bluuebunny/crossref_metadata_2025_split huggingface dataset:
Advanced home care: patients’ opinions on quality compared with those of family members
Authors: Larsson Bodil Wilde , Larsson Gerry , Carlson Solveig Rizell 
Published: December 2004

Background.  Advanced medical care in the patient's home setting is becoming more common. Many of the patients who receive this kind of care have severe illnesses and are unable to respond to questions about the quality of care. The research question was: are the patients’ opinions congruent with those of family members?Aim.  To explore and compare the relationship between patients’ perception of the quality of care and close family members’ perception of this care as well as their perception of the patients’ perception.Methods.  Sixty‐seven patients receiving advanced home care, 82 family members (54 matched patient + family member pairs) participated. Data were collected using a short version of the quality from the patient's perspective questionnaire modified to advanced home care.Results.  A high degree of perceptual congruence was found between patients and their family members. The similarity was also high between family members’ own opinion and their appraisal of how the patient perceived the care. A subgroup of family members who met the patient once a week or less often deviated from this pattern.Conclusion.  Patients’ views on the quality of care are congruent with the opinions of family members if they meet every day (live together) and share the same everyday and care‐related experiences. The results can be understood in the light of empathic accuracy theory.Relevance to clinical practice.  The findings of this study have important implications for clinical nursing practice. Family members’ perception of the quality of care may be a valuable data source for nurses in the case of advanced home care if the patient and family member share the same everyday, care‐related experiences, otherwise family members’ perception tend to be more critical than those of the patients themselves.
Dementia and aggressiveness: stimulated recall interviews with caregivers after video‐recorded interactions
Authors: Skovdahl Kirsti , Kihlgren Annica Larsson , Kihlgren Mona 
Published: December 2004

Background.  In a previous study, nine caregivers and two residents with dementia showing aggressive behaviour, were video recorded. Caregivers who reported problems when dealing with such behaviour and caregivers, who did not, were included in this study.Aim.  The aim of the present study was to obtain insight into the reasoning of the caregivers who had reported problems when dealing with older people with dementia and aggressiveness and those who did not relative to their respective video‐recorded interactions with these residents. A further aim was to gain insight by discussing their reasoning in relation to each other.Method.  Stimulated recall interviews were carried out with all the caregivers who had been video taped in the previous study. The text was analysed by thematic content analysis.Findings.  Two main ways of thinking and discussing the care situations emerged. The caregivers, who had reported problems in handling behavioural and psychiatric symptoms in dementia earlier, reasoned that they were more focused on their duties, this included being responsible for the resident receiving her weekly shower. For this group of caregivers, the well being of the resident was in focus, but their attention was concentrated on the resident's well being and comfort after their shower. However, these caregivers seemed therefore unwittingly to prevent a positive interaction with the resident. The other caregivers were able to reflect spontaneously and appeared to be self‐critical. This caregiver group seemed to sustain a positive interaction with the resident both during and after the shower.Relevance to clinical practice.  In this study a nurturing and supportive climate and competence seemed to be the conditions necessary to facilitate reflections and promote creativity in the caregivers such that they are able to develop possible ways of handling difficult situations like aggressiveness in residents with dementia.
SARS – a perspective from a school of nursing in Hong Kong
Authors: Thompson David R. , Lopez Violeta , Lee Diana , Twinn Sheila 
Published: December 2004

