bluuebunny/crossref_metadata_2025_split huggingface dataset:
Risk of falls after withdrawal of fall‐risk‐increasing drugs: a prospective cohort study
Authors: Van Der Velde Nathalie , Stricker Bruno H. Ch. , Pols Huib A. P. , Van Der Cammen Tischa J. M. 
Published: August 2006

What is already known about this subject • In observational studies, several drugs have been associated with an increased fall risk. A meta‐analysis in 1999 found a significant association for neuroleptics, antidepressants, sedatives, diuretics, type IA antiarrhythmics, and digoxin.• Nevertheless, knowledge on the effect of withdrawal of these drugs on fall risk is scarce. Only one randomized controlled trial has been carried out in 1999, showing a significantly lowered fall risk after withdrawal of sedatives and antidepressants in community‐dwelling older persons. What this study adds • This study indicates that withdrawal of all fall‐risk‐increasing drugs, including both cardiovascular and psychotropic drugs, is an effective intervention for lowering of falls incidence. This effect appears to be highest for withdrawal of cardiovascular drugs.AimsFalling in older persons is a frequent and serious clinical problem. Several drugs have been associated with increased fall risk. The objective of this study was to identify differences in the incidence of falls after withdrawal (discontinuation or dose reduction) of fall‐risk‐increasing drugs as a single intervention in older fallers.MethodsIn a prospective cohort study of geriatric outpatients, we included 139 patients presenting with one or more falls during the previous year. Fall‐risk‐increasing drugs were withdrawn, if possible. The incidence of falls was assessed within 2 months of follow‐up after a set 1 month period of drug withdrawal. Multivariate adjustment for potential confounders was performed with a Cox proportional hazards model.ResultsIn 67 patients, we were able to discontinue a fall‐risk‐increasing drug, and in eight patients to reduce its dose. The total number of fall incidents during follow‐up was significantly lower in these 75 patients, than in those who continued treatment (mean number of falls: 0.3 vs. 3.6; P value 0.025). The hazard ratio of a fall during follow‐up was 0.48 (95% confidence interval (CI) 0.23, 0.99) for overall drug withdrawal, 0.35 (95% CI 0.15, 0.82) for cardiovascular drug withdrawal and 0.56 (95% CI 0.23, 1.38) for psychotropic drug withdrawal, after adjustment for age, gender, use of fall‐risk‐increasing drugs, baseline falls frequency, comorbidity, Mini‐Mental State Examination score, and reason for referral.ConclusionsWithdrawal of fall‐risk‐increasing drugs appears to be effective as a single intervention for falls prevention in a geriatric outpatient setting. The effect was greatest for withdrawal of cardiovascular drugs.
Polypharmacy as commonly defined is an indicator of limited value in the assessment of drug‐related problems
Authors: Viktil Kirsten K. , Blix Hege S. , Moger Tron A. , Reikvam Aasmund 
Published: August 2006

What is already known about this subject • Polypharmacy has been linked to heightened risk of occurrence of drug‐related problems (DRPs) and a detrimental health outcome.• Polypharmacy has been variously defined; in research studies a commonly applied definition has been the concomitant use of five or more drugs.• The value of using a definite number of drugs as a cut‐off to describe polypharmacy as a risk factor for the occurrence of DRPs has not been validated. What this study adds • Nearly half of the patients admitted to general hospitals used five or more drugs; during the hospital stay these patients were prescribed as many new drugs as those admitted with fewer drugs.• The presence of DRPs increased approximately linearly with the number of drugs used, for the range of one to >11 drugs.• To set a strict cut‐off to identify polypharmacy and declare that using more than this number of drugs represents a potential risk for occurrence of DRPs, is of limited value in clinical practice.AimTo investigate whether polypharmacy defined as a definite number of drugs is a suitable indicator for describing the risk of occurrence of drug‐related problems (DRPs) in a hospital setting.MethodsPatients admitted to six internal medicine and two rheumatology departments in five hospitals were consecutively included and followed during the hospital stay, with particular attention to medication and DRPs. Comparisons were made between patients admitted with five or more drugs and with less than five drugs. Clinical pharmacists assessed DRPs by reviewing medical records and by participating in multidisciplinary team discussions.ResultsOf a total of 827 patients, 391 (47%) used five or more drugs on admission. Patients admitted with five or more and less than five drugs were prescribed the same number of drugs after admission: 4.1 vs. 3.9 drugs [P = 0.4, 95% confidence interval (CI) − 0.57, 0.23], respectively. The proportion of drugs used on admission which was associated with DRPs was similar in the patient group admitted with five or more drugs and in those admitted with less than five drugs. The number of DRPs per patient increased approximately linearly with the increase in number of drugs used; one unit increase in number of drugs yielded a 8.6% increase in the number of DRPs (95% CI 1.07, 1.10).ConclusionThe number of DRPs per patient was linearly related to the number of drugs used on admission. To set a strict cut‐off to identify polypharmacy and declare that using more than this number of drugs represents a potential risk for occurrence of DRPs, is of limited value when assessing DRPs in a clinical setting.
Dose selection and population pharmacokinetics of PEG‐Intron in patients with chronic myelogenous leukaemia
Authors: Gupta Samir , Jen Juif , Kolz Karen , Cutler David 
Published: August 2006

