bluuebunny/crossref_metadata_2025_split huggingface dataset:
Cerebral blood flow in the diabetic patient
Authors: Pallas Faith , Larson Douglas F 
Published: November 2007

Diabetes is a major risk factor for cardiovascular disease. Coronary revascularization utilizing cardiopulmonary bypass (CPB) is frequently required for the diabetic patient. Nondiabetic individuals can autoregulate cerebral blood flow (CBF) through metabolic and perfusion pressure mechanisms during CPB. However, it has been reported that diabetic patients have impaired CBF autoregulation during CPB. It is possible, therefore, that impaired CBF autoregulation may contribute to postoperative neuropsychologic dysfunction. The mechanisms for this defect may reside in impaired endothelial-dependent responses in the diabetic that are related to morphological and functional changes linking the vascular endothelium and the vascular smooth muscle. The morphological changes occurring in the diabetic include microangiopathy and macroangiopathy which are characterized by endothelial cell (EC) hyperplasia and basement membrane thickening. Also, significant functional changes in local control of vascular tone, such as an imbalance in the synthesis and secretion of vasoactive factors by the EC and abnormal reactivity of the vascular smooth muscle, are seen in the diabetic when compared to the nondiabetic. More specifically, vascular responses to both calcium-dependent pathways of vasoconstriction and nitric oxide pathways of vasorelaxation have been shown to significantly differ between the diabetic and nondiabetic. The emphasis of this discussion is to examine the molecular mechanisms by which diabetes alters vascular function, with emphasis placed on regulation of cerebral artery blood flow during CPB.
The impact of perfusionist education programme characteristics on programme directors' responsibilities
Authors: Plunkett Patrick F 
Published: November 2007

The purpose of this study was to measure the effect of four programme characteristics (curriculum design, type of degree offered, length of programme and number of students per class) on perfusionist education programme directors (PDs) in the USA in terms of the number of hours worked per week, number of cases pumped per year and workload mix. Descriptive and statistical analyses were performed on the responses to questionnaires sent to all perfusionist programmes between March 1993 and April 1994. PDs reported working an average of 51.8 h/week and pumping an average of 68.8 cases per year. All but one respondent reported spending more than 50% of his/her time (mean 74.5% ± 19%) on programme-related issues such as administration, classroom teaching and clinical instruction. This level of commitment, as well as the total number of hours worked per week, were not found to be influenced by the programme's length, duration, class size or type of degree awarded. However, PDs of baccalaureate programmes, and programmes with more than nine students spent a significantly greater proportion of their time on administrative issues than their colleagues in other types of programmes. The bureaucratic demands of baccalaureate and large programmes require PDs to devote an average of 39.5% of their time to administration, compared to 27.2% in the other programmes. The results of this study show that the operation of all perfusionist education programmes requires a major commitment of time on the part of the individual designated as PD.
Relationship between aerobic fitness and quality of life in female fibromyalgia patients
Authors: Ayán C. , Martín V. , Alonso-Cortés B. , Álvarez M.J. , Valencia M. , Barrientos M.J. 
Published: November 2007

Objective: To determine whether there is a direct link between quality of life and aerobic capacity among female fibromyalgia patients. Design: Cross-section study. Setting: University of León. Subjects: Twenty-nine women belonging to the León Fibromyalgia and Chronic Fatigue Association. Main measurements: Aerobic capacity and quality of life were measured by means of the Six-Minute Walk Test and the Fibromyalgia Impact Questionnaire. Outcome measures included heart rate and rate of perceived fatigue and dypsnoea. Results: The average distance walked was 432.8 (61.2) m and the total average Fibromyalgia Impact Questionnaire score was 47.5 (18.9). Only item 1 of the Fibromyalgia Impact Questionnaire, physical function, showed any statistically significant link with the distance walked, which had no statistically significant relationship with any of the variables studied. Conclusion: The physical fitness of women with fibromyalgia, as determined by the Six-Minute Walk Test and the Fibromyalgia Impact Questionnaire, has no direct relation with quality of life as the patients perceive it.
Usefulness of the Elderly Mobility Scale for classifying residential placements
Authors: Yu Mabel S. W. , Chan Chetwyn C. H. , Tsim Robin K. M. 
Published: November 2007

