bluuebunny/crossref_metadata_2025_split huggingface dataset:
Varicose veins: a qualitative study to explore expectations and reasons for seeking treatment
Authors: Palfreyman Simon John , Drewery‐Carter Kim , Rigby Kathryn , Michaels Jonathan A , Tod Angela Mary 
Published: December 2004

Background.  Patients experience a wide range of symptoms from varicose veins and are seeking treatment from health care providers. However, there is little data on the relative effectiveness of the treatments available. Patients are therefore often confronted with a choice regarding treatment that they are ill‐equipped to make. This lack of certainty and the resultant potential for variability in treatment decisions can mean that patients have expectations that are unrealistic or unfulfilled.Aims and objectives.  The aim of our study was to explore patients’ expectations and reasons for seeking treatment for varicose veins. Additional aims included the exploration of symptoms associated with varicose veins and their impact on quality of life.Design.  Qualitative study conducted in a large NHS Trust.Methods.  A total of 16 patients, who had been referred to a specialist vascular service for the treatment of varicose veins, were recruited. Semi‐structured interviews were used to explore the patients’ reasons for seeking treatment. Framework analysis was used to analyse the data from the anonymized transcripts.Results.  Participants attributed a wide range of symptoms to their varicose veins, and were actively seeking treatment with the expectation that they would gain symptom relief. The symptoms attributed to their varicose veins had a significant negative impact on their quality of life and lifestyle. Improving the cosmetic appearance of their legs was seen as a secondary benefit.Conclusions.  The perceived symptoms of varicose veins can impact on lifestyle and quality of life. Patients seek treatment with the expectation of treatment outcomes that are not supported by robust clinical evidence. Appropriate education and management of such expectations are an essential step in caring for this group of patients.Relevance to clinical practice.  Nurses are caring for patients with varicose veins in a range of clinical settings. When caring and providing information for this group of patients, nurses need to be aware of the impact of varicose vein symptoms and to understanding that patients may have unrealistic expectations or invalid reasons for seeking treatment.
Bed articles for nursing care – state of the art in two German hospitals
Authors: Boggatz Thomas , Grabowski Kati , Winne Heike , Gunzelmann Frank , Tuschke Hagen , Dassen Theo 
Published: December 2004

Background.  Bed articles are basic instruments for positioning. Research about this topic has concentrated on evidence for better practice. However, little is known about what practitioners really do.Aims and objectives.  This study intended to identify the most common bed articles used for positioning in two German hospitals, and to determine the decision‐maker for their application and the purposes and criteria for their choice.Methods.  Nursing experts from 100 wards were interviewed with the help of a structured questionnaire and based on these data a list of the 10 most frequent devices was compiled.Results.  Supporting the body position was the most frequent intervention performed by German nurses, mainly with the help of hydraulic beds, pillows and blankets. Nurses were the main decision‐makers for the use of these bed articles. Their choice was mainly based on work experience and patients’ desires. Guidelines and literature played a minor role in this process.Relevance to clinical practice.  If nurses, despite the medical doctors’ role as the main decision‐maker in German hospitals, exert significant influence on this aspect of care, they can support their position by evidence‐based practice.
Reflection, the way to professional development?
Authors: Gustafsson Christine , Fagerberg Ingegerd 
Published: December 2004

Background.  Many studies have focused on reflection and the advantages that can be gained from the practice of reflection among Registered Nurses (RNs) but, what are the implications of the nurses’ reflections, what do they reflect about, and how do they deal with their reflections?Aims and objectives.  The aim of this study was to describe the RNs’ experiences of reflection in relation to nursing care situations, and to understand how RNs use reflection in their daily work. What are the implications of the nursing care situations that the RNs’ reflect upon? What consequences did the practice of reflection have in nursing care situations in relation to the RNs professional development?Design and method.  The study was carried out with interviews and the phenomenographic method. Interviews were carried out with four RNs. The choice of informants was made with purposive sampling with the aim of finding informants who could bring the kind of knowledge that was necessary for the study.Results.  The qualitative differences regarding the RNs’ experiences of reflection were categorized as follows: to reflect (to think back – consider, mirroring, to reflect before and reflect after, to use experiences), nursing care situations (ethical considerations, to have courage, to use one's imagination, empathy) and consequences (to meet the unique, empathy, development). Finally, the findings were implicated in the model of professional development.Conclusion.  By using reflection as a tool, many advantages can be gained in the development of nursing care. Encouraging RNs to reflect upon nursing situations, in order to promote the nurse's professional development, will imply better nursing care for the patients. The model for professional development implies a simplified representation of the thoughts pertaining to professional nursing development.Relevance to clinical practice.  The relevance for clinical practice will be to understand the contents of the RNs reflections, to recognize the advantages of reflective practice and how and when to use such measures. Furthermore, to show how the model for professional development can be used in order to create a framework for evaluating these observations and consequently, for expressing tacit knowledge.
The development and pilot evaluation of a nutrition education intervention programme for pregnant teenage women (food for life)
Authors: Wrieden W. L. , Symon A. 
Published: December 2004

