bluuebunny/crossref_metadata_2025_split huggingface dataset:
Dyslipoproteinemias in systemic lupus erythematosus: influence of disease, activity, and anticardiolipin antibodies
Authors: Borba EF , Bonfá E. 
Published: November 2007

Objective: To determine the influence of systemic lupus erythematosus (SLE), disease activity, and anticardiolipin antibodies (aCL) on lipid profile, in order to identify patients with high risk for coronary artery disease (CAD). Methods: Fasting lipid profiles were performed in 36 consecutive female SLE patients without any therapy and 30 controls. Exclusion criteria were diabetes mellitus, CAD, liver or thyroid disease, ingestion of lipid-raising drugs, serum creatinine ≥ 1.5 mg/dl, and proteinuria ≥ 0.5 g/d. Disease activity was measured by SLEDAI. Results: High levels of VLDL-C and TG and low levels of HDL-C, the 'lupus pattern', were observed in inactive SLE compared to controls (P < 0.05). Active disease enhanced this difference inducing a more striking increase in VLDL-C and TG levels and also a decrease in HDL-C and LDL-C levels compared to inactive SLE patients (P < 0.05), characterizing the 'active lupus pattern'. Moreover, a significant correlation was found between SLEDAI scores and all lipid fractions. Furthermore these lipid abnormalities were particularly associated with vasculitis. Lower HDL-C levels detected in IgG aCL+ patients compared to IgG aCL - patients were not confirmed by two-way analysis of variance which demonstrated that this difference was exclusively caused by disease activity. Conclusions: Our findings suggest that SLE patients have a lipid profile abnormality which is aggravated by disease activity and may reside in a defect of VLDL metabolism. This pattern of dyslipoproteinemia may increase the risk of developing coronary artery disease.
Elevated anticardiolipin antibodies in autoimmune haemolytic anaemia irrespective of underlying systemic lupus erythematosus
Authors: Lang B. , Straub RH , Weber S. , Röther E. , Fleck M. , Peter H-H. 
Published: November 2007

In patients with systemic lupus erythematosus (SLE) and concomitant Coombs positive autoimmune haemolytic anaemia (AIHA) anticardiolipin antibodies (aCL) are found more frequently and at higher titres than in SLE patients without AIHA. In order to assess if aCL elevation is primarily associated with the underlying SLE, or with AIHA itself, we examined AIHA patients with and without underlying SLE for the presence of aCL. aCL (IgG and IgM) were determined by ELISA in 74 SLE patients without AIHA, 22 SLE patients with AIHA, 50 patients with idiopathic AIHA (warm-reactive autoantibodies), 52 patients with idiopathic AIHA (cold-reactive autoantibodies) and 50 healthy controls. The mean IgG and IgM aCL titres in SLE patients without AIHA (IgG 37.0 U/ml, IgM 8.9 U/ml) were significantly elevated compared with the values in healthy controls (IgG 9.1 U/ml, IgM 3.2 U/ ml; P < 0.005). The mean aCL levels in SLE patients with AIHA (IgG 53.2 U/ml, IgM 28.2 U/ml) were higher than in SLE patients without AIHA ( P = 0.09 for IgG, P < 0.005 for IgM). Interestingly, the mean aCL levels of patients with idiopathic AIHA (warm-reactive autoantibody type: IgG 29.2 U/ml, IgM 19.3 U/ml; cold-reactive autoantibody type: IgG 27.4 U/ml, IgM 18.9 U/ ml) were also significantly elevated compared with healthy controls P < 0.001). As aCL are elevated not only in SLE (with and without concomitant AIHA) but also in idiopathic AIHA it can be speculated that aCL are involved in the pathomechanism of autoantibody-induced erythrocyte destruction per se irrespective of an underlying SLE.
Lack of NK cells in lupus patients with renal involvement
Authors: Erkeller-Yuksel FM , Lydyard PM , Isenberg DA 
Published: November 2007

