Projection of the supply of and demand for board‐certified nephrologists for ESRD in Taiwan
Authors: Chang Huan‐Cheng , Liou Yi‐Min , Yen Amy Ming‐Fang , Chen Tony Hsiu‐Hsi 
Published: March 2008

AbstractObjective  Taiwan is the country where end‐stage renal disease (ESRD) is most prevalent. The purpose of this study was to investigate whether the rising demand for dialysis or transplantation as a result of ESRD can be balanced by the supply of board‐certified (B‐C) nephrologists.Methods  Two Markov processes were applied for the projection of the supply of B‐C nephrologists in ESRD and for the projection of the demand from ESRD in 2020, assuming linear, exponential growth and no increase.Results  The supply of B‐C nephrologists was projected at 1346 in 2020. To make allowance for the share of total time of professional activities in full‐time equivalent (FTE) for B‐C nephrologists, the demand was 1556, 962 and 2652 with assumptions of steady, linear and exponential growth, respectively. By the year 2020, 210 and 1306 additional FTE nephrologists will be required to meet, respectively, a linear and an exponential increase in demand from ESRD.Conclusions  The projection of the supply of and the demand for B‐C nephrologists was made in this study using two Markov processes. The methods and results can be adopted as a reference for health manpower planning on B‐C nephrologists.
Therapeutic approaches to fibromyalgia in the Netherlands: a comparison between 1998 and 2005
Authors: Kroese Mariëlle E. A. L. , Schulpen Guy J. C. , Sonneveld Henk M. , Vrijhoef Hubertus J. M. 
Published: March 2008

AbstractRationale  In this study, information was gathered from five disciplines on their usual management methods for fibromyalgia (FM) in order to asses whether treatment regimens have changed in the Netherlands during a period of 6 years. In addition, insight was gained into the therapeutic motives of the professionals.Method  A questionnaire was sent to a sample of 150 persons per discipline: general practitioners (GPs), rheumatologists (RMTs), rehabilitation specialists (RS), physical therapists and psychologists.Results  The overall response rate was 40.4%. The referral behaviour changed (significantly), especially between GPs and RMTs. An increased choice for aerobic exercise (RS: P = 0.023) and multidisciplinary therapy (RMT: P = 0.046) was found. RMTs and RS showed decreased medication prescribing (RMT: P = 0.024). Preferences of treatment for FM differ per discipline. The choice is principally made on the basis of subjective, professional group‐bound factors. Particularly for GPs, dynamic patient factors are an important motive in the management of FM.Conclusions  Despite the fact that most changes found are in conformity with the literature, the absolute application percentages of recommended therapies are still very low. The differences in practice between the several disciplines seem explicable on the basis of the factors that have a prominent role in the choice of a therapy for FM. This study underlines the need for further research into methods and processes of the management of FM, and their clinical effectiveness. An effective way of dissemination, especially of guidelines, is essential.
Safety is part of quality: a proposal for a continuum in performance measurement
Authors: Kazandjian Vahé A. , Wicker Karol G. , Matthes Nikolas , Ogunbo Sam 
Published: March 2008

AbstractObjectives  Safer care is a strategic priority for health care organizations worldwide. Yet, the measurement and evaluation of key processes and outcomes associated with safer care remains challenging, even with existing performance measurement indicators. The multi‐national Quality Indicator Project (QI Project®) data are analysed to [1] document the patterns of safety indicators used between 1999 and 2006 among hospitals in Asia, Europe and the USA; and [2] to identify trends in using both organization‐level and patient‐level data in hospital performance improvement.Design and setting  Retrospective data are used to ascertain how the use of safety indicators has changed in comparison to other QI Project® indicators. ‘Continent’ rather than ‘hospital’ is used as the unit of analysis and P‐values of the differences in use percentages across Asia, Europe and the USA are calculated.Results  There was a significant increase in the use of QI Project® indicators in Asia between 1999 and 2006. Measured as the mean percentage of usage, the safety versus ‘all other’ indicators' increase in Asia was 43.7% versus 27% (P < 0.05) and 37.2% versus 24.4% (P < 0.05), respectively, during the study's time period. The European participants used both safety and all other indicators less frequently, 14.7% versus 18% (P < 0.05) and 9.5% versus 19.8% (P < 0.05), respectively. Finally, USA hospitals demonstrated a larger difference in the decrease of QI Project® indicator use than European hospitals between the ‘safety’ and ‘all other’ indicators, 12.7% decrease for safety indicators and 7.1% for all others (P < 0.05). These findings are consistent with trends reported in a previous study.Conclusion  Traditional performance measures continue to assist hospitals in identifying crucial aspects of safety in the delivery of care. Building on the findings of a previous study, there are emerging trends in the type of measures used in hospitals in Asia, Europe and the USA pursuing the improvement of overall performance. The increasing use of patient‐level data specifically, in tandem with organizational level indicators, may signal the continuum of measurement strategies, now still predominately in the USA but anticipated to be adopted both in Europe and Asia.
Gender differences and temporal variation in the incidence of type 1 diabetes: results of 8012 cases in the nationwide Diabetes Incidence Study in Sweden 1983–2002
Authors: Östman J. , Lönnberg G. , Arnqvist H. J. , Blohmé G. , Bolinder J. , Schnell A. Ekbom , Eriksson J. W. , Gudbjörnsdottir S. , Sundkvist G. , Nyström L. 
Published: March 2008

