bluuebunny/crossref_metadata_2025_split huggingface dataset:
Arm position and blood pressure: an audit
Authors: Mourad A. , Carney S. 
Published: May 2004

Abstract Although arm position significantly alters blood pressure, this aspect of clinical behaviour has not been evaluated. Consequently, an audit of arm position preference involving 182 clinicians including physicians, general practitioners and nurses was performed. A marked variation in standing and sitting arm position preference, both between and within the three groups, was recorded, although approximately two‐thirds of clinicians preferred the same arm position in the standing and sitting position. In particular, only 8 and 4% of clinicians chose the horizontal arm position in sitting and standing subjects, respectively. Choosing the dependent arm is a behaviour likely to lead to the overdiagnosis of hyper­tension and inappropriate treatment of hypertension because the dependent arm falsely elevates both systolic and diastolic blood pressure. These results should encourage national and international organizations to reaffirm the importance of the horizontal arm in the measurement of blood pressure. (Intern Med J 2004; 34: 290−291)
Left ventricular dysfunction in normotensive Type 1 diabetic patients: the impact of autonomic neuropathy
Authors: Taskiran M. , Rasmussen V. , Rasmussen B. , Fritz‐Hansen T. , Larsson H. B. W. , Jensen G. B. , Hilsted J. 
Published: May 2004

AbstractAims  The pathophysiological mechanisms responsible for increased cardiovascular mortality in diabetic autonomic neuropathy (AN) are largely unknown. The aim was to determine the relative role of AN in the pathogenesis of cardiac diastolic dysfunction and left ventricular hypertrophy in Type 1 diabetes.Methods  Ten Type 1 diabetic patients with AN, defined by cardiovascular tests (AN+) and 10 age‐ and sex‐matched patients without neuropathy (AN–) as well as 10 healthy subjects (C) participated in the study. Left ventricular diastolic function was assessed by Doppler echocardiography, whilst systolic function was evaluated by cine magnetic resonance (MR) imaging.Results  Doppler echocardiography showed a significant decrease in E/A ratio, i.e. the ratio between peak Early transmitral filling velocity during early diastole (E‐wave) and peak transmitral Atrial filling velocity during late diastole (A‐wave), in AN+ compared with C (P < 0.01) [0.95 ± 0.08 (mean ± sem) (AN+); 1.19 ± 0.09 (AN–); 1.33 ± 0.10 (C)]. The E‐wave deceleration time was significantly shorter in AN+ compared with AN– and C (P < 0.02) [178 ± 7 ms (AN+); 203 ± 9 ms (AN–); 205 ± 9 ms (C)]. Cine MR imaging showed a significantly greater left ventricular mass index in AN+ compared with C [103 ± 4 g/m2 (AN+) vs. 98 ± 7 (AN–) and 92 ± 4 g/m2 (C), P < 0.05].Conclusion  Autonomic neuropathy is associated with left ventricular hypertrophy and diastolic dysfunction in Type 1 diabetic patients.
Post‐challenge hyperglycaemia is an independent risk factor for arterial stiffness in Japanese men
Authors: Ohshita K. , Yamane K. , Ishida K. , Watanabe H. , Okubo M. , Kohno N. 
Published: May 2004

AbstractAims  Arterial stiffness is an independent predictor of cardiovascular disease, but the impact of post‐challenge hyperglycaemia on arterial stiffness is unknown. To investigate the association between arterial stiffness and post‐challenge hyperglycaemia, we measured the second derivative of photoplethysmogram as an indicator of arterial stiffness.Methods  This study was done in 159 asymptomatic Japanese men aged 50.7 ± 13.0 years. All subjects underwent a 75‐g oral glucose tolerance test and measurement of the second derivative of photoplethysmogram.Results  According to the World Health Organization criteria (1998), 110 subjects had normal glucose tolerance, 10 had impaired fasting glucose, 30 had impaired glucose tolerance, and nine had diabetes. The b/a ratio (an index of arterial stiffness) showed a significant relationship with age (r = 0.58, P < 0.0001), height (r = −0.33, P < 0.0001), 2‐h post‐challenge glucose (r = 0.32, P < 0.0001), systolic blood pressure (r = 0.22, P = 0.006), and diastolic blood pressure (r = 0.21, P = 0.009). After adjustment for age and height, there were significant correlations between the b/a ratio and diastolic blood pressure (r = 0.18, P = 0.02), fasting glucose (r = 0.16, P = 0.049), and 2‐h post‐challenge glucose (r = 0.21, P = 0.009). Stepwise multiple regression analysis showed that only age (β= 0.006, se = 0.0007, P < 0.001) and 2‐h post‐challenge glucose (β = 0.0005, se = 0.0002, P < 0.05) contributed significantly to the b/a ratio (adjusted R2 = 0.38).Conclusions  These results indicate that post‐challenge hyperglycaemia is an independent risk factor for arterial stiffness.
Diabetes mellitus as a risk factor for primary open‐angle glaucoma: a meta‐analysis
Authors: Bonovas S. , Peponis V. , Filioussi K. 
Published: May 2004

