bluuebunny/crossref_metadata_2025_split huggingface dataset:
Nursing staff resources in direct patient care: comparison of TISS and ICNSS
Authors: Pyykkö A. K. , Ala‐Kokko T. I. , Laurila J. J. , Miettunen J. , Finnberg M. , Hentinen M. 
Published: August 2004

Background:  The aim was to study the variation in the nursing workload and nursing staff resources in direct patient care.Methods:  Nursing staff resources and the patient‐nurse ratio (P/N) were compared between postoperative and mixed‐type intensive care units (ICUs) using the Therapeutic Intervention Scoring System (TISS) and the Intensive Care Nursing Scoring System (ICNSS) during a 4‐month period.Results:  A total of 832 patients were treated. In the postoperative ICU, the mean daily TISS score per nurse was 41.1, corresponding to a P/N of 1 : 1, and the mean ICNSS score was 33.8, corresponding to a P/N of 1 : 1.5. In the mixed‐type ICU, the mean TISS score per nurse was 34.7, corresponding to a P/N of 2 : 1, and the mean ICNSS score was 27.7, corresponding to a P/N of 1 : 1. In the postoperative unit, 50.4% of the patients would have required a 1 : 1 P/N ratio based on their TISS scores and 47.5% would have required 1.5 or two nurses as estimated by the ICNSS score. In the mixed ICU 57.1% of the patients would have required a P/N ratio of 1 : 1 based on TISS scores and 61.3% a ratio of 1 : 1.5 or 1 : 2 according to the ICNSS score.Conclusion:  Intensive Care Nursing Scoring System gives additional information about the nursing staff resources and yields a higher number of nurses needed in direct patient care even when TISS scores show the number of nurses to be adequate.
Body fat patterning in polycystic ovary syndrome women as a predictor of the response to clomiphene
Authors: Douchi Tsutomu , Oki Toshimichi , Yamasaki Hideki , Nakae Mitsuhiro , Imabayashi Akiko , Nagata Yukihiro 
Published: August 2004

Background.  To investigate the difference in the response to clomiphene citrate (CC) based on body fat distribution in women with polycystic ovary syndrome (PCOS).Methods.  Ninety anovulatory PCOS women were divided into two subgroups based on treatment response: women who ovulated with CC (CC responders, n = 49) and those who did not ovulate with CC (CC nonresponders, n = 41). Baseline characteristics included age, age at menarche, height, weight and body mass index [BMI; weight/(height)2]. Percentage of body fat, body fat mass and the ratio of trunk fat to leg fat mass amount (trunk–leg fat ratio) were measured by dual‐energy X‐ray absorptiometry (DEXA).Results.  Age, age at menarche and height did not differ between the two groups. However, trunk–leg fat ratio in CC responders (0.9 ± 0.4) was significantly lower than that in CC nonresponders (1.3 ± 0.4) (p < 0.001). Percentage of body fat, body fat mass and BMI were also lower in CC responders (p < 0.01). On multiple regression analysis, however, trunk–leg fat ratio proved to be a superior predictor of CC responder to percentage of body fat, BMI or body fat mass (standardized regression coefficient ≥ 0.510; t‐values ≥ 3.432; p < 0.001).Conclusions.  Response to CC in anovulatory PCOS women differs with body fat distribution.
Genetic influence on dystocia
Authors: Algovik Michael , Nilsson Emma , Cnattingius Sven , Lichtenstein Paul , Nordenskjöld Agneta , Westgren Magnus 
Published: August 2004

Background.  Dystocia—prolonged and difficult labor—is a common and worldwide problem during parturition. Epidemiological studies have suggested a familial aggregation. This study aimed to quantify the genetic influence (i.e. the heritability) on dystocia.Methods.  A retrospective study of all births in Sweden from 1973 through 1997 was undertaken. Data from the population‐based Swedish Birth, Twin and National Family Registers were linked on an individual basis. In total, 2 539 534 births were analyzed. Relationships between sibling and mother–daughter pairs were established. The relative risk for dystocia was calculated. Model‐fitting (Mx) was used to estimate the relative contribution of genetic and environmental factors for liability to dystocia.Results.  In all, 190 747 women were diagnosed with dystocia. Measures of familial similarity (relative risks and correlation of liability) for dystocia were higher in monozygotic than in dizygotic twins, other sibling pairs and mother–daughter pairs. Correlation of liability was also higher in full‐sisters than in half‐sisters. Model‐fitting suggested that genetic effects accounted for 28%[95% confidence interval (CI) 21–32] of the susceptibility for dystocia.Conclusion.  Dystocia is a complex disorder of poor uterine action that is influenced by a significant genetic component as well as environmental factors. The amount of genetic influence makes it interesting to study the gene expression in these patients. Detection of the genes related to dystocia might lead to better pathophysiological understanding of this condition and the possibility of detecting these mothers before parturition.
Side‐effects of hormone replacement therapy and influence on pattern of use among women aged 45–64 years.  The Norwegian Women and Cancer (NOWAC) study 1997
Authors: Bakken Kjersti , Eggen Anne Elise , Lund Eiliv 
Published: August 2004