Background.  Severe acute respiratory syndrome (SARS) is a new infectious disease with significant morbidity and mortality that has had a major impact on health and health care services worldwide. Hong Kong has had a significant number of cases and deaths. Nurses, at the vanguard of the clinical health care team, have been particularly affected by it. The outbreak prompted the health authorities to implement a series of public health measures and hospital policies, including a guideline for the diagnosis and management of patients with SARS.Aims and objectives.  This paper aims at providing an overview of what is known about SARS and the impact it has had in Hong Kong and to highlight from the perspective of a school of nursing the major clinical, educational and public health implications.Conclusions.  The lack of understanding and uncertainty about the disease led to significant variation in the provision of information, contributing to the confusion and anxiety in the community. Therefore, there is a need to revise the nursing curriculum, to provide continuing education to all health care professionals, particularly with regard to infection control measures, and to revisit the range of public health policies to ensure the health of the community is protected by these policies. There also has been a reaffirmation of the importance of health promotion that highlights the importance of the partnership between nurses, health policy makers and public health personnel. It is evident that the organization and delivery of clinical practice, teaching and health promotion have to be flexible and responsive to a changing health scenario.Relevance to clinical practice.  Nurses must play a crucial role in the prevention, detection and containment of SARS. They will need to implement and ensure strict adherence to infection control measures and, in some circumstances, isolation and quarantine may be warranted. Attention to the psychological state of patients and family members should not be overlooked. Paramount is education of patients, families and members of the public at large.
Barriers to physicians’ decisions to discuss hospice: insights gained from the United States hospice model
Authors: McGorty E. Kiernan , Bornstein Brian H. 
Published: December 2004

AbstractDue to its comprehensive and cost‐saving design, hospice has become a critical component of health care. Physicians have become the primary gatekeepers to information on hospice and sources of referral to hospice. However, many physicians do not discuss hospice options until late in the disease course, when patients and their families are no longer able to benefit from hospice services. Although physicians, as well as patients and hospice personnel, cite patient and hospice structure factors as barriers, the present article will focus on barriers physicians have more control over, such as their discomfort discussing terminality and fear of losing contact with patients. Focusing on the American hospice model, the present article will review past findings, examine gaps in the research, and propose systematic ways to discern whether the factors physicians claim are barriers actually affect their decision making about hospice referral.
Eyelid trichoblastoma: an unusual localization
Authors: Mencía‐Gutiérrez Enrique , Gutiérrez‐Díaz Esperanza , Ricoy José R. , Rodríguez‐Peralto José L. 
Published: December 2004

A 79‐year‐old woman presented with an eyelid mass below the eyebrow. It was first noticed by the patient 7 months before and had slowly increased in size and had become itchy. Physical examination revealed an ulcerated, desquamative, nonumbilicated, nodular mass arising from the inner third of the right upper eyelid (Fig. 1). It was firm, well‐demarcated, and measured 12 mm in diameter and 10 mm in height, without free edge involvement (to 0.9 cm). The remainder of the ocular examination was normal. With a clinical diagnosis of basal cell carcinoma, it was completely excised under local anesthesia, with 3‐mm safety margins of normal appearing tissue. Wound repair by means of a skin flap advanced from the temporal side was performed.Firm, well‐defined nodular mass (12 mm in diameter) arising from the inner third of the right upper eyelid below the eyebrow; ulcerated, desquamative, and nonumbilicatedimageA histopathologic diagnosis of trichoblastoma was made based on the presence of a well‐circumscribed, symmetrical mass occupying dermal and upper areas of subcutaneous tissue and closely related to the overlying epidermis (Fig. 2, top). The tumor consisted of nests and cords of cells with an interlacing pattern included in an abundant, delicate, fibrocytic, fibrillary stroma. A follicular germ‐like structure was also seen (Fig. 2, bottom). Immunohistochemistry showed isolated Merkel cells positive for chromogranin A.Top: panoramic view with the presence of a well‐circumscribed, symmetrical mass occupying dermal and upper areas of subcutaneous tissue and closely related to the overlying epidermis (hematoxylin and eosin; original magnification, × 5). Bottom: the tumor consists of nests and cords of cells with an interlacing pattern included in an abundant, delicate, fibrocytic, fibrillary stroma. A follicular germ‐like structure at the central part of the neoplastic epithelial cells can also be seen (hematoxylin and eosin; original magnification, × 50)image
Melanocyte–keratinocyte cell transplantation for stable vitiligo
Authors: Mulekar Sanjeev V. 
Published: December 2004

