bluuebunny/crossref_metadata_2025_split huggingface dataset:
Influence of depressive symptoms and premorbid adjustment on factor structure of phenomenology of schizophrenia: a study from India
Authors: Kulhara Parmanand , Avasthi Ajit 
Published: September 2003

AbstractThis study investigated the nature of factor structure of schizophrenia syndromes using a sample of 151 patients with schizophrenia according to DSM-IV. The patients were assessed on the Scale for the Assessment of Positive Symptoms (SAPS), the Scale for the Assessment of Negative Symptoms (SANS), Hamilton Depression Rating Scale (HDRS) and the Phillips Rating Scale of Premorbid Adjustment in schizophrenia. Three factors—negative syndrome, reality-distortion syndrome and disorganized syndrome were extracted when only SAPS and SANS were analysed. Addition of the Phillips Rating Scale scores to SAPS and SANS ratings in the factorial equation led to splitting of the negative syndrome though reality-distortion and disorganized syndromes remained stable. Factor analysis of the HDRS scores with SAPS and SANS ratings resulted in the HDRS loading highly on reality-distortion syndrome and splitting of negative syndrome. Factor analysis of all the variables taken together resulted in delineation of four factors. The study suggests a link between depression and reality distortion. Apathy and anhedonia seem to be linked to premorbid adjustment.
Comorbidity of parkinsonism and schizophrenia in a patient treated with clozapine
Authors: Urban A. , Libiger J. , Hosák L. , Kupka K. 
Published: September 2003

AbstractClozapine is the least likely anti-psychotic to induce extrapyramidal symptoms (EPS). We present a surprising case of a woman schizophrenic patient treated with clozapine suffering from EPS. Single photon emission computed tomography (SPECT) revealed a low density of presynaptic dopamine transporters in our patient's brain. A comorbid diagnosis of Parkinson's disease in schizophrenia was confirmed in this way. This helped us to find a proper therapeutic strategy for our patient.
Matrix metalloproteinase‐8 correlates with the cervical ripening process in humans
Authors: Sennström Maria B. , Brauner Annelie , Byström Birgitta , Malmström Anders , Ekman Gunvor 
Published: September 2003

Background.  To determine levels of matrix metalloproteinases MMP‐1, ‐3 and ‐8 and localize them and the tissue inhibitors of metalloproteinases TIMP‐1 and ‐2 in human cervical tissue during the cervical ripening process.Methods.  Cervical biopsies were obtained from 10 term‐pregnant (TP) women and from nine women immediately after vaginal delivery. Ten nonpregnant (NP) women served as controls.Levels of MMP‐1, ‐3 and ‐8 were analyzed in supernatants of homogenized cervical tissue by specific enzyme‐linked immunosorbent assay (EIA). Localization with immunohistochemistry of these MMPs and TIMP‐1 and ‐2 was performed using monoclonal antibodies.Results.  MMP‐8 reached its peak median level, 7300 ng/mg wet weight, in biopsies obtained from postpartum (PP) women, as compared to 86 ng/mg wet weight in NP (p < 0.001) and 266 ng/mg wet weight in TP (p = 0.016) women. The immunohistochemical results confirmed these findings, with a clear increase in MMP‐8 staining in ripened cervix localized primarily in the stromal tissue. Levels of MMP‐1 and ‐3 as measured with EIA were low in all three groups, but immunohistochemically a more frequent positive staining for MMP‐1 and ‐3 was registered in pregnant cervical tissue compared to nonpregnant. For TIMP‐1 and also for TIMP‐2 immunohistochemical analysis showed that staining in all groups was more prominent in pregnant cervical tissue compared to nonpregnant.Conclusion.  The results indicate that MMP‐8 is involved in the process of cervical ripening, and that MMP‐1 and ‐3 and their inhibitors TIMP‐1 and ‐2 may also play a role in this complicated process.
Midtrimester triple test levels in women with severe preeclampsia and HELLP syndrome
Authors: Shenhav Simon , Gemer Ofer , Volodarsky Michael , Zohav Efraim , Segal Shmuel 
Published: September 2003