Background.  Use of hormone replacement therapy (HRT) increased considerably in Norway during the 1990s. The aim of this study was to investigate reasons for starting and discontinuing HRT use and examine the prevalence of side‐effects and what impact they had on pattern of use.Methods.  The Norwegian Woman and Cancer (NOWAC) study is a population‐based, prospective study based on mailed questionnaires to women 30–70 years. This report is limited to a random sample of 4996 Norwegian women aged 45–64 years who participated in 1997 (response rate 62%). The questionnaire included detailed questions about HRT: reasons for starting and stopping, type of preparation, duration of use and side‐effects experienced.Results.  Most women started HRT to ameliorate climacteric complaints (75.9%). Only 8.7% had prevention of osteoporosis as the only reason for therapy. Mean duration of use was 4.9 years among current users. Side‐effects were reported by 43% of the ever users, nearly half of them reporting more than one side‐effect. Weight gain was the most frequent stated side‐effect (56.3%), although not statistically significant in association with HRT. Among ever users 28.2% discontinued therapy, more than half of them because of side‐effects.Conclusions.  The women's primary reason for starting HRT was climacteric complaints. Side‐effects were common and constituted the major reason for discontinuation of therapy. The women perceived weight gain as a side‐effect.
A population‐based case–control study of oral griseofulvin treatment during pregnancy
Authors: Czeizel Andrew E. , Métneki Júlia , Kazy Zoltán , Puho Elisabeth 
Published: August 2004

Aim:  To study the teratogenicity of oral griseofulvin during pregnancy.Methods:  The data of the population‐based Hungarian Case–Control Surveillance of Congenital Abnormalities between 1980 and 1996 and the Hungarian Congenital Abnormality Registry between 1970 and 2002 were evaluated.Results:  In total, 38 151 pregnant women who delivered newborn infants without any defects (control group) and 22 843 pregnant women who had fetuses or newborns with congenital abnormalities were included in the study. Seven (0.03%) case and 24 (0.06%) control pregnant women were treated with the griseofulvin (crude odds ratio with 95% confidence interval: 0.49, 0.21–1.13). A teratogenic potential of griseofulvin was not indicated by a comparison of the expected and observed number of different congenital abnormalities. A higher mean birth weight was found in control newborn infants born to mothers with griseofulvin treatment compared with the data of control newborn infants without this treatment. In addition, 55 conjoined twins were evaluated in the data set of the Hungarian Congenital Abnormality Registry, and no conjoined twins had mother with griseofulvin treatment during pregnancy.Conclusion:  Our data do not indicate a detectable teratogenic risk of oral griseofulvin treatment during pregnancy; however, the numbers of cases and controls were limited. Therefore, international collaboration is needed for the final conclusion.
Restricted fetal growth in sudden intrauterine unexplained death
Authors: Frøen J. Frederik , Gardosi Jason O. , Thurmann Anne , Francis André , Stray‐Pedersen Babill 
Published: August 2004