AbstractBackground Vitiligo is a common disorder with a worldwide prevalence of 1–2%. In India the psychological and social impact of the disease is significant and is detrimental to patients.Objective To evaluate the usefulness of epidermal cell transplantation in the treatment of vitiligo.Methods A simpler and modified method based on that of Olsson and Juhlin has been used. It utilizes a shave biopsy skin sample of up to one‐tenth the size of the recipient area. The skin sample is incubated, the cells mechanically separated using trypsin EDTA solution, and then centrifuged to prepare a suspension. The cell suspension is then applied to the derm‐abraded depigmented skin area and collagen dressing is applied to keep it in place.Results One hundred and twenty‐two patients with generalized vitiligo, 43 with segmental and 19 with focal vitiligo were treated and observed for a period of 1 year. In the generalized vitiligo group 65 (53%) showed excellent pigmentation, 10 (8%) showed good pigmentation, 11 (9%) showed fair pigmentation and 28 (23%) patients showed poor pigmentation. Eight (7%) patients did not follow up. Thirty‐six (84%), five (12%) and two (4%) patients showed excellent, good and poor pigmentation, respectively, in the segmental vitiligo group. Thirteen (69%) and five (26%) patients showed excellent and poor results, respectively, in the focal vitiligo group. One (5%) patient did not appear for follow up. Recurrence was observed in 15 patients.Conclusion This surgical treatment gives its best results in segmental and focal vitiligo, even with large affected areas, and in at least 50% of patients with generalized vitiligo, thus improving their appearance.
Comparison of efficacy criteria across onychomycosis trials: need for standardization
Authors: Gupta Aditya K. , Ryder Jennifer , Summerbell Richard C. 
Published: December 2004

AbstractBackground The last 10 years have seen a substantial increase in the number of studies reporting the efficacy of the various antifungal agents used to treat onychomycosis.Aim To examine the definitions of efficacy parameters reported in clinical studies on the treatment of onychomycosis and discuss the importance of standardized reporting.Methods We searched MEDLINE (1966–2001) for studies in which oral treatments, griseofulvin, ketoconazole, terbinafine (continuous and pulse), itraconazole (continuous and pulse), and fluconazole, were used to treat dermatophyte onychomycosis.Results Mycologic cure was predominantly defined as negative microscopy and culture. Unlike mycologic cure, clinical parameters (e.g. clinical response, clinical cure) were variably defined. Subjective terms, such as “cure” or “markedly improved,” were used; although these terms appear to be explicit, what is considered to be “cured” or “markedly improved” by one evaluator may not be by another. Also, infected nails were clinically evaluated to determine the response to treatment. Studies measured the distance between the proximal nail fold and a notch in the nail plate, at the junction between the diseased and normal‐appearing nail, or in some cases estimated the diseased nail plate involvement.Conclusions This review of the literature on systemic agents used to treat onychomycosis shows that standard and explicit definitions are required for the accurate comparison of the effectiveness of the various therapies.
Eruption associated with amoxicillin in a patient with infectious mononucleosis
Authors: Leung Alexander K. C. , Rafaat Massoud 
Published: December 2004

A 9‐year‐old boy presented with a history of fever, malaise, and sore throat for 1 day. He was seen by his family physician who diagnosed tonsillitis. The past medical history was unremarkable. There was no previous history of allergy to medications. After a throat swab had been taken and sent for bacterial culture, the patient was started on amoxicillin, 250 mg three times daily.Two days later, the child developed an extensive pruritic eruption over the body. We were consulted at this point. On examination, the child was afebrile. His pulse rate was 74/min and his blood pressure was 90/60 mmHg. An erythematous, maculopapular eruption was noted on the face, neck, trunk, buttocks, and extremities (Fig. 1). The palms and soles were also involved, but to a lesser extent. The pharynx and tonsils were erythematous. Yellowish exudates were seen in the tonsillar area. There were shotty lymph nodes in the cervical area. The spleen and liver were not palpable. The rest of the physical examination was normal.An erythematous maculopapular eruption on the extremitiesimageA provisional diagnosis of infectious mononucleosis was made. In the meantime, the throat swab culture came back as negative. Amoxicillin therapy was discontinued. Hydroxyzine hydrochloride, 10 mg four times daily as required, was given to relieve the itchiness.Laboratory investigations showed a hemoglobin of 125 g/L, white blood cell count of 12 × 109/L with 75% lymphocytes, 23% neutrophils, 5% monocytes, and 2% eosinophils, and a platelet count of 200 × 109/L. Many atypical lymphocytes were seen in the peripheral smear. Monospot test was positive, confirming the diagnosis of infectious mononucleosis.The child was reassessed 7 days later. By then, the pruritus had subsided and the eruption had cleared without desquamation. The pharynx and tonsils looked normal and there was no cervical lymphadenopathy.The child was seen by his family physician 5 months later because of a left‐sided earache. He was diagnosed with left otitis media and was treated with amoxicillin, 250 mg three times daily for 7 days. No skin eruption was noted with the use of amoxicillin on this occasion.
Dyskeratosis congenita with esophageal and anal stricture
Authors: Arca Ercan , Tüzün Ahmet , Tastan H. Bülent , Akar Ahmet , Köse Osman 
Published: December 2004