Background and purpose: To investigate the factor structure and cut-off scores of the Elderly Mobility Scale for making placement decisions in extended care settings. Subjects: Ninety elderly residents of mean ages ranging from 79.0 to 86.4 years were recruited from homes for the aged (OAH group), and care and attention homes with or without supplemental infirmary care (IS and non-IS groups, respectively). Methods: The Elderly Mobility Scale was administered to all the residents by five trained practising physiotherapists. Results: Factor analysis revealed a two-factor structure, with two items into a bed mobility subscale and the other five items into a functional mobility subscale. Significant differences were found in the residents' Elderly Mobility Scale scores among the OAH, non-IS and IS groups. The accuracy of the three cut-off scores based on the five functional mobility items reached 90% for classifying the residents into different placements. Discussion and conclusion: The findings suggested that Elderly Mobility Scale scores can be better interpreted with the `bed mobility' and `functional mobility' subscales. The high accuracy of classification based on the cut-off scores reflects a good item and construct match of the Elderly Mobility Scale. Our findings support the usefulness of the Elderly Mobility Scale for residential placement of elderly people, which can be generalized to residential settings and post-discharge plans similar to those used in this study.
Review article : The spinal administration of opioids in the treatment of acute and chronic pain: bolus doses, continuous infusion, intraventricular administration and implanted drug delivery systems
Authors: Cherry David A , Gourlay Geoffrey K 
Published: November 2007

The spinal administration of opioids has been a significant addition to the previously available alternatives for pain control for patients with pain related to cancer. This article does not debate the more widespread use of these techniques in patients with nonmalignancy related pain. The incidence of destructive neurolytic procedures has fallen in most centres where spinal opioids have been administered. Some types of cancer pain have proved to be more effectively controlled than others, but in most circumstances potentially reversible procedures, such as outlined in this article, should be given a therapeutic trial before embarking on neuro-destructive procedures.1 It should be reemphasized however, that the spinal route of administration should be instituted only after systemically administered opioids have been shown to be ineffective or associated with intolerable side effects.
Cancer pain and intrathecal morphine
Authors: Gonzalez-Navarro Andres , Molinero-Aparicio Tomas , Manzo Liliana 
Published: November 2007

A total of 40 cancer patients suffering from chronic pain were treated with morphine by intrathecal administration through a subcutaneous implanted reservoir. All patients had been treated previously with other methods without good results. Pain evaluation was made using the visual analogue scale (VAS) and our INO scales. A morphine intrathecal test was made initially, to disclose if this method of administration would be effective. The most frequent initial dose of morphine was 2mg/day and according to the pain relief, the dose was modified during the treatment. The tolerance phenomenon was present in our series but in a very large number of patients, the initial dose was maintained until the end of treatment. Side effects were comparable with those described by other authors. Respiratory depression did not occur in our series. The most important complications consisted of infection in the nervous system. This method of treatment can alleviate pain in cancer patients, but should not be done routinely, only when other methods have failed.
Isolated digital metastasis in bronchogenic carcinoma
Authors: Stone Ruth L. , Davies Jonathan P. 
Published: November 2007

Malignant metastasis to the bones of the hand is rare. Metastases may be isolated and presentation deceptive. Routine bone scan involves only the axial skeleton and therefore does not rule out metastasis elsewhere. A specific request must be made to scan peripheral bones if this is the area of interest. We present a case which illustrates these points and emphasizes the role of palliative surgery where other measures have failed.
Clinical audit by a palliative care team
Authors: McCarthy Mark , Higginson Irene 
Published: November 2007

Objective: To develop a method of audit for, and evaluate the work of, a palliative care support team. Methods: Through observation and discussion with the team, 14 items, forming the Support Team Assessment Schedule (STAS), were identified which were considered to represent independent care objectives. Definitions of scale points (0-6) were agreed for each item. The team made ratings at their weekly meeting for each patient during a 12-month period. Results: Of 124 patients seen by the team there were a minimum of two recordings for 82 patients which provided a measure of the outcome of care. The group mean scores showed statistically significant improvements on all items, but there were differences between items in the extent of improvement. The STAS helped to make the team's assessments more systematic, and feedback of the information focused attention on the team's treatment of terminal dyspnoea. Conclusion: Audit of palliative care is practicable by this method. The approach could also be developed for use in inpatient hospital and hospice settings.
Quality of care of the terminally ill: the carer's perspective
Authors: Sykes Nigel P , Pearson Sally E , Chell Susan 
Published: November 2007