Background.  Unexplained antepartum stillbirth is a common cause of perinatal death, and identifying the fetus at risk is a challenge for obstetric practice. Intrauterine growth restriction (IUGR) is associated with a variety of adverse perinatal outcomes, but reports on its impact on unexplained stillbirths by population‐based birthweight standards have been varying, including both unexplained and unexplored stillbirths.Aim.  We have studied IUGR, assessed by individually adjusted fetal weight standards, in antepartum deaths that remained unexplained despite thorough postmortem investigations.Methods.  Antenatal health cards from a complete population‐based 10‐year material of 76 validated sudden intrauterine unexplained deaths were compared to those of 582 randomly selected liveborn controls. Birthweight <10th percentile of the individualized standard adjusted for gestational age, maternal height, weight, parity, ethnicity, and fetal gender was defined as growth restriction.Results.  52% of unexplained stillbirths were growth restricted, with a mean gestational age at death of 35.1 weeks. Suboptimal growth was the most important fetal determinant for sudden intrauterine unexplained death (odds ratio 7.0, 95% confidence interval 3.3–15.1). Concurrent maternal overweight or obesity, high age, and low education further increase the risk. Overweight and obesity increase the risk irrespective of fetal growth, and while high maternal age increases the risk of the normal weight fetus, it is not associated to growth restriction as a precursor of sudden intrauterine unexplained death.Conclusions.  IUGR is an important risk factor of sudden intrauterine unexplained death, and this should be excluded in pregnancies with any other risk factor for sudden intrauterine unexplained death.
Comparison of protein carbonyl and total plasma thiol concentrations in patients with complete hydatidiform mole with those in healthy pregnant women
Authors: Harma Mehmet , Harma Muge , Kocyigit Abdurrahim 
Published: August 2004

Background.  Normal pregnant women are known to have increased oxidative stress and lipid peroxidation (which can be estimated by protein carbonyl concentration) but offsetting antioxidant protection (of which plasma thiols are an important component).Aim.  This study set out to compare levels of these markers in normal pregnant women and patients with complete hydatidiform mole (CHM).Methods.  Blood was taken from 41 healthy pregnant women and 39 patients with CHM attending a university hospital, and protein carbonyl and thiol levels determined spectrophotometrically on plasma. Statistical analysis of the results was performed using Student's t‐test and Pearson's correlation.Results.  Patients with CHM were found to have significantly higher levels of protein carbonyls and lower (but non‐significant) levels of thiols.Conclusion.  The results may indicate oxidative stress as a feature of CHM.
Pregabalin Pharmacology and Its Relevance to Clinical Practice
Authors: Ben‐Menachem Elinor 
Published: August 2004

Summary:  Pregabalin is a potent ligand for the alpha‐2‐delta subunit of voltage‐gated calcium channels in the central nervous system that exhibits potent anticonvulsant, analgesic, and anxiolytic activity in a range of animal models. In addition, pregabalin has been shown to be a highly effective adjunctive therapy for partial seizures in clinical trials. Potent binding to the alpha‐2‐delta site reduces depolarization‐induced calcium influx with a consequential modulation in excitatory neurotransmitter release. Pregabalin has no demonstrated effects on GABAergic mechanisms. Pregabalin demonstrates highly predictable and linear pharmacokinetics, a profile that makes it easy to use in clinical practice. Absorption is extensive, rapid, and proportional to dose. Time to maximal plasma concentration is ∼1 h and steady state is achieved within 24–48 h. These characteristics reflect the observed onset of efficacy as early as day two in clinical trials. High bioavailability, a mean elimination half life (t1/2) of 6.3 h, and dose‐proportional maximal plasma concentrations and total exposures predict a dose–response relationship in clinical practice and allow an effective starting dose of 150 mg/day in clinical practice without need for titration. Administration with food has no clinically relevant effect on the amount of pregabalin absorbed, providing for a dosing regimen uncomplicated by meals. Pregabalin does not bind to plasma proteins and is excreted virtually unchanged (<2% metabolism) by the kidneys. It is not subject to hepatic metabolism and does not induce or inhibit liver enzymes such as the cytochrome P450 system. Therefore, pregabalin is unlikely to cause, or be subject to, pharmacokinetic drug–drug interactions—an expectation that has been confirmed in clinical pharmacokinetic studies. However, dose adjustment may be necessary in patients with renal insufficiency. Thus, the pharmacological and pharmacokinetic profiles of pregabalin provide a predictable basis for its use in clinical practice.
Narcissistic disorders in clinical practice
Authors: Britton Ronald 
Published: August 2004

Abstract:  In this paper1, the concept of narcissism in the psychoanalytic literature is reviewed and three uses of the term are defined, firstly, clinical narcissism, secondly, an innate force or tendency opposed to relationships and thirdly, narcissistic personality disorders. The latter can be further differentiated on the basis of the transference/countertransference into borderline (thin‐skinned), aloof (thick‐skinned) and as‐if (false‐self) narcissistic disorders. The characteristics of each of these patterns are described. The author suggests that narcissistic disorders arise when there is a failure of containment in infancy and childhood that gives rise to an ego‐destructive super‐ego leading to the evolving of a narcissistic organization. The libidinal defensive organization arises when parental failure of containment is the primary factor and destructive organization when the infant has an excess of object‐hostility.Two case descriptions are given to illustrate the distinction between a predominantly destructive and a predominantly libidinal narcissistic disorder and the author suggests that both arise from the production, by projective identification, of a narcissistic relationship with an ego ideal in order to evade a relationship with a destructive parental super‐ego.
Multicenter evaluation of two flow cytometric methods for counting low levels of white blood cells
Authors: Dijkstra‐Tiekstra Margriet J. , Van Der Meer Pieter F. , Pietersz Ruby N.I. , De Wildt‐Eggen Janny 
Published: August 2004

