bluuebunny/crossref_metadata_2025_split huggingface dataset:
Medium-term results of permanent sacral nerve stimulation for faecal incontinence
Authors: Kenefick N J , Vaizey C J , Cohen R C G , Nicholls R J , Kamm M A 
Published: March 2003

Abstract

Background
Anal sphincter surgery for faecal incontinence is associated with significant morbidity and a variable outcome. Sacral nerve stimulation may provide a good functional outcome with minimal morbidity. This paper reports the experience in a single centre over 5 years.

Methods
Fifteen consecutive patients (14 women), median age 60 (range 37–71) years, underwent temporary, and subsequent permanent, stimulation. All had incontinence to solid or liquid stool; the aetiology was obstetric injury (seven patients), scleroderma (four), idiopathic (two), fistula surgery (one) and repaired rectal prolapse (one). Median duration of symptoms was 6 (range 2–15) years. Clinical evaluation, endoanal ultrasonography, bowel diary, quality of life questionnaire (Short Form (SF) 36) and anorectal physiological testing were performed before and after stimulation.

Results
Continence had improved in all patients at median follow-up of 24 (range 3–60) months. Eleven patients were fully continent. Episodes of faecal incontinence decreased from median (range) 11 (2–30) per week before stimulation to 0 (0–4) per week after permanent stimulation (P &lt; 0·001). Urgency improved in all patients (median (range) ability to defer less than 1 (0–1) versus 8 (1–15) min; P = 0·01). ‘Social function’ and ‘role-physical’ subscales of the SF36 improved significantly. Mean resting pressure (35 versus 49 cmH2O with temporary stimulation; P &lt; 0·05) and squeeze pressure increment (43 versus 69 cmH2O with permanent stimulation; P &lt; 0·01) increased. Rectal sensitivity to initial distension changed (mean 47 versus 34 ml air; P &lt; 0·05). There were no major complications.

Conclusion
Sacral nerve stimulation is a safe and effective treatment for faecal incontinence when conventional treatment has failed. There is minimal morbidity. The benefit is maintained in the medium term.
Randomized clinical trial of specific lactobacillus and fibre supplement to early enteral nutrition in patients with acute pancreatitis
Authors: Oláh A , Belágyi T , Issekutz Á , Gamal M E , Bengmark S 
Published: March 2003

AbstractBackgroundMicrobial infection of the pancreatic tissue in patients with severe acute pancreatitis increases the morbidity and mortality rates. Colonization of the lower gastrointestinal tract and oropharynx with Gram-negative, but sometimes also Gram-positive, bacteria precedes contamination of the pancreas. The aim of this study was to determine whether lactic acid bacteria such as Lactobacillus plantarum 299 could prevent colonization of the gut by potential pathogens and thus reduce the endotoxaemia associated with acute pancreatitis.MethodsPatients with acute pancreatitis were randomized into two double-blind groups. The treatment group received a freeze-dried preparation containing live L. plantarum 299 in a dose of 109 organisms, together with a substrate of oat fibre, for 1 week by nasojejunal tube. The control group received a similar preparation but the Lactobacillus was inactivated by heat.ResultsA total of 45 patients completed the study. Twenty-two patients received treatment with live and 23 with heat-killed L. plantarum 299. Infected pancreatic necrosis and abscesses occurred in one of 22 patients in the treatment group, compared with seven of 23 in the control group (P = 0·023). The mean length of stay was 13·7 days in the treatment group versus 21·4 days in the control group (P not significant).ConclusionSupplementary L. plantarum 299 was effective in reducing pancreatic sepsis and the number of surgical interventions.
Effect on outcome of early intensive management of geriatric trauma patients
Authors: Demetriades D , Karaiskakis M , Velmahos G , Alo K , Newton E , Murray J , Asensio J , Belzberg H , Berne T , Shoemaker W 
Published: March 2003

Abstract

Background
Despite significant injuries elderly patients (aged 70 years or more) often do not exhibit any of the standard physiological criteria for trauma team activation (TTA), i.e. hypotension, tachycardia or unresponsiveness to pain. As a result of these findings the authors' TTA criteria were modified to include age 70 years or more, and a protocol of early aggressive monitoring and resuscitation was introduced. The aim of the present study was to assess the effect of the new policy on outcome.