The experience and opinions of carers of 106 patients dying of cancer in Pontefract Health District were obtained by semistructured interview approximately six months after bereavement. A balanced population of patients who had died either at home or in hospital was selected by quota sampling. The interview investigated the perceived quality of key areas of care and also collected carers' spontaneous comments about the service. These comments were grouped into the following categories related to dimensions of satisfaction with health care: organization of care; interpersonal relationships with health care professionals; communication of information; and the hotel services and environment in hospital. A total of 106 carers, 63% of those contacted, were interviewed and there was no significant difference in response rate between patient categories. Despite general satisfaction with medical treatment, 65% of carers cited inadequate control of symptoms; 58% of patients had not applied for any financial benefits, despite almost universal eligibility. Nearly 60% of patients had died in hospital, but a carer was present at the time of death in only 40% of these cases. Over half the carers had received no support since bereavement. Spontaneous comments about palliative care and relationships with staff were generally favourable, but were highly critical of communication with professionals and of the organization of care, although no carer had lodged any formal complaint. A smaller, local hospital was preferred to the district general hospital. It is concluded that informal carers provide a perspective on the quality of palliative care which complements that of health professionals. Methods of gathering carers' views which do not restrict comment to those areas perceived as important by health professionals should be an integral component of the monitoring and evaluation of all services involved in the provision of palliative care. The results of this study have already proved highly influential in directing the attention of the health authority to areas of service provision where deficiencies had not previously been recognized.
Palliative care services in Britain and Ireland - update 1991
Authors: Eve Ann , Smith Anthony M 
Published: November 2007

The objective of this study was to repeat part of a survey carried out the previous year and to describe and quantify the hospice and palliative care inpatient units throughout Great Britain and Ireland for the year 1991, this also to include a survey of palliative care day centres and hospital support services. Questionnaires were sent to 346 hospice and palliative care services in Great Britain and Ireland. Replies were analysed by the Hospice Information Service. A total of 293 replies were received (84% response). The report details bed usage, length of stay and admissions, deaths and discharges in inpatient units. It also describes provision of day centre places and type of services offered. An initial assessment is made of the different types of hospital palliative care support services available. An estimate of the number of patients receiving palliative care in inpatient units and in day care centres is made.
A self-evaluated assessment suitable for seriously ill hospice patients
Authors: Rathbone GV , Horsley S. , Goacher J. 
Published: November 2007

Current quality of life (QOL) assessments, whilst being suitable for patients undergoing active treatment, are often too cumbersome for patients who are in the terminal phase of their illness, and may themselves produce distress. In an attempt to measure QOL in these patients a simple assessment was piloted (PEPS - patient evaluated problem score) in which patients were asked to identify and grade major problems as they perceived them and also to grade problems previously identified by the medical and nursing staff. A global QOL score and a self-administered WHO score completed the assessment. Of 70 patients admitted to the unit over a seven-month period, 44 completed questionnaires, 38 in full. Subsequently, uptake has been far greater (due to establishment of the method as part of routine care) with 73% of all patients admitted to our unit completing PEPS. Overall, a mean of 5.6 problems per patient were identified, of which 14% were psychosocial. Of those patients who completed questionnaires, 58% identified problems not picked up by the nursing and medical staff; 52% of these were psychosocial problems. Of 28 patients who died having previously completed questionnaires 22 had done so in the previous three weeks including eight in the previous seven days. PEPS has proved very useful in the management of patients, enabling the identification of previously unrecognized or underrated problems, particularly of a psychosocial nature, and also as a means of evaluating progress. It is readily acceptable to patients, even those close to death.
The efficacy of choline magnesium trisalicylate (CMT) in the management of metastatic bone pain: a pilot study
Authors: Johnson JR , Miller AJ 
Published: November 2007

Twenty-six patients with painful, bony metastases were recruited into a randomized, double-blind, single dose, two-treatment, three-part crossover study of choline magnesium trisalicylate (CMT) and placebo. Assessments were made prior to and at one, two, three and four hours after dosing. Bone pain caused by metastatic cancer was significantly relieved one hour after the administration of 1500 mg CMT ( p = 0.04). At all four time points the pain was less than baseline with CMT and at three time points greater than baseline with placebo but these results did not reach statistical significance. The summed pain intensity difference for patients was greater with CMT than with placebo, but this also did not reach significance. The incidence of volunteered side-effects was similar for both treatments. The results suggest that a nonacetylating, nonsteroidal anti-inflammatory drug may have a role complementary to that of an opioid in the management of metastatic bone pain.
Epidural infection associated with epidural catheterization in a cancer patient with back pain: case report
Authors: Yap Keng Bee , Finlay Ilora G 
Published: November 2007