BACKGROUND: Flow cytometric methods can be used to count residual white blood cells (WBCs) in WBC‐reduced blood products, which should contain fewer than 1 × 106WBCs per unit (∼3.3 WBCs/µL). In this study two flow cytometric methods for counting WBCs under routine conditions in nine laboratories were evaluated.STUDY DESIGN AND METHODS: Panels of red blood cells (RBCs), platelets (PLTs), and plasma were prepared containing 33.3, 10.0, 3.3, 1.0, and 0.3 WBCs per µL and counted with flow cytometric methods (either LeucoCOUNT, BD Biosciences, four laboratories; or LeukoSure, Beckman Coulter, five laboratories). Requirements were that at the level of 3.3 WBCs per µL, coefficient of variation was ≤20 percent and accuracy was ≥80 percent. Routine flow cytometric quality control (QC) data of WBC‐reduced blood products from two laboratories were analyzed.RESULTS: At the level of 3.3 WBCs per µL, none of the laboratories met the requirements for all three blood products. The LeucoCOUNT method met requirements at more laboratories than the LeukoSure method for RBCs and PLTs, but the opposite was true for plasma. Routine QC data showed that >99 percent of the flow cytometric measurements for WBC‐reduced products was below the 95 percent prediction interval at 3.3 WBCs per µL.CONCLUSION: None of the laboratories met the requirements for accuracy and precision for all three blood products. Nevertheless, routine results showed that in >99 percent of the products, WBC counts were below guideline limits. Therefore, both flow cytometric methods are suitable for QC with pass‐fail criterion.
Hypotensive transfusion reactions can occur with blood products that are leukoreduced before storage
Authors: Arnold Donald M. , Molinaro Giuseppe , Warkentin Theodore E. , DiTomasso Julie , Webert Kathryn E. , Davis Ian , Lesiuk Lawrence , Dunn Geoffrey , Heddle Nancy M. , Adam Albert , Blajchman Morris A. 
Published: August 2004

BACKGROUND:  Leukoreduction before storage, rather than bedside white blood cell filtration, is recommended to prevent hypotensive transfusion reactions.STUDY DESIGN AND METHODS:  Investigation of hypotensive transfusion reactions during radical prostatectomy in two patients on angiotensin‐converting enzyme inhibitors. In Patient A, hypotension occurred during the transfusion of each of the following blood products: 2 units of autologous blood deposited and leukoreduced (LR) before storage; 3 units of allogeneic red cells LR before storage; and 2 units of non‐LR acute normovolemic hemodilution (ANH) whole blood. When each of the transfusions was stopped, the blood pressure recovered. In Patient B, hypotension occurred during the transfusion of non‐LR ANH whole blood. All implicated units were administered rapidly using a blood infuser at 37°C. Bradykinin (BK) and des‐Arg9‐BK formation and degradation and the activity of kinin‐degrading metallopeptidases were measured in plasma samples from both patients.RESULTS:  Degradation of des‐Arg9‐BK was severely impaired and the activity of aminopeptidase P severely reduced in Patient A, but not in Patient B. BK degradation was mildly impaired in both patients.CONCLUSION:  Hypotensive reactions can occur with blood products that are LR before storage and non‐LR ANH. An inherent defect in the metabolism of kinins may be a risk factor for the development of hypotensive transfusion reactions.
Increasing hemoglobin oxygen saturation levels in sickle trait donor whole blood prevents hemoglobin S polymerization and allows effective white blood cell reduction by filtration
Authors: Stroncek David F. , Byrne Karen M. , Noguchi Constance T. , Schechter Alan N. , Leitman Susan F. 
Published: August 2004