We have previously shown that patients with SLE have significantly lower percentages and absolute numbers of NK(CD3-/CD16+56) cells in their peripheral blood compared with normals.1 Patients with active disease had very low levels of NK cells and the reduction was also associated with patients who had renal involvement. We have now performed a serial study immunophenotyping 11 patients with SLE and renal involvement using dual colour immuno flourescence and flow cytometry. Patients were tested every three months on an average of three occasions. As a control, nine SLE patients without renal involvement were immunophenotyped for similar intervals; 11 normal controls were also tested. Major lymphocyte subsets (T, B and NK) remained very stable during serial bleeds. However, the NK cell populations were decreased significantly in patients with renal involvement both as percentages (5±6 vs 9±5, P<0.0001) and absolute counts (75±108 vs 109±52, P<0.001) in comparison to non-renal patients. Analysis of disease activity using BILAG score showed an inverse correlation between renal system activity and percentage and absolute number of NK cells (P<0.002 and 0.01, respectively). In this study we have also analysed a CD8 T cell subset which we have not studied before. We have found a significantly increased percentage of CD38+ CD8+ T cells(activated CD8 subset) in patients with SLE in comparison to normal controls. We did not find any association with the CD38 + CD8 + T cells and disease activity as measured by BILAG or renal involvement. NK cells are important factors in immunity against virus infections and tumour cells. CD38 +CD8+T cells are increased in viral infections. We speculate that the lack of NK cells in SLE patients might have an association with increased CD38 expression.
Professional Codes: an Exercise in Tokenism?
Authors: Tadd Vic 
Published: November 2007

The paper questions the effectiveness of the United Kingdom Central Council's (UKCC's) Code of Professional Conduct upon the moral climate of nursing. It challenges the claim that the empowerment of nurses is significantly enhanced by the Code or that it necessarily makes them more accountable for their practice. The position is taken that the Code, in the absence of an effective support network for whistle-blowers, places an unreasonable burden upon nurses in its exhortations to report unprofessional conduct. The paper acknowledges the need to retain the Code, but with more modest claims being made concerning its empowering qualities. It is argued that unless more attention is focused on ways to support potential whistle-blowers, the Code will come to be seen as an irrelevance. Cet article met en question l'effet du Code du UKCC sur le climat moral des soins infirmiers. Il conteste l'affirmation que les infirmiers/ères sont considérablement plus fort à cause du Code ou qu'il les rend plus responsables dans leur pratique. La position est prise que le Code, en l'absence d'un réseau efficace de soutien pour les 'Whistleblowers' (personnes qui dévoilent un système), met un fardeau excessif sur les infirmiers/ères dans ses exhortations de signaler une conduite contraire au Code professionnel. Cet article reconnâit la nécessité de retenir le Code, mais avec des demandes plus modestes concernant ses pouvoirs de rendre fort. Il est soutenu que si non plus d'attention est concentré sur les moyens de soutenir les 'Whistlebowers', le Code va devenir hors de propos. Dieser Artikel bezweifelt die Wirksamkeit des Kodex des UKCC über das moralische Klima der Krankenpflege. Er stellt die Behauptung in Frage, dass der Kodex das Pflegepersonal bedeutend ermächtigt, oder dass er es mehr verantwortlich macht für seine Praxis. Die Position ist hier, dass der Kodex, in der Abwesenheit von effektiver Unterstützung für 'Whistleblowers' (d.h. Leute, die ein System verpfeifen), zu viel vom Pflegepersonal verlangt, in seiner Ermahnung, berufswidrige Praxis zu melden. Dieser Artikel anerkennt die Notwendigkeit, den Kodex zu behalten, aber mit kleineren Ansprüchen für seine ermächtigenden Qualitäten. Wenn nicht mehr Aufmerksamkeit gelegt wird, auf welche Weise die 'Whistleblowers' unterstützt werden können, dann wird der Kodex als eine Nebensächlichkeit verurteilt.
Confidentiality and Nursing Practice: Ethics and Law
Authors: Ngwena Charles , Chadwick Ruth 
Published: November 2007