Abstract.Objectives.  To establish the gender difference amongst newly diagnosed type 1 diabetic patients aged 15–34 years, considering age at diagnosis, temporal trend and seasonal variation at time of diagnosis.Study design.  A population‐based prospective study with a mean annual population at risk of 2.3 million.Setting.  All departments of medicine, endocrinology and paediatrics and primary health care units in Sweden.Subjects.  Incident cases of diabetes aged 15–34 years at diagnosis 1983–2002.Measure instrument.  Basic characteristics of patients at diagnosis were reported by the diagnosing doctor on a standardized form. Level of ascertainment was estimated at 80–90%.Results.  Amongst all incident cases (n = 8012), 74% was diagnosed with type 1 diabetes. The mean annual incidence rate of type 1 diabetes was 12.7/100 000, in men 16.4/100 000 and in women 8.9/100 000. The incidence of type 1 diabetes decreased slowly by increasing age but was in all age groups higher in men, yielding an overall male/female ratio of 1.8. In both genders the incidence of type 1 diabetes decreased in average of 1.0% per year. A seasonal pattern with significantly higher incidence during January–March and lower during May–July was seen in both genders.Conclusions.  A clear male predominance of type 1 diabetes was seen in all ages. The temporal trend and the seasonal pattern was similar in men and women. Hence, internal factors related to the gender rather than differences in the exposure to environmental factors seem to explain the consistent male–female bias in the postpubertal risk of developing type 1 diabetes.
Autologous transplantation of bone marrow mononuclear cells for limb ischemia in a caucasian population with atherosclerosis obliterans
Authors: Vriese A. S. De , Billiet J. , Droogenbroeck J. Van , Ghekiere J. , Letter J. A. De 
Published: March 2008

Abstract.Background.  Autologous transplantation of bone marrow mononuclear cells (ATBMMNC) has been used successfully in critical limb ischemia. All reported patients were of Asian descent, however, and several studies included only young patients with thromboangiitis obliterans. Whether the beneficial results can be extrapolated to older Caucasian patients with atherosclerosis obliterans and a heavy burden of cardiovascular risk factors remains unclear.Methods.  We enrolled 16 patients (age 78 ± 2 year) with critical limb ischemia and a high prevalence of hypertension, smoking, diabetes, hypercholesterolemia and uremia. Mononuclear cells were isolated from the bone marrow and injected in the gastrocnemius muscle of the affected limb.Results.  Four patients died because of progressive gangrene (two) or unrelated causes (two). Three patients required an amputation and one patient a femorocrural bypass within 12 weeks. The remaining eight patients had a modest improvement of resting pain and/or trophic lesions. Transcutaneous oxygen pressure (ratio lesion/reference) improved from 0.51 ± 0.11 before to 0.86 ± 0.03 (P < 0.001) after 12 weeks, whereas ankle‐brachial index did not change significantly (0.42 ± 0.15 vs. 0.59 ± 0.1; P = 0.23). The number of visible collateral vessels on digital subtraction angiography changed with 0.89 ± 0.86 on a scale of 1–4 (P = 0.33). Capillary surface area in a biopsy of gastrocnemius, evaluated by immunostaining for endothelial nitric oxide synthase, increased from 0.61 ± 0.07% to 2.38 ± 0.73% (P < 0.05).Conclusions.  Although ATBMMNC was associated with objective signs of neovascularization, symptomatic improvement was only modest and restricted to the least affected patients. The discrepancy with previous findings may be related to the high prevalence of cardiovascular risk factors which causes endothelial progenitor cell dysfunction.
Clinical factors influencing the sensitivity to warfarin when restarted after surgery
Authors: Schulman S. , El Bouazzaoui B. , Eikelboom J. W. , Zondag M. 
Published: March 2008