AbstractBackground  A healthy diet in pregnancy is important for both maternal and infant health but this may be difficult to achieve particularly for groups such as teenage pregnant women, many of whom are from disadvantaged backgrounds. To our knowledge this is the first report of a practical nutrition education programme for this group in the UK.Method  An intervention was designed incorporating seven informal food preparation sessions, which allowed opportunities for discussion of nutritional, and other topics (e.g. food safety and well‐being in pregnancy). Midwives in a community centre setting led the sessions.The acceptability of the package to participants and midwives was recorded and pre‐ and post‐intervention data collected on sociodemographic details, dietary intake (using an eating‐habits questionnaire and a 24‐h dietary recall) and cooking skills.Results  The midwives found the package easy to follow and use. The 16 (of the 120 invited) women who attended found the courses helpful but objective evaluation of dietary intake was not possible because of poor compliance.Conclusions  The nutrition education programme was favourably received by midwives and the women who participated. However recruitment was problematic and alternative methods of delivering and evaluating such a package should be investigated.
High GAD65 autoantibody levels in nondiabetic adults are associated with HLA but not with CTLA‐4 or INS VNTR
Authors: Rolandsson O. , Hägg E. , Janer M. , Rutledge E. , Gaur L. K. , Nilsson M. , Hallmans G. , Lernmark Å. 
Published: December 2004

Abstract.  Rolandsson O, Hägg E, Janer M, Rutledge E, Gaur LK, Nilsson M, Hallmans G, Lernmark Å (Umeå University, Umeå, Sweden; Institute for Systems Biology and University of Washington, Seattle, WA, USA). High GAD65 autoantibody levels in nondiabetic adults are associated with HLA but not with CTLA‐4 or INS VNTR. J Intern Med 2003; 253: 447–453.Objectives.  To explore the relationship between genetic background and antibody levels in a nondiabetic population. We evaluated if high levels of autoantibodies against the 65 kDa isoform of glutamic acid decarboxylase (GAD65Ab), were associated with high‐risk genes, i.e. HLA, CTLA‐4 and INS VNTR genes.Design and subjects.  Seventy‐five (M/F 39/36) subjects exceeding the 95th percentile of GAD65 autoantibody index and 75 age and sex matched subjects below the 95th percentile, randomly selected amongst participants in the Västerbotten Intervention Programme.Methods.  The GAD65 Ab were measured in a radioligand‐binding assay. HLA class II typing was performed by an oligoblot hybridization method. CTLA‐4 repeat length was analysed and divided into short forms and long forms. Class I and class III alleles of INS VNTR were detected. Differences in distribution were tested by Pearson chi‐square with Yates correction. Odds ratios (OR) were used to compare groups calculated with Cochran's and Mantel–Haenszel statistics.Results.  The DQB1*0201‐DQA1*0501‐DRB1*03 haplotype was increased in subjects with high GAD65Ab levels (P = 0.04). This increase seemed to be explained by a difference in haplotype frequencies amongst men (P = 0.01). Calculating OR showed a significant association between the DQB1*0201‐DQA1*0501‐DRB1*03 haplotype and elevated levels of GAD65Ab in all subjects (OR 2.2, 95% CI 1.02–4.9) as well as in men (OR 4.6, 95% CI 1.3–15.9). There was no association between high levels of GAD65Ab and either INS VNTR or CTLA‐4 polymorphisms.Conclusion.  Our study suggests that adult males with the DQB1*0201‐DQA1*0501‐DRB1*03 haplotype tend to develop high GAD65Ab titres. As none of these subjects have developed diabetes these data suggest that HLA may be important in GAD65Ab formation but that additional factors are required for the progression to overt type 1 diabetes.
Life‐threatening thrombotic complications of relative polycythaemia
Authors: Biswas M. , Prakash P. K. , Cossburn M. , Myers K. , Hanna F. 
Published: December 2004