Methods
This trauma registry study included patients aged 70 years or more with an Injury Severity Score (ISS) greater than 15 who were admitted over a period of 8 years and 8 months. The patients were divided into two groups: group 1 included patients admitted before age 70 years and above became a TTA criterion and group 2 included patients admitted during the period when age 70 years or more was a TTA criterion and the new management protocol was in place. The two groups were compared with regard to survival, functional status on discharge and hospital charges.

Results
There were 336 trauma patients who met the criteria, 260 in group 1 and 76 in group 2. The two groups were similar with respect to mechanism of injury, age, gender, ISS and body area Abbreviated Injury Score. The mortality rate in group 1 was 53·8 per cent and that in group 2 was 34·2 per cent (P = 0·003) (relative risk (RR) 1·57 (95 per cent confidence interval 1·13 to 2·19)). The incidence of permanent disability in the two groups was 16·7 and 12·0 per cent respectively (P = 0·49) (RR 1·39 (0·59 to 3·25)). In subgroups of patients with an ISS of more than 20 the mortality rate was 68·4 and 46·9 per cent in groups 1 and 2 respectively (P = 0·01) (RR 1·46 (1·06 to 2·00)); 12 of 49 survivors in group 1 and two of 26 in group 2 suffered permanent disability (P = 0·12) (RR 3·18 (0·77 to 13·20)).

Conclusion
Activation of the trauma team and early intensive monitoring, evaluation and resuscitation of geriatric trauma patients improves survival.
Pathological appraisal of lines of resection for bile duct carcinoma
Authors: Ebata T , Watanabe H , Ajioka Y , Oda K , Nimura Y 
Published: March 2003

Abstract

Background
The aim of this study was to determine the most appropriate line of resection for extrahepatic bile duct carcinoma.

Methods
A retrospective review was carried out of 253 resected specimens of extrahepatic bile duct carcinoma. Carcinomas were classified histologically as invasive or non-invasive in addition to assessment of the resection margin.

Results
Tumour was present microscopically at the resection margin in 80 (31·6 per cent) of 253 cases, with 46 showing marginal involvement by non-invasive carcinoma, 20 showing invasive carcinoma at a margin, and 14 showing both. Involvement of the resection margin by invasive carcinoma was encountered only when the margin was shorter than 10 mm, whereas non-invasive carcinoma was encountered even when the margin length reached 40 mm. The observed length of microscopic extension of invasive carcinoma beyond the macroscopically evident tumour mass was limited to 10·0 mm. Median microscopic extension of non-invasive carcinoma beyond the mass was 10 mm (75th percentile 19·5 and 14·5 mm in proximal and distal directions respectively; maximum 52 mm). Margins of 20 mm could be assured to be negative proximally in 89·0 per cent of cases and distally in 93·8 per cent.

Conclusion
For eradication of invasive extrahepatic bile duct carcinoma, a 10-mm margin is required. However, additional removal of any non-invasive component requires a 20-mm margin. These guidelines should be followed in any operation performed with curative intent.
Laparoscopicin situablation of liver cancer with cryotherapy and radiofrequency ablation
Authors: Tait I S , Yong S M , Cuschieri Sir A 
Published: March 2003