AimsTo assess the dose selection using population pharmacokinetics of Pegylated Intron‐α2b (PEG‐Intron) in patients with chronic myelogenous leukaemia (CML).MethodsPEG‐Intron 3–6 µg kg−1 was administered subcutaneously once a week and blood samples were collected up to 48 weeks of treatment. A total of 624 samples collected from 137 patients were included in the analysis. Nonlinear mixed‐effects modelling was used to analyse the sparsely sampled concentration data from a clinical efficacy trial. Covariates in the analysis included weight, sex, age, race, serum creatinine and estimated creatinine clearance (CLcr).ResultsThe apparent clearance of PEG‐Intron decreased after repeated dosing. The clearance at treatment week 4 was 42.3 l day−1 (patients with CLcr 120 ml min−1) with interpatient variability 30%. At treatment week 48, the clearance value was reduced to 69% of its week 4 value. CLcr, a composite variable calculated from body weight, sex, age and serum creatinine, had a small but statistically significant influence on the clearance of PEG‐Intron. The clearance of PEG‐Intron in patients with CML was 40% higher than that of hepatitis C virus‐infected patients.ConclusionThe dose of PEG‐Intron 6.0 µg kg−1 week−1 appeared appropriate in the treatment of patients with CML.
Comparative bioequivalence study between a novel matrix transdermal delivery system of fentanyl and a commercially available reservoir formulation
Authors: Marier Jean‐Francois , Lor Mary , Morin Josée , Roux Lionel , Di Marco Marika , Morelli Gaetano , Sædder Eva Aggerholm 
Published: August 2006

AimTo determine the pharmacokinetics, safety and performance of a novel matrix formulation of fentanyl.MethodsTransdermal fentanyl was administered as the novel matrix and the Durogesic® reservoir formulations (24 subjects, 100 µg h−1) in a randomized, fully replicate, four‐way crossover study. Serum concentrations of fentanyl were assayed by LC/MS/MS. Pharmacokinetic parameters of fentanyl and performance (adherence and skin irritability) were evaluated.ResultsTest/reference ratio (90% confidence intervals) for AUC0–t, AUCinf and Cmax were 105.5% (99.4, 112.0), 105.3% (99.3, 111.6) and 111.4% (100.4, 123.6), respectively. Adherence and skin irritability results of the two formulations were similar.ConclusionThe two formulations are expected to result in similar efficacy for the management of severe pain.
Integration of visual and olfactory cues of hosts and non‐hosts by three bark beetles (Coleoptera: Scolytidae)
Authors: CAMPBELL STUART A. , BORDEN JOHN H. 
Published: August 2006