Abstract.  Biswas M, Prakash PK, Cossburn M, Myers K, Hanna F. Life‐threatening thrombotic complications of relative polycythaemia (Case Report). J Intern Med 2003; 253: 481–483.Relative polycythaemia refers to raised haematocrit with normal red cell mass. Plasma volume may be reduced. This condition is associated with acute hypoxia, smoking, alcohol and diuretics. We describe two life‐threatening thrombotic events in two patients with relative polycythaemia under age 40 years. The first had myocardial infarction and on admission haemoglobin was 21.6 g dL−1. The second developed pulmonary embolism and haemoglobin was 19.1 g dL−1. Both patients received antithrombotic measures and isovolumetric venesection. Sixteen patients (age <40 years) who attended our accident and emergency department in 1 year had a haemoglobin level of >18.0 g dL−1. Recognition of relative polycythaemia in at risk‐individuals may help reduce thrombotic risk.
DNA vaccines: a review
Authors: Liu M. A. 
Published: December 2004

Abstract. Liu MA (Strasbourg, France and Karolinska Institute, Stockholm, Sweden). DNA vaccines: a review (Review). J Intern Med 2003; 253: 402–410.The DNA vaccines are simple rings of DNA containing a gene encoding an antigen, and a promoter/terminator to make the gene express in mammalian cells. They are a promising new approach for generating all types of desired immunity: cytolytic T lymphocytes (CTL), T helper cells and antibodies, whilst being a technology that has the potential for global usage in terms of manufacturing ease, broad population administration and safety. This review gives an overview of the mechanisms, preclinical and clinical efficacy of DNA vaccines, and point out the limitations of the first generation of such vaccines, and some of the promising second‐generation developments. This technology is also being utilized in the field of proteomics as a tool to elucidate the function of genes. The breadth of applications for DNA vaccines thus ranges from prophylactic vaccines to immunotherapy for infectious diseases, cancer, and autoimmune and allergic diseases.
The reliability of different formulae to predict creatinine clearance
Authors: Verhave J. C. , Baljé‐Volkers C. P. , Hillege H. L. , De Zeeuw D. , De Jong P. E. 
Published: December 2004

Abstract.  Verhave JC, Baljé‐Volkers CP, Hillege HL, de Zeeuw D, de Jong PE (University Medical Center Groningen, Groningen University, Institute of Drug Exploration, Groningen, the Netherlands). The reliability of different formulae to predict creatinine clearance. J Intern Med 2003; 253: 563–573.Objectives.  Creatinine clearance (CCR) is a commonly used tool to measure glomerular filtration rate (GFR) in clinical practice. This tool requires collection of 24‐h urine, which is quite bothersome. Several different formulae have been used to estimate GFR using plasma creatinine and other easy formulae to obtain biometrical data. We examined 10 formulae and compared them with actually measured CCR in a large sample of the general population.Design.  Cross‐sectional cohort study.Setting.  University hospital outpatient clinic, a population based study.Subjects.  A total of 8592 inhabitants of the city of Groningen, 28–75 years of age. The cohort is enriched for microalbuminuria.Results.  In general, the formulae did not give an accurate estimation of CCR, particularly not in male and in obese subjects. Six formulae, including the Cockcroft–Gault gave a fairly good estimation of CCR in the overall population and in subgroups of specific gender, body mass index and age. All formulae however, gave an underestimation of the measured CCR in higher ranges of CCR and an overestimation in the lower ranges. Moreover, the age‐related decline of CCR is hard to approximate with a formula.Conclusions.  We conclude that formulae to estimate CCR in the general population, although giving a fairly good estimate of mean CCR, do not offer reliable data on CCR in the upper and lower ranges and do not adequately estimate the age–related decline in CCR.
Current status of blood substitute research: towards a new paradigm
Authors: Winslow R. M. 
Published: December 2004