AbstractBackgroundIn situ ablation has potential for the treatment of patients with liver cancer either as a single-modality treatment or in combination with liver resection.MethodsLaparoscopy and intraoperative ultrasonography was used to target cryotherapy and radiofrequency ablation. Thirty-eight patients with 146 liver lesions were treated between January 1995 and December 2000 using cryotherapy alone (nine patients), combined cryotherapy and radiofrequency (eight), radiofrequency alone (15) and in situ ablation with liver resection (six). Cancers treated were metastases from colorectal tumours (n = 25), hepatocellular carcinoma (n = 5), and neuro endocrine (n = 5), melanoma (n = 2) and renal cell (n = 1) metastases. Complications and survival after in situ ablation were compared with age- and disease-matched controls treated with systemic chemotherapy.ResultsThe mean age was 61·6 years. At mean follow-up of 26·6 (range 3–62, median 26) months, 22 patients were alive. Survival was increased following in situ ablation compared with that in controls (P &lt; 0·001). Local recurrence at the ablation site was noted in 12 of 44 lesions following cryotherapy and in 20 of 102 lesions after radiofrequency ablation, and new disease in the liver was found in six of 17 and six of 29 patients respectively. The complication rate was higher with cryotherapy than with radiofrequency ablation (four of 17 versus one of 29). Intraoperative ultrasonography identified 14 new hepatic lesions (10 per cent) not seen on preoperative imaging.ConclusionLaparoscopic in situ ablation should include ultrasonography to stage the disease. In situ ablation appears to have a survival benefit and should be considered for the treatment of liver cancer in appropriate patients.
Human glioma PKC‐ι and PKC‐βII phosphorylate cyclin‐dependent kinase activating kinase during the cell cycle
Authors: Acevedo‐Duncan M. , Patel R. , Whelan S. , Bicaku E. 
Published: March 2003

Abstract.Cell cycle phase transition is regulated in part by the trimeric enzyme, cyclin‐dependent kinase activating kinase (CAK) which phosphorylates and activates cyclin‐dependent kinases (cdks). Protein kinase C (PKC) inhibitors prevent cell cycle phase transition, suggesting a fundamental role for PKCs in cell cycle regulation. We report that in glioma cells, CAK (cdk7) is constitutively associated with PKC‐ι. In vitro phosphorylation, co‐immunoprecipitation, and analysis of phosphorylated proteins by autoradiography indicate that CAK (cdk7) is a substrate for PKC‐ι and PKC‐βII hyperphosphorylation. These results establish a role for PKC‐ι and PKC‐βII in the activation of CAK during the glioma cell cycle.
Cell kinetic studies in the murine ventral tongue epithelium: mucositis induced by radiation and its protection by pretreatment with keratinocyte growth factor (KGF)
Authors: Potten C. S. , Booth D. , Cragg N. J. , Tudor G. L. , O'Shea J. A. , Booth C. , Meineke F. A. , Barthel D. , Loeffler M. 
Published: March 2003

Abstract. Radiation kills or reduces reproductive capacity of proliferating cells, including stem cells. In the oral mucosae this can result in a decline in the number of cells in the tissue which, if severe enough, will result in the formation of an ulcer when the cellularity essentially reaches zero. We have used histometric measurements of cellularity following exposure to radiation in mouse ventral tongue epithelium as a model for oral mucositis (ulcer development). Here we provide further measurements of cellularity changes in the basal layer and in the epithelium as a whole at various times following 15, 20 or 25 Gy doses. The protective effects of prior treatment with keratinocyte growth factor (KGF) are also investigated. 20 Gy of 300 kV X‐rays has become our standard reference dose and the changes in cellularity seen following this dose are highly reproducible, with minimum values being observed 6 days following irradiation. A higher dose results in a greater reduction of cellularity, although the minimum value also occurs at 6 days. A lower dose (15 Gy) results in a much shallower curve, with a minimum value being observed about 1 day earlier. These changes in cellularity can be related to the less sensitive index of mucositis, namely epithelial thickness. There is also a sharp peak in proliferation about 1 day after the minimum in cellularity, i.e. on day 7. The peak following a lower dose of radiation occurs a little earlier and, following the higher dose, the peak tends to be broader. Previous work and data presented in the preceding paper in this series has shown that KGF, given over a period of 3 days, results in a dramatic increase in epithelial thickness in oral mucosa, including the ventral tongue. As a result of the increased cellularity induced by KGF given before radiation, a delay in the fall in cellularity results, which is the consequence of the increased number of cells in the epithelium at the beginning of the study.
Everybody needs good neighbours: an evaluation of an intensive project for families facing eviction
Authors: Hill Malcolm , Dillane Jennifer , Bannister Jon , Scott Suzie 
Published: March 2003