Abstract 1. There has been a long‐standing pre‐occupation with how phytophagous insects use olfactory cues to discriminate hosts from non‐hosts. Foragers, however, should use whatever cues are accurate and easily assessed, including visual cues.2. It was hypothesised that three bark beetles, the mountain pine beetle (MPB), Dendroctonus ponderosae Hopkins, the Douglas‐fir beetle (DFB), D. pseudotsugae Hopkins, and the western balsam bark beetle (WBBB), Dryocoetes confusus Swaine, integrate visual and olfactory information to avoid non‐host angiosperms (e.g. paper birch, trembling aspen), that differ in visual and semiochemical profile from their respective host conifers (lodgepole pine, Douglas‐fir, interior fir), and tested this hypothesis in a series of field trapping experiments.3. All three species avoided attractant‐baited, white (non‐host simulating) multiple‐funnel traps, and preferred attractant‐baited black (host‐simulating) traps. In experiments combining white, non‐host traps with non‐host angiosperm volatiles, bark beetles were repelled by these stimuli in an additive or redundant manner, confirming that these species could integrate visual and olfactory information to avoid non‐host angiosperms while flying.4. When antiaggregation pheromones were released from white traps, the DFB and MPB were repelled in an additive‐redundant manner, suggesting that beetles can integrate diverse and potentially anomalous stimuli.5. The MPB demonstrated the most consistent visual preferences, suggesting that it may be more of a ‘visual specialist’ than the DFB or WBBB, for which visual responses may be more contingent on olfactory inputs.
Statistical power analysis of a 2‐year field study and design of experiments to evaluate non‐target effects of genetically modified Bacillius thuringiensis corn
Authors: DUAN JIAN J. , JIANG CHANGJIAN , HEAD GRAHAM P. , BHATTI MUHAMMAD A. , WARD DENNIS P. , LEVINE STEVE L. , NICKSON THOMAS E. , NEMETH MARGARET A. 
Published: August 2006

Abstract 1. A 2‐year field study was conducted in 2000 and 2001 at a farm in Monmouth, Illinois to evaluate the effect of MON 863, a transgenic corn event that expresses the Cry3Bb1 protein for control of corn rootworms, on diverse groups of arthropod populations in a corn ecosystem.2. The field study employed a split‐plot design with MON 863 and conventional corn as the main plots and several insecticide treatments as subplots; each main plot was replicated four times (i.e. n = 4 block replications for each corn variety). A large number of arthropod taxa were trapped, taxonomically characterised, and counted in all plots. A mixed linear repeated‐measures model was used for analysis of each taxon collected to determine if there was an effect of MON 863 or insecticide regime on that taxonomic group.3. This report describes the results of a power analysis to determine the ability of the study design to detect an effect of MON 863 corn on the abundance of different groups of arthropods. A 50% difference in average taxon abundance between MON 863 and conventional corn plots was the criterion used in assessing the power.4. A statistical power analysis of the taxonomic group comparisons made in the 2‐year field study (with independent assignment of treatments each year) showed that only about 28% (22 of 56) of the statistical comparisons made with single years of data achieved ≥80% power to detect a 50% difference in population density. When data from both years of the study were analysed jointly, this level of power was obtained for 86% (24 of 28) the comparisons made.5. Graphical examination of the mean abundance and coefficient of variation (CV) for different taxa indicated that high abundance (> 5 trap captures per plot per sampling period) and low CV (< 100%) contributed to high statistical power (> 80%). Taxa with extremely low abundance (mean trap captures < 1 individual per plot per sampling period) generally had high CV (> 100%), and statistical comparisons for those taxa had lower power (< 80%).6. The relevance of these findings for designing field studies on the effects of genetically modified crops on non‐target arthropods with desired levels of power is discussed.
Nocturnal migration of dragonflies over the Bohai Sea in northern China
Authors: FENG HONG‐QIANG , WU KONG‐MING , NI YUN‐XIA , CHENG DENG‐FA , GUO YU‐YUAN 
Published: August 2006