Single epidural injections of local anaesthetic/steroid mixtures and epidural catheterization are useful in controlling pain when other measures fail. However, epidural infection is a recognized risk of these procedures, but can be difficult to diagnose. This case report illustrates the complexity of diagnosis and management of epidural infection.
Regional Study of Care for the Dying: methods and sample characteristics
Authors: Addington-Hall Julia , McCarthy Mark 
Published: November 2007

The Regional Study of Care for the Dying (RSCD) was established in 1990 with the dual aims of providing district health authorities with an audit of local services for the dying, and of addressing questions about experiences of people dying from cancer, effectiveness of hospice care, and needs of, and appropriate service provision for, people dying from causes other than cancer. The survey methods are described in this paper, together with the characteristics and representativeness of the sample. An interview survey was conducted of family or others who knew about the last year of life of a random sample of people who died in 1990. It was based upon methods used in nationally representative surveys by Cartwright in 1969, and Cartwright and Seale in 1987. The setting was 20 district health authorities, who paid for local data collection. Approximately 270 deaths were randomly sampled in each district: 5375 deaths were sampled in total. As cancer patients are the focus of most services for the dying, cancer deaths were sampled disproportionately (54%). Interviews were obtained for 69% (3696) of the sample. The response rate varied significantly by cause of death, age and social class of deceased, and the degree of deprivation of the district. There were small, but statistically significant, differences in cause of death and age between those deaths for whom interviews were obtained and national figures for deaths occurring in 1990. The discussion addresses key issues in the study, including responses from ethical committees, response rate and quality of data. The survey has been successful, both in providing districts with information on local services, and in obtaining a large, broadly representative, sample of deaths, thus enabling many outstanding questions about the needs of dying patients and their families, and about appropriate service provision, to be addressed.
An investigation of the ability of oral naloxone to correct opioid-related constipation in patients with advanced cancer
Authors: Sykes NP 
Published: November 2007

A dose-ranging study of the use of oral naloxone in opioid-related constipation in patients with far-advanced cancer is reported. Naloxone doses were calculated as a percentage of the morphine dose each patient was receiving. Seventeen patients entered the first phase of the study, which had a randomised, double-blind design. Outcome measures were small bowel transit time (SBTT) measured by the lactulose/hydrogen breath test, pain scores and the occurrence of adverse events. One subject was excluded before receiving naloxone. No significant difference between placebo and naloxone occurred in the 14 remaining patients receiving total daily doses of naloxone 10% or less of the 24 h dose of morphine. Two further patients experienced a marked laxative effect with naloxone at 20% of the 24 h dose of morphine. In one of these, SBTT was available and was unchanged from placebo. The other declined to continue with SBTT measurement. Phase two of the study had an open design, in which laxative effects were determined clinically. Naloxone at a maximum dose level of 20% was given to seven patients, up to 40% to two patients and up to 80% to one patient. Four out of the seven patients in the 20% dose level group, and all of the remainder, experienced laxative effects. Two patients experienced symptoms of opioid withdrawal, one of whom also had return of pain. It is concluded that oral naloxone at a daily dose of 20% or more of the prevailing 24 h morphine dose is a potentially valuable therapy for opioid- related constipation. However, opioid withdrawal was observed and it is suggested that initial individual naloxone doses should not exceed 5 mg. Further research is needed into the oral absorption of naloxone, as well as further studies of clinical efficacy and dosing.
A comparison of hospice and hospital care for the spouses of people who die
Authors: Seale Clive , Kelly Moira 
Published: November 2007

To compare the quality of care for spouses of dying people in St Christopher's Hospice, London and nearby hospitals in 1994 and to make comparisons with earlier studies of the same setting, interviews were undertaken with spouses of people who had died from cancer in these settings, matched by the deceased's age and sex. The subjects comprised 66 people whose spouses had died in 1994, 33 of whom had died in the hospice, 33 in local hospitals. The mean age was 69.3; 61 % were female. No significant differences between groups were found on the outcome measures (adjustment to bereavement, anxiety and psychosomatic symptoms at the time of the final admission), largely replicating earlier studies in the same setting. In various respects hospitals have moved closer to hospice practice: in contrast to earlier studies, there were no differences in visiting patterns or in spouses helping with inpatient care. Bereavement follow-up is now initiated in some cases by hospitals. Liberal visiting hours could be stressful, however, and spouses sometimes helped with care to remedy staff shortcomings. Regret at not being present at the death was more common in the hospital group. Bereavement interventions may have more effect on subsequent adjustment if targeted on high-risk individuals. Other benefits than adjustment, however, may be achievable. Steps to create a calm atmosphere on hospital wards where people can be with their relatives near the time of death are desirable.