Background.  The levels of midtrimester triple test constituents are known to be altered in hypertensive disorders of pregnancy.Objective.  Our aim was to determine whether midtrimester triple test constituent levels differ in women with severe preeclampsia and those who also develop HELLP (hemolysis, elevated liver enzymes, and low platelet count) syndrome.Methods.  A retrospective chart analysis of 106 women with severe preeclampsia for whom midtrimester triple test data were available was made. None of these patients had fetuses with abnormal karyotype, nor did they deliver infants with malformations. The levels of midtrimester maternal serum alpha‐fetoprotein (MSAFP), human chorionic gonadotropin (MShCG) and unconjugated estriol (MSuE3) of 74 patients with severe preeclampsia were compared with those of 32 patients who also developed HELLP syndrome.Results.  The mean MShCG was significantly higher and the mean MSuE3 was significantly lower in patients with HELLP syndrome than in those with only severe preeclampsia [1.78 multiple of the medians (MoM), standard error (SE) 0.18 vs. 1.27 MoM, SE 0.07, p = 0.015 and 0.86 MoM, SE 0.05 vs. 1.04 MoM, SE 0.07; p = 0.03, respectively].The two groups did not differ significantly with regard to MSAFP levels.Conclusion.  Unexplained high levels of midtrimester MShCG and low levels of MSuE3 may be associated with the development of HELLP syndrome in women with severe preeclampsia.
Relationship between vitamin use, smoking, and nausea and vomiting of pregnancy
Authors: Källén Bengt , Lundberg Gittan , Åberg Anders 
Published: September 2003

Background.  Nausea and vomiting in pregnancy (NVP) is a common complaint but risk factors for NVP are not well characterized.Methods.  Occurrence of NVP was studied by questionnaires given to pregnant women at their first visit to the antenatal care unit and were returned around gestational week 28.Results.  Analysis of 3675 completed questionnaires was made. Nausea and vomiting in pregnancy was reported by 79% of the women, approximately half of which had been vomiting. Various therapies (drugs, acupuncture, acupressure) were tried by 18% of the women with NVP, of which the majority used drugs, most notably antihistamines (specifically meclozine). Hospitalization occurred in 1% of all women. Nausea and vomiting in pregnancy caused 28% of all sick‐leaves during the first 28 weeks of pregnancy. Low maternal age and parity 1+ independently increased the risk for NVP. Smoking before pregnancy and using vitamins in early pregnancy were associated with a decreased risk for NVP. Women working outside the home had a lower rate of NVP than housewives and women out of work.Conclusions.  Nausea and vomiting in pregnancy is a common complaint with a significant impact on leave of absence from work. The study identifies a number of factors that are related to the occurrence of NVP and that may give hints on the etiology of the condition.
Determinants of episiotomy in rural Zimbabwe
Authors: Van Den Bergh Janneke E. , Sueters Marieke , Segaar Marc , Van Roosmalen Jos 
Published: September 2003

Background.  To assess the influence of parity, mode of birth, place of birth, a history of birth by only cesarean section and birthweight on episiotomy rates.Methods.  Retrospective study of 3589 women giving birth vaginally from October 1997 to October 1998 in the Gutu district in Zimbabwe, to obtain the rate of episiotomy and its determinants.Results.  The overall episiotomy rate was 27%; 54% in nulliparous and 6% in multiparous women. Perineal tears varied between 5 and 11% in the different places of birth.Discussion.  An episiotomy rate of 54% in nulliparous women is higher than necessary. Medical and midwifery training should be adapted to facilitate a more restrictive use of episiotomy.
Careful nursing: a model for contemporary nursing practice
Authors: Meehan Therese Connell 
Published: September 2003