Abstract. Winslow RM (University of California, San Diego, CA, USA). Current status of blood substitute research: towards a new paradigm (Minisymposium). J Intern Med 2003; 253: 508–517.For many reasons, haemoglobin, modified to prolong its circulation time, seems to be the optimal choice for a cell‐free O2 carrier (blood substitute) because of its capacity to reversibly bind O2 in the lung and release it in tissue. After refining methods to prepare highly purified haemoglobin solutions and to chemically or genetically modify haemoglobin to overcome renal toxicity and to prolong retention time, a number of unwanted effects were observed in human clinical trials. These included symptoms referable to the GI tract, elevated pancreatic enzymes and hypertension, presumed to be the result of vasoconstriction. Studies on the mechanism of vasoconstriction induced by haemoglobin, using new techniques to investigate the microcirculation have led to a surprising new paradigm for the design of safe and effective solutions. These include increased O2 affinity (low P50) and increased viscosity and oncotic pressure. These second‐generation solutions hold greater promise for clinical development.
Future generations of red blood cell substitutes
Authors: Chang T. M. S. 
Published: December 2004

Abstract.Chang TMS (Artificial Cells & Organs Research Center, McGill University, Montreal, Quebec, Canada). Future generations of red blood cell substitutes (Minisymposium). J Intern Med 2003; 253: 527–535.Polyhaemoglobins (PolyHb) and perfluorochemicals are in advanced phase III clinical trials and conjugated haemoglobins in phase II clinical trial. New recombinant human haemoglobin with no vasoactivity is being developed. A soluble macromolecule of PolyHb–catalase–superoxide dismutase is being studied as an oxygen carrier with antioxidant properties. New artificial red blood cells that are more like RBC are being developed. One is based on haemoglobin lipid vesicles. A more recent one is based on nano‐dimension artificial red blood cells containing haemoglobin and RBC enzymes with membrane formed from composite copolymer of polyethylene glycol–polylactic acid. Their circulation time is double that of PolyHb.
Redox side reactions of haemoglobin and cell signalling mechanisms1
Authors: Yeh L.‐H. , Alayash A. I. 
Published: December 2004

Abstract.  Yeh L‐H, Alayash AI (Center for Biologics Evaluation and Research, Food and Drug Administration, Bethesda, MD, USA). Redox side reactions of haemoglobin and cell signalling mechanisms (Minisymposium). J Intern Med 2003; 253: 518–526.Cell‐free chemically modified or recombinant haemoglobins developed as oxygen therapeutics are designed to correct oxygen deficit caused by ischaemia in a variety of clinical settings. Oxidative processes, which are in some cases enhanced when modifications are introduced that lower oxygen affinity, can limit the safety of these proteins. Direct cytotoxic effects associated with haemoglobins have been ascribed to the redox reactions between haemoglobin and biological peroxides [i.e. hydrogen peroxide (H2O2), lipid peroxides (LOOH) and peroxynitrite (ONOO–)]. Biochemical changes at the cellular, tissue and organ levels have been documented to occur in response to haemoglobin oxidative reactions. These peroxides have been implicated as regulators of redox sensitive cell signalling pathways. The effects of reactions between haemoglobin and biologically relevant peroxides may be more subtle than oxidative damage and may thus involve perturbation of redox sensitive signalling pathways. In this review, a brief outline of the role of cell‐free haemoglobin in oxidative and cell‐signalling pathways and the implications of these reactions on the safety and efficacy evaluation of haemoglobin‐based oxygen carries are presented.
Effect of vitamins and aspirin on markers of platelet activation, oxidative stress and homocysteine in people at high risk of dementia
Authors:   VITAL Trial Collaborative Group
Published: December 2004