This paper examines the ethical and legal duties of confidentiality owed by the nurse, with special reference to obligation to the employer. The main focus is on exploring the parameters of that duty and determining circumstances in which it might be ethically and legally justifiable to disclose confidential information. It is submitted that the obli gation to preserve the confidence of the patient or employer is relative rather than abso lute. In exceptional cases, disclosure is permissible in order to prevent harm to others or to promote a greater public good. A number of suggestions for reform are also made, with a view to reinforcing nurses' ethical and legal rights to exercise discretion to dis close confidential information in appropriate cases in order to protect themselves from victimization by employers. Cet article passe à l'examen les devoirs éthiques et légales de la confidence que les infirmiers/ères doivent obligatoirement à leur employeur. Le point de mire est l'exploration des donnés de cette obligation, et la détermination des circonstances dans lesquelles il est légitime, éthiquement et légalement, d'exposer de l'information confidentielle. Il est suggéré que l'obligation de préserver la confiance du malade ou de l'employeur est relative plutôt qu'absolu. Dans des cas exceptionels pourtant, la révélation d'information est permisible pour prévenir le mal des autres ou pour promouvoir un plus grand bien public. Quelques suggestions pour réformes sont proposées en vue du renforcement des droits éthiques et légales des infirmiers/ères d'exercer la discretion en ce qui concerne la révélation d'information dans des cas bien choisis, et de les protéger des représailles de l'employeur. Dieser Artikel prüft die ethischen und legalen Pflichten des Vertrauens, die das Pflegepersonal dem Arbeitsgeber schuldet. Das Zentrum des Arguments ist eine Untersuchung dieser Pflichten, und eine Festsetzung der Umstände, in welchen es ethisch und rechtlich möglich ist, Information bekannt zu machen. Es ist anerkennt, dass die Pflicht des Vertrauens des Patienten oder des Arbeitsgebers zu behalten, eher relativ als absolut ist. In aussergewöhnlichen Fällen jedoch ist die Bekanntgabe von Information erlaubt, um das Böse zu verhindern und das Gute aller zu fördern. Eine Anzahl von Vorschlägen für Reformen sind gemacht, mit der Absicht, die ethischen und legalen Rechte des Pflegepersonals, in gegebenen Fällen Information bekannt zu machen, zu verstärken, und es von ungerechter Behandlung eines Arbeitsgebers zu schützen.
Participant Observation and Informed Consent: Relationships and Tactical Decision-Making in Nursing Research
Authors: Merrell Joy , Williams Anne 
Published: November 2007

This paper draws on research undertaken by the authors in community well woman clinics and hospital settings. Discussion focuses on issues around informed consent and participant observation. The authors are concerned to highlight the complexity of decision-making where researchers hold dual or multiple agendas, which are sometimes in conflict. Further situational factors which affect decision-making in research settings are explored. In particular, the complexity of gaining informed consent throughout the research process is addressed. The intention is not to point to definitive resolutions to the problems posed, but rather to prompt debate about the often taken for granted meaning of 'informed' consent in relationship to participant observation. Cet article est basé sur les recherches que les auteurs avaient entrepris dans des polycliniques de santé de femmes et des hôpitaux. La discussion est concentré sur les thèmes du consentement informé et l'observation participante. Les auteurs sont inquiets de montrer la complexité du processus de se décider quant les chercheurs ont un rôle double ou multiple qui peut être en conflit. D'autres éléments qui influencent la prise de décisions dans des cadres de recherche sont aussi étudiés. En particulier, la compléxité de l'acquisition du consentement informé est adressée. L'intention n'est pas d'amener à une résolution définitive du problème posé, mais plutôt d'inviter á une discussion sur le sens (trop souvent pris pour réalité) du consentment 'informé' quant il s'agit de l'observation participante. Dieser Artikel stützt auf Forschungen, die die Autoren in Frauengesundheits-Kliniken und Spitälern unternommen hatten. Die Diskussion ist hier über die Themen Informierte Zustimmung und Mitteilende Beobachtung. Die Autoren befassen sich mit der Vielschichtigkeit der Entscheidungskräfte wenn die Forscher doppelte oder mehrfache Rollen haben, die manchmal im Konflikt sein können. Andere Faktoren, die die Entscheidungsmöglichkeit beeinflussen, sind auch untersucht. Besonders wird hier die Komplexität des erhalten von informierter Zustimmungung während des Forschungsprozesses angesprochen. Die Absicht ist nicht, eine definitive Lösung des Problems zu finden, sondern eher zu einer Debatte einzuladen über die zu oft als selbstverständlich betrachtete Bedeutung der 'informierten' Zustimmung auf der Ebene der mitteilenden Beobachtung.
Medical and Nursing Ethics: Never the Twain?
Authors: Gallagher Ann 
Published: November 2007