Abstract 1. A sudden increase and subsequent sharp decrease of catches of dragonflies in a searchlight trap, with Pantala flavescens Fabricius (Odonata: Libellulidae) predominating, observed at Beihuang Island in the centre of the Bohai Gulf, in 2003 and 2004, indicated a seasonal migration of these insects over the sea during the night in China. The movements were associated with the onset of fog.2. Simultaneous radar observations indicated that the nocturnally migrating dragonflies generally flew at altitudes of up to 1000 m above sea level, with high density concentrations at about 200–300 or 500 m; these concentrations were coincident with the temperature inversion.3. During early summer, the dragonflies oriented in a downwind direction, so that the displacement direction varied between different altitudes. In contrast, during late summer, the dragonflies were able to compensate for wind drift, even headwind drift, so as to orient south‐westward no matter how the wind changed, and thus the displacement direction was towards the south‐west.4. The duration of flight, estimated from the variation of area density derived from radar data and hourly catches in the searchlight trap through the night, was about 9–10 h. The displacement speed detected using radar was ≈5–11 m s−1. Therefore, the dragonflies might migrate 150–400 km in a single flight.5. The dragonflies were thought to originate in Jiangsu province and they migrated into north‐east China to exploit the temporary environment of paddy fields in early summer. Their offspring probably migrated back south during late summer and autumn.
Costs and benefits of gregarious feeding in the meadow spittlebug, Philaenus spumarius
Authors: WISE MICHAEL J. , KIEFFER DWIGHT L. , ABRAHAMSON WARREN G. 
Published: August 2006

Abstract 1. To study the function of group living in a non‐social animal, costs and benefits of feeding in different group sizes (one to eight) were measured for nymphs of the meadow spittlebug (Philaenus spumarius) on tall goldenrod (Solidago altissima).2. In a controlled greenhouse experiment, the number of nymphs per plant had a significant influence on their mass as adults. Adult mass increased as group size went from one to five nymphs per plant, but fell as the group size increased beyond five. In contrast, the density of nymphs on a plant had no effect on the duration of nymphal development.3. Nymphal mortality increased linearly as the number of nymphs increased from one to eight per plant.4. These performance results suggest that the optimal group size of spittlebug nymphs reflects a compromise between bottom‐up influences (e.g. overcoming physical barriers to feeding on xylem) and within‐trophic‐level influences (e.g. avoiding competition for limited plant resources).5. In a survey of local populations of goldenrod, spittlebug nymphs were found to be slightly but significantly aggregated among host‐plant individuals. In addition, when more than one nymph occurred on a plant, the nymphs tended to feed in shared spittle masses.6. It is concluded that the aggregated dispersion pattern of spittlebug nymphs reflects an adaptive balance of coping with potentially conflicting demands from different trophic levels.
The relationships between net primary productivity, human population density and species conservation
Authors: Luck Gary W. 
Published: August 2006

AbstractAim  In this study, I determine the relationships between net primary productivity (NPP), human population density, species richness and land use. I also examine the implications of human settlement patterns for species conservation.Location  Australia.Methods  I document the associations between NPP, human population density and the species richness of birds, butterflies and mammals using correlations and spatial regressions. I also assess changes in land‐use with NPP and population density, focussing particularly on protected areas. An initial exploration into the implications of the NPP‐population density relationship for regional conservation strategies is provided.Results  Human population density increases with NPP suggesting that available energy may be a key driving force of human settlement patterns. The species richness of each taxonomic group and geographically restricted species also increases with NPP leading to substantial overlap between species diversity and populated regions. The percentage of land designated as minimal use decreases considerably with increasing human population density and NPP, while intensive agriculture is confined entirely to areas of high NPP. There are strong negative relationships between the size of Australia's National Parks and human population density and NPP. Small parks are often surrounded by relatively dense settlements, but have high average NPP, while large parks are mostly isolated and characterized by low productivity. There are no areas in the highest quartile of NPP that also occur in the most sparsely populated regions, presenting challenges for conservation strategies wanting to protect productive areas under the least threat of human development.Main conclusions  Human population density and species richness respond similarly to variation in NPP, leading to spatial congruence between human settlements and productive, species rich regions. Planning strategies are required that minimize the potential threat posed by human development to diverse ecosystems and maximize the underlying productivity of protected areas. Reducing the level of threat may require stabilizing the size of the human population, while capturing larger areas of relatively high productivity in the conservation reserve system would lead to greater protection of local diversity.
Handling of peripheral intravenous cannulae: effects of evidence‐based clinical guidelines
Authors: Ahlqvist Margary , Bogren Agneta , Hagman Sari , Nazar Isabel , Nilsson Katarina , Nordin Karin , Valfridsson Berit Sunde , Söderlund Mona , Nordström Gun 
Published: August 2006