Abstract. VITAL Trial Collaborative Group. Effect of vitamins and aspirin on markers of platelet activation, oxidative stress and homocysteine in people at high risk of dementia. J Intern Med 2003; 254:–.Objectives. To examine the association of cognitive impairment with platelet activation and reactive oxygen species and total homocysteine levels; and to assess the biochemical efficacy of treatment with aspirin and vitamin supplements in people at high risk of dementia.Subjects. People with dementia or mild cognitive impairment.Design and intervention. In a 2 × 2 × 2 factorial design trial, 149 people at high‐risk of dementia were randomized to receive either low‐dose aspirin (81 mg) or placebo; and folic acid (2 mg) plus vitamin B12 (1 mg) or placebo; and vitamins E (500 mg) plus C (200 mg) or placebo. Participants were seen twice before and once after 12 weeks of treatment.Main outcome measures. At each visit, participants had their cognitive function assessed and had blood collected for homocysteine, folate and vitamin B12 determination and urine collected for markers of platelet activation (11‐dehydro‐thromboxane B2) and reactive oxygen species (8‐epi‐PGF2α).Results. Prior to treatment, cognitive function was inversely related with homocysteine and with urinary thromboxane and isoprostane, and these associations were independent of age. Aspirin was associated with a median reduction in 11‐dehydrothromboxane B2 of 73% (P < 0.001). B‐vitamins lowered plasma homocysteine concentration by 30% (P < 0.0001) and antioxidant vitamins lowered isoprostane excretion by 26% (P < 0.1). No effect of treatment on cognitive function was detected.Conclusions. Aspirin and B‐vitamins were effective in reducing biochemical factors associated with cognitive impairment in people at risk of dementia. Large‐scale trials are now required to assess the relevance of aspirin and B‐vitamins for the maintenance of cognitive function in people at risk of dementia.
F‐18‐fluorodeoxyglucose positron emission tomography leading to a diagnosis of septic thrombophlebitis of the portal vein: description of a case history and review of the literature
Authors: Bleeker‐Rovers C. P. , Jager G. , Tack C. J. , Van Der Meer J. W. M. , Oyen W. J. G. 
Published: December 2004

Abstract.Pylephlebitis or septic thrombophlebitis of the portal vein is a serious infectious disorder. Early diagnosis is difficult, due to nonspecific symptoms and signs, limitations of diagnostic modalities and the lack of familiarity of physicians with this entity. We report the history of a 73‐year‐old man with fever of unknown origin (FUO) in whom laboratory tests, blood and urine cultures, chest X‐ray, abdominal ultrasound, and Indium‐111‐leucocyte scintigraphy did not reveal the cause of the fever. F‐18‐fluorodeoxyglucose (FDG) positron emission tomography (PET) subsequently pointed to the diagnosis of pylephlebitis, which was confirmed by computed tomography (CT) and percutaneous puncture. We conclude that FDG PET allows detecting inflammatory foci in patients with FUO and offers to make the diagnosis of pylephlebitis at an early stage.
Translation of clinical trials into clinical practice
Authors: Julian D. G. 
Published: December 2004

Abstract.The results of well‐conducted clinical trials should be translated into practice but there is good evidence that this is not happening. There are a number of reasons for this – ignorance of doctors and patients, uncertainty as to the applicability of trials to individual patients, indolence and inefficiency on the part of practitioners, and financial considerations. More attention needs to be paid to correct all these factors.
In vitroandex vivoeffects of the phosphodiesterase 4 inhibitor, rolipram, on thromboxane production in equine blood
Authors: Rickards K. J. , Page C. P. , Lees P. , Gettinby G. , Cunningham F. M. 
Published: December 2004

Phosphodiesterase 4 (PDE4) inhibitors have been shown to inhibit equine neutrophil functionin vitroand may be of benefit in recurrent airway obstruction (RAO), an allergy‐based respiratory disease characterized by inflammatory cell recruitment and activation within the lungs following exposure of susceptible horses to allergens in mouldy hay. The aim of this study was to evaluate the inhibitory effects of the PDE4 inhibitor, rolipram, in anin vitroassay of thromboxane (Tx) production. The assay was then used to monitor the activity of this compoundin vivoin normal and RAO‐affected horses. Rolipram and the structurally distinct PDE4 inhibitor, denbufylline, attenuated both lipopolysaccharide (LPS)‐induced and unstimulated Tx production in blood from normal horses. Thromboxane production appeared to involve a calcium‐dependent interaction between leucocytes and platelets (LPS‐induced Tx production = 2.3 ± 0.4, 4.5 ± 1.1 and 20.8 ± 3.6 ng/mL for platelets, leucocytes and blood, respectively) and rolipram‐inhibited Tx production via an effect on leucocytes. Inhibition ofex vivoLPS induced Tx production was detected after intravenous administration of rolipram (5 μg/kg) to normal ponies. This dose did not significantly affect either lung function or neutrophil accumulation when administered to three horses with clinical signs of RAO. This study suggests that inhibition of Tx production in equine blood can be used to measure PDE4 activity. However, PDE4 inhibitors with improved therapeutic profiles are required for evaluation in RAO.