A 20‐year‐old man presented with skin lesions on his forearms and legs that had started to appear at 3 years of age. On exposure to the sun, his skin became red. He suffered from dysphagia and dysdefecation. His parents’ marriage was not consanguineous, and they were well. His five brothers and sister were also well. He stated that one of his aunt's sons and his uncle's son had the same lesions, but we were unable to examine them.Physical examination revealed a reticulated pattern of atrophy, pigmentation, erythema, and telangiectasia on the neck (Fig. 1), shoulders, popliteal fossa, and limbs. Atrophic lesions were also present on the extensor aspects of the elbow and knees, and on the dorsum of the proximal and distal interphalangeal joints of both hands (Fig. 2). Oral mucosal examination showed leukokeratosis on the dorsum and sides of the tongue. There was mild hyperkeratosis on the dorsum of the feet and hands. Sclerodactyly of the hands and feet was also present. The patient had no fingerprints. The nails were thickened and rough, and had longitudinal and transverse ridges. Hairs on the legs, forearms, and trunk were sparse. There was no splenomegaly or genital abnormalities.Patient's neck showing reticulated, hyperpigmented, and atrophic skin lesions and telangiectasiasimageThin and atrophic skin of the dorsum of the hands and dystrophic fingernailsimageLaboratory tests were as follows (normal values in parentheses): white blood count, 10,000/mm3 (4000–10,000/mm3), with 66% neutrophils and 34% lymphocytes; red blood cell count, 5.68 × 106/µL; hemoglobin, 10.6 mg/dL; hematocrit, 35.4%; mean corpuscular volume, 62.2 fL; platelet count, 419 × 103/µL; erythrocyte sedimentation rate, 4 mm/h (0–13 mm/h); vitamin B12, 285 pg/mL (211–911 pg/mL); folic acid, 6.4 ng/mL (1.1–20 ng/mL); ferritin, 3.7 ng/mL (22–322 ng/mL). There was mild anisocytosis, microcytosis, and hypochromic anemia in a peripheral blood smear. Liver transaminase levels were normal. There was a mild monoclonal gammopathy, with a serum immunoglobulin G (IgG) of 1630 mg/dL (normal, 751–1560 mg/dL) and a C3 of 155 mg/dL (normal, 79.2–152 mg/dL). The IgM and IgA levels were normal.Chest X‐ray was normal, and there was no evidence of abnormal calcification on skull X‐ray.An upper gastrointestinal endoscopy demonstrated a stricture at the upper esophageal sphincter. Esophagography clearly revealed an esophageal stricture at the proximal esophagus (Fig. 3). Sigmoidoscopy could not be performed because of the significant anal stricture, nor could a digital rectal examination.Esophagographic image demonstrating an esophageal stricture at the proximal esophagusimageHistopathology of a biopsy specimen from the skin of the shoulder showed flattening of the epidermis, a mild infiltrate of chronic inflammatory cells and melanophages, and dilated capillaries in the dermis.
Xeroderma pigmentosum with limited involvement of the UV‐exposed areas: a case report
Authors: Mirshams‐Shahshahani Mostafa , Namazi Mohammad Reza 
Published: December 2004