Since the publication of Carol Gilligan's In a different voice in 1982, there has been much discussion about masculine and feminine approaches to ethics. It has been suggested that an ethics of care, or a feminine ethics, is more appropriate for nursing practice, which contrasts with the 'traditional, masculine' ethics of medicine. It has been suggested that Nel Noddings' version of an 'ethics of care' (or feminine ethics) is an appropriate model for nursing ethics. The 'four principles' approach has become a popular model for medical or health care ethics. It will be suggested in this article that, whilst Noddings presents an interesting analysis of caring and the caring relationship, this has limitations. Rather than acting as an alternative to the 'four principles' approach, the latter is necessary to provide a framework to structure thinking and decision-making in health care. Further, it will be suggested that ethical separatism (that is, one ethics for nurses and one for doctors) in health care is not a progressive step for nurses or doctors. Three recommendations are made: that we promote a health care ethics that incorporates what is valuable in a 'traditional, masculine ethics', the why (four principles approach) and an 'ethics of care', the 'how' (aspects of Noddings' work and that of Urban Walker); that we encourage nurses and doctors to participate in the 'shared learning' and discussion of ethics; and that our ethical language and concerns are common to all, not split into unhelpful dichotomies.
Ethical Issues in Qualitative Nursing Research
Authors: Holloway Immy , Wheeler Stephanie 
Published: November 2007

This article is concerned with ethical issues that have to be considered when under taking qualitative research. Some of the issues - such as informed consent, the dignity and privacy of the research subjects, voluntary participation and protection from harm - are the same as in other types of research and have their basis in moral and ethical principles. Qualitative research, however, generates specific ethical problems because of the close relationship that researchers form with participants. Qualitative research with patients is especially difficult because of their vulnerability and lack of power in the clinical situation. Therefore the potential conflict between the dual role of the nurse - the professional and the research roles - has to be solved. Researchers also learn how to cope with the tension of subjective and objective elements of the research. Nurses who attempt qualitative research have to consider a variety of complex ethical issues, which are addressed in this paper.
Enhancing Ethical Thinking: the Role of a National Nurses' Association
Authors: Panchaud Catherine 
Published: November 2007

In democratic Switzerland, each of its 26 cantons (states) has its own government and its own laws. Thus there are 26 ministries of health and as many different laws regulating medical and health care practice. The Swiss Nurses' Association likewise has 13 regional chapters and a central organization that works on the national level. Medicine is private and practically all of the Swiss population is privately insured. High technology has led to high specialization with, among other results, a reduced number of premature deaths, longer life span but also rising costs of health. Health professionals are also becoming much more aware of ethical issues such as cost versus quality, high technology versus compassionate care, etc. A multilingual (four national languages) and multicultural country, Switzerland's health care system relies heavily on foreign nurses, many of whom come from neighbouring France and Germany but also from England, Yugoslavia, Canada and other countries. Regulation of nursing practice is still poor. Nursing or nurses are hardly mentioned in the state laws and, when mentioned, are often put in a dependent relation to the physician. Basic nurse training is regulated nationally by cantonal delegations to the Swiss Red Cross. Although there is a good postbasic training scheme, nurses are still striving for access to the university. Meanwhile, they go abroad to acquire degrees. Research in nursing is being developed mainly by the efforts of individuals and the Swiss Nurses' Association.
Client Age, Gender, Behaviour: Effects On Quality of Predicted Self-Reactions and Colleague Reactions
Authors: Greipp Mary Elizabeth 
Published: November 2007

This comparative study shows biases relative to client age, gender and behaviour demon strated by 268 female nurse subjects. A repeated measures design was utilized. All three main effects were significant (p < 0.001) for how respondents predicted that they would react to various clients and also how they predicted that their colleagues would react. Most two-way and three-way interaction effects were significant. Subjects demonstrated more favourable reactions to nice, young, male clients and least favourable reactions to not nice, old, male clients. Study subjects predicted more favourable self-reactions to simulated clients than for their colleagues. What should be important to every professional as a result of this study is the need to be aware of self-biases, which may cause errors in decision-making and nursing care interventions and lead to ethical violations with clients.
Ethics in the Intensive Care Unit: a Need for Research
Authors: Kendrick Kevin , Cubbin Bev 
Published: November 2007