ABSTRACTThis paper presents details of a largely qualitative evaluation of an intensive multi‐method Project, with a residential component, which aims to help families facing eviction to overcome their housing‐related difficulties. The families served by the Project had a host of other problems related to parenting, with child care and protection issues, addictions and mental health difficulties figuring prominently. Just over half the referrals came from the local authority housing services, with nearly all the remainder coming from the social work department. The majority of families made good progress, but in some cases it proved harder to have an impact on parenting than on tenancy‐related matters. Nevertheless, the Project was deemed to have helped some families stay together or be reunited, resulting in substantial financial savings for social work services. Crucial ingredients were good management, stable staff, shared ‘ownership’ by other agencies, a repertoire of challenging methods, and a holistic approach.
Using the ‘Looking After Children’ dimensions to collect aggregate data on well‐being
Authors: Bailey Sue , Thoburn June , Wakeham Hilary 
Published: March 2003

ABSTRACTThe Department of Health has funded the development of a set of schedules for collating information on and monitoring the progress of children looked after by local authorities. An additional aspiration underlying official encouragement of the use of these ‘Looking After Children’ (LAC) materials was that they would provide aggregate data to feed into national and local policy and planning. Progress on this aim has been slow, in part because instruments designed to aid practice in individual cases have not adapted easily to the hoped for dual role, and in part because completion rates have been patchy and often poor. This paper describes an action research project designed to use the children's reviewing system to collect aggregate data on the LAC dimensions of well‐being. It comments on the viability of this method of aggregate data collection as well as locating the information on a cohort of 96 children in the context of other studies, and debates about whether the state can be a ‘good parent’.
‘Can I come home?’ The experiences of young runaways contacting the Message Home helpline
Authors: Mitchell Fiona 
Published: March 2003

ABSTRACTThis paper reports the findings of a 3‐month survey of young people calling the Message Home helpline. Message Home is a national freephone helpline available to people who have run away or left home which allows them to send a message to their family or carer, to seek confidential help and advice and, if necessary, to be helped to a place of safety. The paper explores the characteristics, circumstances and motivations of the young people contacting the helpline. It also considers who the young people contacted through the helpline and the kinds of messages that were relayed to parents, social services and others. This study differs from most preceding studies of runaways in recording the views of young people while they are missing. The immediacy palpable in their accounts highlights the distress and isolation experienced by many of these young people who have run away or been forced to leave home.
Drug information leaflets: adolescent and professional perspectives
Authors: Jones R , Finlay F , Crouch V , Anderson S 
Published: March 2003

SummaryThis study was undertaken to evaluate a range of drug information leaflets from both an adolescent and professional perspective. 72 adolescents were interviewed in focus groups within school settings. Fifteen paediatricians were also interviewed individually. Participants were asked to consider the leaflets under the following categories: initial impact, content and overall suitability for adolescents. Paediatricians were not good judges of which leaflets would appeal to adolescents. They tended to choose the leaflets with comic strip illustrations and those written in a ‘cool’ or witty style. In contrast the adolescents seemed to prefer a more sober approach with high quality factual information combined with clear illustrations.
Coping when a child has a disability: exploring the impact of parent‐to‐parent support
Authors: Kerr S M , McIntosh J B 
Published: March 2003

Summary Aim To explore the impact of parent‐to‐parent support when a child is born with a disability. Design The research approach was qualitative. Data were collected retrospectively and were derived from in‐depth interviews with parents. The audio‐taped interviews were transcribed and then analysed using constant comparative procedures. Setting Scotland. Participants The parents of 63 children born with a congenital upper limb deficiency. Findings The early weeks and months following the birth of their baby was a difficult and emotional time for most parents. Feelings of isolation were common and there was a lot of concern about what the future would hold. Although a certain amount of support was derived from contact with family, friends and health professionals, parents did not generally obtain the level of support that was required from these sources. Contact with other parents of limb‐deficient children, however, clearly exerted a powerful stress‐buffering influence, providing much needed emotional, social and practical support. Conclusions This study suggests that parents of children with special needs are uniquely qualified to help each other. The challenge is to ensure that health professionals are aware of the potential benefits of parent‐to‐parent support and provide parents with information about appropriate local organizations/ contacts.
Assessing children's and teenagers' bereavement when a sibling dies from cancer: a secondary analysis
Authors: Birenbaum L K 
Published: March 2003