Aim.  This study aimed at evaluating the outcome of implemented evidence‐based clinical guidelines by means of surveying the frequency of thrombophlebitis, nurses’ care, handling and documentation of peripheral intravenous cannulae.Background.  Peripheral intravenous cannulae are frequently used for vascular access and, thereby, the patients will be exposed to local and systemic infectious complications. Evidence‐based knowledge of how to prevent these complications and how to care for patients with peripheral intravenous cannula is therefore of great importance. Deficient care, handling and documentation of peripheral intravenous cannulae have previously been reported.Design.  A cross‐sectional survey was conducted by a group of nurses at three wards at a university hospital before and after the implementation of the evidence‐based guidelines.Method.  A structured observation protocol was used to review the frequency of thrombophlebitis, the nurses’ care, handling and the documentation of peripheral intravenous cannulae in the patient's record.Results.  A total of 107 and 99 cannulae respectively were observed before and after the implementation of the guidelines. The frequency of peripheral intravenous cannulae without signs of thrombophlebitis increased by 21% (P < 0·01) and the use of cannula size 0·8 mm increased by 22% (P < 0·001). Nurses’ documentation of peripheral intravenous cannula improved significantly (P < 0·001).Conclusion.  We conclude that implementation of the guidelines resulted in significant improvements by means of decreased frequency of signs of thrombophlebitis, increased application of smaller cannula size (0·8 mm), as well as of the nurses’ documentation in the patient's record.Relevance to clinical practice.  Further efforts to ameliorate care and handling of peripheral intravenous cannulae are needed. This can be done by means of increasing nurses’ knowledge and recurrent quality reviews. Well‐informed patients can also be more involved in the care than is common today.
A new research agenda: improving health care in general hospitals
Authors: Brown Michael , MacArthur Juliet 
Published: August 2006

Aim and objectives. To set out the research required to improve the health of people with learning disabilities in general hospital settings. The objectives are: (i) to share service developments in a mapping exercise to provide a picture of current work in this area, and (ii) to identify practice issues and experiences that can contribute to a broader research agenda.Background. It is recognized that people with learning disabilities are high users of all healthcare systems and have different pattern of health needs that often go unidentified, with some requiring general hospital care. The research evidence base in this area of practice needs to be developed to promote and improve health care.Method. A facilitated focus group design was employed at a conference event to identify areas for research in the future and determined that action is required on four broad research fronts.Results. Research is required to establish core principles of care, service developments, practical care measures and influencing change in practice.Conclusion. Research collaborations need to be established to support activity in this area and requires action in the future.Relevance to clinical practice. The evidence base and understanding of the high and differing pattern of health needs of people with learning disabilities continues to evolve and develop, with considerable scope to identify new areas for research. A conference approach was used to identify research questions to improve the care of this group in general hospital settings and offers a model that may be helpful in defining new areas of enquiry in the future.
The meaning of living with dementia and disturbing behaviour as narrated by three persons admitted to a residential home
Authors: Graneheim Ulla H , Jansson Lilian 
Published: August 2006

Aim.  The aim of our study was to illuminate the meaning of living with dementia and disturbing behaviour, as narrated by three persons admitted to a residential home.Background.  Living with dementia and so‐called disturbing behaviour in an institution involves interaction with care providers and fellow residents and poses a challenge to all who are involved.Methods.  We asked the head nurses at a residential home to select persons with dementia and disturbing behaviour who were willing to be interviewed and able to communicate verbally. We performed 10 informal conversational interviews with three persons. The interviews were transcribed into text and interpreted using a phenomenological hermeneutic method inspired by Ricoeur's philosophy.Results.  The findings indicate that the meaning of living with dementia and disturbing behaviour, as narrated by three persons admitted to a residential home, is about being surrounded by disorder, being trapped by restriction and being set aside, as well as about being included. The findings are interpreted as a collapse of relations to self and others intertwined with occasional episodes of togetherness. This is reflected on in relation to the literature on homelessness and at‐homeness and loss and maintenance of personal and social selves.Relevance to clinical practice.  The view others have of the person with dementia and of disturbing behaviour determines the nursing care given. Taking the residents’ personal history and actual context into account, disturbing behaviour may be seen as a way persons with dementia express their story and maintain their self.