A 21‐year‐old woman with skin type IV, who had developed photophobia and brown, spotty, hyperpigmented lesions on her face from early childhood, presented to our center for treatment of her facial lesions.Examination on admission revealed numerous, freckle‐like, hyperpigmented macules and actinic keratoses over the central part of the face, with sparing of the forehead, chin, and peripheral area (Fig. 1). The area involved was approximated to be around 2% of the total body surface. The dorsal parts of the hands showed no lesions (Fig. 2), but guttate hypomelanotic lesions were apparent on both forearms.Limitation of xeroderma pigmentosum lesions to the center of the faceimageHands are devoid of any lesionsimageHistologic examination of biopsies from four different facial lesions revealed them to be keratoacanthoma (1.5 × 2.5 cm ulcerative nodule on the right cheek), sclerosing basal cell epithelioma (nasal lesion), lentigo simplex, and hypertrophic actinic keratosis.Corneal clouding, conjunctival injection, loss of lashes, and atrophy of the lids were apparent on ophthalmologic examination.Other parts of the physical examination, including examination of the oral cavity, were nonsignificant. In addition, except for the presence of mild eczema in a sibling, the patient's family history regarding the presence of any similar problem and also any other important dermatologic or general disorder was negative.
Reconstruction of epidermis by grafting of keratinocytes cultured on polymer support – clinical study
Authors: Dvořánková Barbora , Holíková Zuzana , Vacík Jiří , Königová Radana , Kapounková Zuzana , Michálek Jiří , Přádn Martin , Smetana Karel 
Published: December 2004

AbstractBackground Extensive wound coverage still represents a challenge for contemporary medicine. We demonstrate the results of a clinical trial of the grafting of cultured keratinocytes directly on a polymer cultivation support in the treatment of skin defects in seriously burned patients and in patients with trophic ulcers.Methods Wound closure was evaluated clinically. The morphology and phenotypic pattern of the reconstructed epidermis, including the basal lamina, as well as the presence of Langerhans cells, were evaluated immunocytochemically using a panel of monoclonal antibodies.Results All layers of the reconstructed epidermis were normally differentiated (cytokeratin immunocytochemistry). The basal lamina contained collagen type IV and laminin. The reconstructed epidermis was extensively colonized by Langerhans cells.Conclusions The results of the described technology are encouraging, especially in patients after a burn injury. The described procedure is suitable for the treatment of skin defects in clinical practice.
Argyria associated with colloidal silver supplementation
Authors: McKenna Jeffrey K. , Hull Christopher M. , Zone John J. 
Published: December 2004

A 65‐year‐old male presented for skin examination and was incidentally noted to have discoloration of the fingernails. These findings were completely asymptomatic. The patient had been taking colloidal silver supplementation (Silverzone™ 140 p.p.m. silver Gifts of Nature, St. George, UT, USA) for 2 years as therapy for diabetes. He first noticed the onset of nail discoloration 1 year ago. His past medical history included type II diabetes and hypertension. His current medications were metformin, glyburide, and benazepril. Physical examination revealed slate‐gray discoloration involving the lunulae of the fingernails (Fig. 1). The skin, mucous membranes, and sclerae were unaffected.Slate‐blue pigmentation of the lunula of an affected nailimage
A skin cancer education initiative at a professional baseball game and results of a skin cancer survey
Authors: Jungers Emily Ann , Guenthner Scott Thomas , Farmer Evan R. , Perkins Susan M. 
Published: December 2004

AbstractBackground It is important to develop an understanding of what the public knows about skin cancer and what sun safety precautions they are taking. Research on the evaluation of skin cancer education targeting adults is minimal.Aim To assess the knowledge and behavior related to skin cancer and sun exposure, and to determine if an informal interaction between dermatologists and the public could promote skin cancer awareness and precautions.Methods In May 2000, a dermatologist‐staffed educational booth was set up at an Indianapolis Indians baseball game. Attendees were educated through discussions and handouts. Attendees completed a self‐administered questionnaire prior to this interaction and a mailed follow‐up questionnaire in August 2000.Results One hundred and thirty‐six attendees participated in May, and 60 completed the second questionnaire in August. The May results revealed that 92% believed that sun exposure caused skin cancer; 37% used sunscreens “sometimes” and 29%“never.” There was a significant decrease in the number of hours spent outdoors per week during the summer of 2000 compared to 1999.Conclusions Frequent and unprotected sun exposure occurs despite awareness of the adverse effects. Although the number of subjects in our study was small, informal education at public events has the potential to influence behavior.