SummaryThe purposes of this paper are to: (1) provide conceptual and empirical descriptions of the most frequently reported children's and teenagers' responses in anticipation of and after the death of a sibling from cancer; (2) describe these behaviours by age groups (3–5, 6–11 and 12–19 years); and (3) discuss the clinical utility of two new scales measuring children's bereavement. The literature review and an exploratory secondary analysis from a prospective longitudinal design were used to develop the empirical criteria for behavioural items indicative of bereavement. Data from four points in time: (1) 2 months before a child's death; (2) 2 weeks after death; (3) 4 months after death; and (4) 12 months after death were treated as a cross‐sectional design, because of sample size, to describe bereavement behaviours and to discuss the beginning development of a screening tool for childhood bereavement services
‘If I had a friend in a wheelchair’: children's thoughts on disabilities
Authors: Tamm M , Prellwitz M 
Published: March 2003

SummaryThe purpose of the present study was to examine what notions there are among ordinary preschool children and schoolchildren about physically handicapped children using wheelchairs. Forty‐eight children–16 children of preschool age (half boys, half girls, aged around 6), 16 children in primary school class 2 (half boys, half girls, aged around 8) and 16 children in class 4 (half boys, half girls, aged around 8)–constituted the investigated group. The method used was a combination of drawings produced by the children themselves serving as a projective image, interview questions in connection with the drawings and a self‐assessment scale, based on Osgood's semantic differential technique. The results showed that most children had favourable attitudes towards a child in a wheelchair. They were willing to include the disabled child in their games and recreational activities, and they considered that the disabled child would have many friends and a high self‐esteem. However, they saw real obstacles for the disabled child both in play situations and in other environmental settings. No tangible differences between the sexes could be found; however, differences by age were present. The results were discussed with regard to earlier research and topics for further research are suggested.
Difficulties for mothers in using an early intervention service for children with cerebral palsy in Bangladesh
Authors: McConachie H , Huq S , Munir S , Kamrunnahar  , Akhter N , Ferdous S , Khan N Z 
Published: March 2003

AbstractGiven the numbers of disabled children in Bangladesh and the lack of trained professionals, innovative forms of service delivery are required. The Bangladesh Protibondhi Foundation has developed an outreach parent training service based at two centres, one urban and one rural. Mothers are shown how to use pictorially based Distance Training Packages (DTP), which they take home. This paper presents findings concerning factors which seem to affect mothers’ attendance with their children at DTP advisory sessions. The study followed 47 children with cerebral palsy, aged between 2 and 5.5 years, over a period of around 18 months. The main factors predicting higher attendance were the child’s sex (i.e. boys were brought back more often), particularly in the rural area, and lower adaptation to the child reported by the mother. The problems described by mothers in using the DTP advisory service were economic (such as transport costs), cultural (such as mothers not being permitted out alone), and medical (such as the child having repeated fits). The implications for future service development are discussed.
Children’s understanding of the physical, cognitive and social consequences of impairments
Authors: Smith L A , Williams J M 
Published: March 2003

AbstractThe present study explored typically developing children’s (n= 77) understanding of physical, cognitive and social competencies of children with impairments. Children in each of four age groups (4–5 years, 6–7 years, 9–10 years and 11–12 years) were interviewed to explore their ideas about the abilities of children with physical impairments (minor: missing thumb; major: wheel‐chair bound), sensory impairments (vision and hearing), learning disabilities (non‐specific and Down’s syndrome) and emotional/behavioural difficulties (attention deficit hyperactivity disorder and lack of social skills). Significant age differences were found in children’s judgements of the capabilities of children with impairments. Furthermore, children’s understanding of the consequences of impairments varied as a function of disability type. Findings are discussed in relation to previous research on children’s disability concepts and implications for inclusive education practices.
Hair‐element analysis — still on the fringe
Authors: Morley N. , Ford R. P. K. 
Published: March 2003

AbstractIncreasing biological interest in minerals has led to the search for reliable methods to quantify body levels of trace elements and toxic metals. Hair has been a prime candidate because of its ease of collection and the possibility that this body tissue might accurately reflect body loads of these substances. A vast amount of research effort has been expended to explore the value of hair‐element analysis. Unfortunately, there are so many confounding factors that influence these measurements that isolated individual results cannot be relied upon. Their current value is in epidemiological studies.