Intensive care units are challenging and technologically advanced environments. Dealing with situations that have an ethical dimension is an intrinsic part of working in such a milieu. When a moral dilemma emerges, it can cause anxiety and unease for all staff involved with it. Theoretical and abstract papers reveal that having to confront situations of ethical difficulty is a contributory factor to levels of poor morale and burnout among critical care staff. Despite this, there is a surprising dearth of published nursing research in the UK that investigates how staff deal with ethical issues in intensive care units. The purpose of this paper is to explore and discuss the development of a research framework designed to explore how staff deal with moral dilemmas in a British inten sive care unit.
Ethical Dilemmas Experienced By Hospital and Community Nurses: an Israeli Survey
Authors: Wagner Nurit , Ronen Ilana 
Published: November 2007

The objective of this survey was to assess the extent to which nurses encounter and identify dilemma-generating situations in the light of the publication and circulation of the Israeli code of ethics for nurses in 1994. The results are being used as a basis for a programme aimed at promoting nurses' decision-making skills in coping with ethical dilemmas. In this era of major advances in medicine, the nurse's role as the protector of patient rights may bring about conflicts with physicians' orders, with institutional policies, or with patients' families. Nurses will then become confronted with ethical and moral dilemmas. A nationwide survey was carried out to identify and describe the ethical conflicts with which nurses in Israel are confronted in the course of their work. A third of the enumerated dilemmas were encountered by more than 50% of the nurses. The major determinant influencing encounters with dilemmas, as perceived by the participating nurses, was their work setting, namely, the hospital versus the community. It was shown that nurses seek support mainly among their peers, they are barely familiar with the Israeli Code, and they consider their own families as the predominant factor in shaping their ethical attitudes.
Dehydration Among Terminally Ill Patients: an Integrated Ethical and Practical Approach for Caregivers
Authors: De Ridder Dolf , Gastmans Chris 
Published: November 2007

The purpose of this paper is to examine the possibilities and limitations of an ethical and practical approach to terminal dehydration. We have argued that dehydration among terminally ill patients offers an important key to a better understanding of the dying process, and that the caregivers' reactions can lead to a deepening of holistic palliative care. This article makes clear that the moral question of terminal dehydration can only be treated by an interdisciplinary approach. Therefore, before studying the question of the most humane course possible, we must first understand the meaning of dehydration and its repercussions for the dying patient. Inspired by an attitude of respect for a good dying process, we have suggested that it is possible to put forward as a general guideline that medical therapy should be progressively reduced when it has been determined that a patient has reached the terminal stage, or is in an irreversible deteriorating process. We describe the critical somatic, social, psychological, moral and spiritual points, which make up an ethical approach to terminal dehydration (TD). In the total care of the irreversibly terminally ill patient, tolerating TD can be an expression of an authentic and caring involvement in the dying patient's welfare.
Overview of targeted therapies in Oncology
Authors: Kalyn Rhonda 
Published: November 2007

Background: Recent scientific advances have provided a map of the human genome along with a better understanding of the processes that transform healthy cells into diseased cells. This has led to the emergence of a new class of drugs called targeted therapies. Objective: To describe the classifications and basic pharmacology of targeted therapies. Methods: A literature search was performed for peer reviewed journal articles using Medline (1996—2007), Embase (1996—2007) and Google. The search was performed using keywords such as angiogenesis inhibitors, cancer vaccines, gene therapy, monoclonal antibodies, small molecules, proteasome inhibitors, targeted therapy and tyrosine kinase inhibitors. Conclusions: A review of the basic pharmacology is described in this article, including the following major categories of targeted therapies: • Small molecule drugs • Monoclonal antibodies • Apoptosis-inducing drugs • Angiogenesis Inhibitors • Cancer vaccines • Gene therapy J Oncol Pharm Practice (2007) 13: 199—205.