Background. Careful nursing, a system of nursing developed in Ireland by Catherine McAuley in the early years of the 19th century and used by Irish nurses at the Crimean war, has been described as Ireland's legacy to nursing. Although records of careful nursing have been preserved, it has received little attention in the nursing literature.Aim. The purpose of this study was to conduct a preliminary content analysis of the mainly primary source historical documentation of the careful nursing system and present it within the structure of a contemporary conceptual model of nursing.Methods. The documents describing the careful nursing system were studied and re‐studied to gain understanding of the philosophical assumptions underlying careful nursing and of the thinking, attitudes, actions and practice of the nurses. Content relating to the four central nursing concepts was identified and summarized.Results. Careful nursing definitions of person, environment, health and nursing are presented. Ten key concepts of careful nursing practice are identified as disinterested love, contagious calmness, creation of a restorative environment, ‘perfect’ skill in fostering safety and comfort, nursing interventions, health education, participatory‐authoritative management, trustworthy collaboration, power derived from service and nurses’ care for themselves. The spiritual dimension of human life and the spiritual in nursing emerge as important characteristics of the model.Conclusions. The results of this preliminary analysis require further verification and critical examination. However, the careful nursing model illuminates important aspects of professional nursing and could be further developed to conceptualize and guide nursing practice.
Lyme disease presenting with multiple erythema migrans lesions: an illustrative case
Authors: Weed Brent , Davis Mark D. P. 
Published: September 2003

A 39‐year‐old, previously healthy male park ranger presented to the emergency room with a 24‐h history of a rapidly progressive, widespread, painful skin eruption associated with severe viral illness‐like symptoms of fever as high as 40 °C, generalized migratory arthralgias, exhaustion, and malaise with prostration. On physical examination, confluent urticarial plaques, many with dusky and bruise‐like central discoloration, were observed involving approximately 90% of the skin, sparing the scalp, palms, and soles (Fig. 1). He was febrile with a temperature of 39 °C, and had signs of dehydration with orthostatic hypotension. Physical examination, including cardiovascular and neurologic examination, was otherwise normal. There was no evidence of lymphadenopathy.Confluent urticarial plaquesimageBecause the patient was severely dehydrated, he was admitted to the hospital service for intravenous fluids and further evaluation. He was started on oral doxycycline, 100 mg twice daily. Within 3 h, he experienced increased arthralgia, malaise, and fever. Because of the possibility that these symptoms represented a reaction to the antimicrobial, the medication was changed to ceftriaxone, 2 g intravenously every 24 h.A skin biopsy was obtained from the edge of one of the plaques on the patient's back (Fig. 2). The biopsy showed scant perivascular lymphocytic infiltrates consistent with urticaria. Borrelia‐like spirochetes were observed on dark‐field examination of the tissue. An enzyme‐linked immunosorbent assay (ELISA) Lyme disease screen was positive. Borrelia burgdorferi antibodies were as follows: immunoglobulin G (IgG) (Western blot) showed five bands with molecular weights of 66, 45, 41, 39, and 23 kDa; immunoglobulin M (IgM) antibodies were positive, as demonstrated by immunofluorescence. Polymerase chain reaction was positive for B. burgdorferi in the skin, but negative in blood. A search for serologic markers for ehrlichiosis, babesiosis, and Rocky Mountain Spotted Fever was negative.Biopsy of urticarial plaqueimageOver the following 4 days, the patient's skin eruption cleared, leaving mild postinflammatory pigmentary changes; he still felt listless and tired. One week later, his systemic symptoms had resolved, and he returned to work.
Effect of 17‐α‐ethynylestradiol on germ cell proliferation in organ and primary culture of medaka (Oryzias latipes) testis
Authors: Song Miyeoun , Gutzeit Herwig O. 
Published: September 2003

Organ cultures and primary cell cultures of medaka (Oryzias latipes) testis were compared with respect to cell viability and cell proliferation. The analysis by fluorescence microscopy and flow cytometry showed that in both cultures, the cells remained viable for at least 1 day and cell proliferation could be analyzed reliably by BrdU incorporation. The proliferating cells were mostly spermatogonia located at the periphery of the testis in tissue sections. Both culture systems were used to study the effect of 17‐α‐ethynylestradiol on cell proliferation. The results obtained with organ and primary cultures were consistent: low concentrations (0.01 and 1 nm) of synthetic estrogen stimulated cell proliferation slightly, while a higher concentration (100 nm) had an inhibitory effect. Both culture methods are suitable for the analysis of substances that might interfere with germ cell proliferation or other functions in spermatogenesis.
Mapping the range and scope of emergency nurse practitioner services in the Northern and Yorkshire Region: a telephone survey
Authors: Marr S , Steele K , Swallow V , Craggs S , Procter S , Newton J , Sen B , McNabb A 
Published: September 2003