Abstract.Background and objective.  Resumption of oral anticoagulation after surgery may result in a different maintenance dose of warfarin than before the procedure. Knowledge of the clinical determinants of postoperative response could help avoid excessive anticoagulation in sensitive patients or avoid extended delays in achieving a therapeutic level in resistant patients.Design.  Retrospective review.Subjects.  Two hundred warfarin‐treated patients who were managed by our clinic for surgery.Outcome.  Two independent adjudicators classified the postoperative response to warfarin as Resistant, Normal or Sensitive, based on previous maintenance dose, international normalized ratio (INR) on the day of resumption, number of days until INR of >1.9 and doses of warfarin given. A third adjudicator resolved disagreements. Clinical data were extracted from the patient records and correlated with the response.Results.  Interobserver agreement for classification of postoperative response was moderate (weighted kappa 0.46) with 37 (18.5%) considered resistant, 135 (67.5%) normal, 27 (13.5%) sensitive and one patient was not classifiable. The main type of surgery was cardiac. In univariable analysis only addition of amiodarone after surgery was associated with a sensitive response (P = 0.04). After adjustment for all other factors with an ordered categorical response, amiodarone remained as the sole independent risk factor (P = 0.02) for a sensitive response, odds ratio 0.41 (95% confidence interval 0.19–0.89) for Normal instead of Sensitive or for Resistant instead of Normal.Conclusion.  Altered sensitivity to warfarin occurs in about one‐third of patients after surgery and can be predicted by the introduction of concomitant amiodarone therapy but not by patient factors or the nature of the procedure. Changes in concomitant medications after surgery should alert doctors of the potential for increased sensitivity to warfarin.
High circulating levels of RBP4 and mRNA levels of aP2, PGC‐1α and UCP‐2 predict improvement in insulin sensitivity following pioglitazone treatment of drug‐naïve type 2 diabetic subjects
Authors: Hammarstedt A. , Pihlajamäki J. , Graham T. E. , Kainulainen S. , Kahn B. B. , Laakso M. , Smith U. 
Published: March 2008

Abstract.Context.  High levels of circulating retinol‐binding protein 4 (RBP4) and baseline expression of adipogenic genes correlate with subsequent improvement in insulin sensitivity following Thiazolidinedione (TZD) treatment.Objective.  The aim was to identify baseline characteristics and early changes related to TZD treatment that could predict a good treatment response.Design.  Subjects were examined with oral glucose tolerance test, intravenous glucose tolerance test, hyperinsulinaemic euglycaemic clamp, body composition and standard blood sampling at baseline and after 4 and 12 weeks treatment. Subcutaneous adipose tissue biopsies were taken from the abdominal region at baseline, after 3 days and 4 weeks treatment to examine the gene expression profile.Setting.  Research laboratory in a University hospital.Participants.  Ten newly diagnosed and previously untreated type 2 diabetic subjects were treated with pioglitazone for 3 months.Main outcome measures.  Baseline characteristics and early changes related to TZD treatment that could predict the response after 3 months.Results.  Pioglitazone improved insulin sensitivity after 4 weeks combined with lower glucose and insulin levels without any change in BMI. It was accompanied by lower circulating resistin and plasminogen activator inhibitor‐1 levels rapidly increased levels of circulating total and high molecular weight adiponectin as well as adiponectin and adipocyte fatty acid‐binding protein (aP2) mRNA expression in the adipose tissue. High levels of circulating RBP4 at baseline and adipose tissue expression of aP2, proliferator‐activated receptor‐gamma coactivator 1 alpha (PGC‐1α) and uncoupling protein 2 (UCP‐2) predicted a good treatment response measured as improvement in insulin‐stimulated whole‐body glucose uptake after 3 months.Conclusions.  Circulating levels of RBP4 as an index of insulin sensitivity and mRNA levels of adipogenic genes correlate with the subsequent improvement in insulin sensitivity following TZD treatment.
Essential role of choline for pneumococcal virulence in an experimental model of meningitis
Authors: Gehre F. , Leib S. L. , Grandgirard D. , Kummer J. , Bühlmann A. , Simon F. , Gäumann R. , Kharat A. S. , Täuber M. G. , Tomasz A. 
Published: March 2008

Abstract.Objectives:  The goal of the present study was to elucidate the contribution of the newly recognized virulence factor choline to the pathogenesis of Streptococcus pneumoniae in an animal model of meningitis.Results:  The choline containing strain D39Cho– and its isogenic choline‐free derivative D39Cho–licA64 –each expressing the capsule polysaccharide 2 – were introduced intracisternally at an inoculum size of 103 CFU into 11 days old Wistar rats. During the first 8 h post infection both strains multiplied and stimulated a similar immune response that involved expression of high levels of proinflammatory cytokines, the matrix metalloproteinase 9 (MMP‐9), IL‐10, and the influx of white blood cells into the CSF. Virtually identical immune response was also elicited by intracisternal inoculation of 107 CFU equivalents of either choline‐containing or choline‐free cell walls. At sampling times past 8 h strain D39Cho– continued to replicate accompanied by an intense inflammatory response and strong granulocytic pleiocytosis. Animals infected with D39Cho– died within 20 h and histopathology revealed brain damage in the cerebral cortex and hippocampus. In contrast, the initial immune response generated by the choline‐free strain D39Cho–licA64 began to decline after the first 8 h accompanied by elimination of the bacteria from the CSF in parallel with a strong WBC response peaking at 8 h after infection. All animals survived and there was no evidence for brain damage.Conclusion:  Choline in the cell wall is essential for pneumococci to remain highly virulent and survive within the host and establish pneumococcal meningitis.