BACKGROUND Red blood cell (RBC) components from donors with sickle cell trait (Hb AS) often occlude white blood cell (WBC) reduction filters. Techniques were investigated to successfully filter Hb AS donor blood by increasing the Hb oxygen saturation with storage bags and conditions suitable for transfusion products.STUDY DESIGN AND METHODS:  Oxygenation kinetics were measured over 3 days in whole‐blood units stored in standard‐sized 600‐mL polyvinylchloride (PVC) bags and whole‐blood units divided into three equal parts and stored in standard‐sized blood bags made from PVC, tri‐2‐(ethylhexyl)trimellitate (CLX) plastic, or Teflon. The filterability of Hb AS blood stored for 3 days was tested with whole‐blood filters.RESULTS:  Oxygen saturation levels did not increase in full whole‐blood units from donors without sickle cell trait during 3 days of storage in 600‐mL PVC bags. In divided Hb AS whole‐blood units stored for 3 days, oxygen saturation levels increased from baseline levels of 45 to 56, 66, and 94 percent after storage in 600‐mL PVC, CLX, and Teflon bags, respectively (n = 5, p < 0.02), and all components filtered completely. When full Hb AS whole‐blood units from eight donors were stored for 3 days in 1.5‐L CLX bags, all units filtered completely, but one had a high residual WBC count.CONCLUSION:  Storage of Hb AS whole blood in large‐capacity oxygen‐permeable bags increases oxygen tension and allows more effective WBC reduction by filtration.
A red blood cell autoantibody with mimicking anti‐E specificity
Authors: Dwyre Denis M. , Clapper Adam , Heintz Mary , Elbert Char , Strauss Ronald G. 
Published: August 2004

BACKGROUND:  Uncommonly, antibodies that appear to exhibit antigenic specificity on red blood cell (RBC) panels fail to maintain specificity following alloadsorption (i.e., they mimic antigenic specificity). Understanding both the pitfalls and the proper pathways to establish the diagnosis and to interpret the clinical significance of these mimicking antibodies is important for patient management.CASE REPORT:  A 68‐year‐old woman was admitted with dyspnea, anemia, bilateral pulmonary emboli, and metastatic ovarian cancer. Blood bank evaluation identified anti‐E reactivity in the patient's plasma sample and a positive direct antiglobulin test (DAT).RESULTS:  The DAT was positive for immunoglobulin G and negative for C3b. An eluate of the RBCs showed E‐antigen specificity on a RBC antibody panel. Repeat serologic testing with RBC antibody panels with adsorbed patient plasma showed removal of apparent anti‐E reactivity with either E‐antigen‐positive or E‐antigen‐negative RBC stroma.CONCLUSION:  A mimicking autoantibody with apparent E‐antigen specificity was identified in the plasma sample of a woman with newly diagnosed ovarian cancer. Despite their relative low frequency, mimicking antibodies, whether auto‐ or alloantibodies, may interfere with the timely issuance of compatible blood products and may confuse laboratory and clinical staff. Determining the clinical significance of the antibody, by taking into account the RBC phenotype of the patient and the antigen prevalence in the general population, guides the extent of workup required to best utilize resources while assuring patient safety.
Real‐time amplification of HLA‐DQA1 for counting residual white blood cells in filtered platelet concentrates
Authors: Mohammadi Tamimount , Reesink Henk W. , Vandenbroucke‐Grauls Christina M.J.E. , Savelkoul Paul H.M. 
Published: August 2004

BACKGROUNDA real‐time polymerase chain reaction (PCR) assay based on amplification of a conserved region of the HLA‐DQA1 locus was developed and validated to assess its suitability in quantitating low levels of white blood cells (WBCs) in filtered platelet (PLT) concentrates (PCs).STUDY DESIGN AND METHODS: To determine the detection limit, serial dilutions of nonfiltered PCs with known quantities of WBCs were prepared. The analytical sensitivity and accuracy of the assay was tested with WBC concentrations ranging from 300 to 0.03 per µL with real‐time PCR and flow cytometry. In addition, 126 random PCs were investigated to assess the capacity of the PCR method to quantify residual WBCs in clinical specimens.RESULTS: A sensitivity of 0.2 WBC equivalent per µL (1.5 × 104WBC equivalents/unit) was achieved. The assay was shown to be accurate and the HLA‐DQA1 gene was reproducibly and consistently amplified in all tested samples (coefficient of variance of < 5%). Overall, the results of the PCR assay correlated well with those of the flow cytometry. The PCR assay detected a concentration of 3 WBCs per µL (approximately 1 × 106WBCs/unit) with 100 percent accuracy.CONCLUSION: Real‐time PCR is rapid, sensitive, accurate, and reproducible. Hence this approach may prove suitable in routine monitoring of residual WBCs in PCs.