Objective:To map the range and scope of emergency nurse practitioner (ENP) services in the Northern and Yorkshire Region as part one of a three phased study investigating the developing role of the ENP on a multi-professional context.Methods:A telephone survey was conducted in the 48 hospital trusts within the region. Semi-structured interviews were arranged with the senior nurses responsible for accident and emergency services in responding departments. Data collection entailed completion of a form comprising 14 open-ended questions designed to elicit information about the range and scope of ENP services (as defined by the Royal College of Nursing). Data were analysed using descriptive statistics.Results:Interviews were conducted at 35 (73%) of the sites, 22 (63%) of which had an ENP service as defined above. Wide variation was found in the range of services in relation to: hours/days of availability; age range and sources of referrals of patients accessing the service; clinical caseloads of ENPs and the referral pathways to other services.Conclusion:The findings from the survey highlight the organic, context specific nature of ENP role developments in response to national government initiatives, professional agendas, and local service needs.
Predictors of falls in a high risk population: results from the prevention of falls in the elderly trial (PROFET)
Authors: Close J C T , Hooper R , Glucksman E , Jackson S H D , Swift C G 
Published: September 2003

Objectives:The prevention of falls in the elderly trial (PROFET) provides evidence of the benefits of structured interdisciplinary assessment of older people presenting to the accident and emergency department with a fall. However, the service implications of implementing this effective intervention are significant. This study therefore examined risk factors from PROFET and used these to devise a practical approach to streamlining referrals from accident and emergency departments to specialist falls services.Methods:Logistic regression analysis was used in the control group to identify patients with an increased risk of falling in the absence of any intervention. The derived predictors were investigated to see whether they also predicted loss to follow up. A second regression analysis was undertaken to test for interaction with intervention.Results:Significant positive predictors of further falls were; history of falls in the previous year (OR 1.5 (95%CI 1.1 to 1.9)), falling indoors (OR 2.4 (95%CI 1.1 to 5.2)), and inability to get up after a fall (OR 5.5 (95%CI 2.3 to 13.0)). Negative predictors were moderate alcohol consumption (OR 0.55 (95%CI 0.28 to 1.1)), a reduced abbreviated mental test score (OR 0.7 (95%CI 0.53 to 0.93)), and admission to hospital as a result of the fall (OR 0.26 (95%CI 0.11 to 0.61)). A history of falls (OR 1.2 (95%CI 1.0 to 1.3)), falling indoors (OR 3.2 (95%CI 1.5 to 6.6)) and a reduced abbreviated mental test score (OR 1.3 (95%CI 1.0 to 1.6)) were found to predict loss to follow up.Conclusions:The study has focused on a readily identifiable high risk group of people presenting at a key interface between the primary and secondary health care sectors. Analysis of derived predictors offers a practical risk based approach to streamlining referrals that is consistent with an attainable level of service commitment.
Incidence and prevalence of domestic violence in a UK emergency department
Authors: Boyle A , Todd C 
Published: September 2003

Background:American and Australian studies indicate that domestic violence is common among patients attending for emergency care. It is not clear whether this applies to patients attending emergency departments in the UK.Methods:A single centre cross sectional study. Adult patients attending the emergency department of Addenbrooke’s Hospital, Cambridge were interviewed in randomly allocated time blocks, using validated questions from a US study. Potential participants were excluded if they (1) were unwilling (2) had an altered mental status (3) had a companion who refused to leave (4) were too ill (5) were unable to speak English (6) personal contacts of the interviewer.Results and Conclusions:256 completed interviews were returned out of a possible 307 (84.8%). The incidence of domestic violence was 1.2% (95% CI 0.2% to 3.4%). The lifetime prevalence of domestic violence was 22.4% (95% CI 15.6% to 30.4%) among men and 22.1% (95% CI 15.1% to 30.5%) among women. The incidence and prevalence rates of domestic violence were considerably lower than in the US study, but similar to prevalence rates recorded in British community surveys. A significant association was found between reported domestic violence and reported deliberate self harm in women (odds ratio 75.4 95% CI 13.1% to 433.7). There was no significant association between higher use of medical care and domestic violence.Interpretation:Domestic violence is common among patients attending for emergency care in the UK. There is a significant association between domestic violence and deliberate self harm in women, further work is required to see if this association is causal. Larger emergency department surveys are required to confirm these results.
A pragmatic approach to timely disease surveillance in the emergency department
Authors: Chan J T K , Cameron P A 
Published: September 2003

Background:Computerised emergency department (ED) logs have been in use for more than 20 years. Despite this, public health authorities have failed to fully utilise this important surveillance tool.Setting:Alice Ho Miu Ling Nethersole Hospital (AHNH) is a 500 bed community hospital with ED attendance of 350–400 patients a day in Hong Kong.Intervention:After the introduction of an ED computerised management system across Hong Kong in 1997, AHNH monitored common presentations using standard statistical software. Deviations from average attendance frequency were reported to public authorities. Experience during 1999 and 2000 calendar years is reported.Results:Apart from the usual seasonal variation in presentations such as respiratory tract infection and gastroenteritis, specific public health interventions appeared warranted in presentations related to dog bites, bee stings, rubella, hand foot and mouth, chicken pox, and scooter injuries.Discussion:ED computer information systems should be an effective tool for disease surveillance. In communities where this is not the case, public health authorities should insist on timely access and reporting of ED attendance data.
Paramedic accuracy in using a decision support algorithm when recognising adult death: a prospective cohort study
Authors: Jones T , Woollard M 
Published: September 2003

Background:Prolonged advanced life support for cardiac arrest victims who present with non-shockable arrhythmias in an out of hospital setting is associated with extremely poor survival rates. This and the risks associated with rapid ambulance transport to hospital have resulted in the development of decision support algorithms, enabling paramedics to recognise when adult death has occurred. The aim of the study was to assess the accuracy with which paramedics used such an algorithm.Method:This prospective 16 month cohort study evaluated 188 events of recognition of adult death (ROAD) by paramedics in the period from November 1999 to February 2001.Results:Of 188 ROAD applications, errors were made in 13 cases (6.9%, 95% CI 3.7 to 11.5. Additionally, there was one adverse clinical incident associated with a case in which ROAD was applied (0.5%, 95% CI 0.01 to 2.9%). ECG strips were unavailable for eight cases, although ambulance records indicated a rhythm of asystole for each of these. Assuming this diagnosis was correct, ROAD was used 174 times without errors (93%, 95% CI 88 to 96%). Assuming that it was not, the ROAD protocol was applied without errors in 166 cases (88.3%, 95% CI 82.8 to 92.5%). None of the errors made appeared to be attributable to poor clinical decision making, compromised treatment, or changed patient outcome. The mean on-scene time for ambulance crews using the ROAD policy was 60 minutes.Conclusion:Paramedics can accurately apply a decision support algorithm when recognising adult death. It could be argued that the attendance of a medical practitioner to confirm death is therefore an inappropriate use of such personnel and may result in unnecessarily protracted on-scene times for ambulance crews. Further research is required to confirm this, and to determine the proportion of patients suitable for recognition of adult death who are actually identified as such by paramedics.
Comparison of a long spinal board and vacuum mattress for spinal immobilisation
Authors: Luscombe M D , Williams J L 
Published: September 2003

Objectives:This study was designed to compare the stability and comfort afforded by the long spinal board (backboard) and the vacuum mattress.Methods:Nine volunteers wearing standardised clothing and rigid neck collars were secured on to a backboard and vacuum mattress using a standard strapping arrangement. An operating department table was used to tilt the volunteers from 45 degrees head up to 45 degrees head down, and additionally 45 degrees laterally. Movements of the head, sternum, and pubic symphysis (pelvis) from a fixed position were then recorded. The comfort level during the procedure was assessed using a 10 point numerical rating scale (NRS) where 1=no pain and 10=worst pain imaginable.Results:The mean body movements in the head up position (23.3v6.66 mm), head down (40.89v8.33mm), and lateral tilt (18.33v4.26mm) were significantly greater on the backboard than on the vacuum mattress (p<0.01 for all planes of movement). Using the NRS the vacuum mattress (mean score=1.88) was significantly more comfortable than the backboard (mean score=5.22) (p<0.01).Conclusions:In the measured planes the vacuum mattress provides significantly superior stability and comfort than a backboard.