AbstractAim  The association of diabetes mellitus with primary open‐angle glaucoma has been controversial. The study aimed to examine the strength of this association through a detailed meta‐analysis of studies published in peer‐reviewed journals.Methods  A comprehensive search for articles published through 2002 was performed and data were abstracted. Prior to meta‐analysis, all studies were evaluated for publication bias and heterogeneity. Pooled odds ratio (OR) was calculated using the random and the fixed‐effects model.Results  Twelve studies published between 1987 and 2001 were included (five case–control studies and seven cross‐sectional studies). Significant heterogeneity among the studies was detected (P = 0.023). No evidence of publication bias was found (P = 0.37). The association of diabetes mellitus with primary open‐angle glaucoma was statistically significant assuming either a random effects [OR = 1.50, 95% confidence interval (CI) 1.16, 1.93], or a fixed‐effects model (OR = 1.27, 95% CI 1.10, 1.45).Conclusions  Our meta‐analysis results suggest that diabetic patients are at significantly increased risk of developing primary open‐angle glaucoma. Clinicians should be aware of this possibility.Diabet. Med. (2004)
Childhood diabetes: parents’ experience of home management and the first year following diagnosis
Authors: Lowes L. , Lyne P. , Gregory J. W. 
Published: May 2004

AbstractAims  To explore parents’ experience of having a child diagnosed with Type 1 diabetes, managed at home, and their first year following diagnosis.Methods  A qualitative, longitudinal study based on 40 in‐depth interviews with parents of 20 children with newly diagnosed Type 1 diabetes managed at home from diagnosis in South Wales.Results  Many parents were alarmed by the speed of diagnosis following the gradual progress of their child's symptoms. The provision of timely, adequate information was important to all parents. Although five parents had initial concerns about going home, all parents were subsequently pleased their children had not been hospitalized. Home management enabled parents to integrate diabetes management into the family's normal lifestyle from diagnosis. Professional support, particularly accessible telephone advice, was valued by and reassured parents. Parents experienced a loss of spontaneity, a continuing fear of hypoglycaemia and did not want their child to feel different to other children. Acutely aware of the seriousness of diabetes, they did their utmost to achieve optimal glycaemic control but felt that diabetes could not ‘dominate’ if they were to lead a ‘normal’ life.Conclusions  The experience of parents in this study suggests that parents of children with newly diagnosed diabetes are able to cope successfully when given the opportunity to start treatment at home. Therefore, if children with diabetes are clinically well at diagnosis, this study supports home management as a system of care from the parents’ point of view. These findings are relevant to clinicians, policy makers and health service managers involved in planning and providing paediatric diabetes care.
An assessment of the adequacy of suspension of insulin in pen injectors
Authors: Brown A. , Steel J. M. , Duncan C. , Duncan A. , McBain A. M. 
Published: May 2004

AbstractAims  To evaluate the completeness of insulin resuspension by users of neutral Hagedorn (NPH) insulin pens and premixed insulin pens and to relate this to how patients mix insulin before injecting.Methods  Patients (n = 180) administering a medium duration or premixed insulin in cartridges in disposable pens were asked questions about mixing insulin, injection technique and storing insulin. They were also asked to demonstrate how they mixed their insulin and to send in a half‐used pen. The cloudy component equates to the complexed insulin, while the clear component is the diluting fluid or soluble insulin, depending on the type of insulin used. The optical density, a simple way of measuring cloudiness, was measured in each cartridge or disposable pen and was compared with the range obtained from a series of unused control pens. The results for 146 pens containing the most commonly used insulin were included. The 21 patients whose residual pen insulins showed optical densities > 5 sd from the mean were re‐interviewed and their medical records were examined in detail. Insulin in the pens was also measured by immunoassay to confirm the utility of optical density measurements.Results  Only one patient mixed the insulin as the manufacturers recommended. In 58 out of 146 pens or cartridges (40%) the opacity of the insulin varied significantly from the expected value.Conclusions  Most patients in Kirkcaldy do not mix insulin adequately. This may result in their giving different incorrect doses of insulin during the use of each pen. More emphasis should be given to teaching patients to mix correctly.
Improving glycaemic control of patients with Type 2 diabetes in a primary care setting: a French application of the Staged Diabetes Management programme
Authors: Varroud‐Vial M. , Simon D. , Attali J. , Durand‐Zaleski I. , Bera L. , Attali C. , Letondeur C. , Strauss K. , Petit C. , Charpentier G. 
Published: May 2004

AbstractAims  To assess the impact of a French adaptation of the Staged Diabetes Management (SDM) programme on glycaemic control of people with Type 2 diabetes in primary care. Secondary endpoints were blood pressure, blood lipids, healthcare costs and quality of life.Methods  Prospective, randomized controlled study, of 1 years’ duration. General practitioners (GPs) were recruited in four separate districts of a French region. They enrolled consecutive patients with Type 2 diabetes. GPs in the intervention group were educated in the SDM programme. GPs in the control group were asked to provide usual care. Healthcare costs were collected by medical departments of the Health Insurance systems. Quality of life was assessed with the Duke Health Profile.Results  Three hundred and forty patients enrolled by 57 GPs completed the study, 192 in the intervention group and 148 in the control group. Patients in the intervention group were managed more adequately in accordance with the guidelines (P < 0.05 for nine out of 10 items). HbA1c decreased by 0.31% in the intervention group and increased by 0.56% in the control group, resulting in a difference of 0.87% by the end of the study (P = 0.001). Blood pressure and blood lipids did not differ between groups. Occurrence of major complications was low and identical in both groups. Incremental costs during the study in the intervention group were 35 euros per patient per month, and this was not significantly different in comparison with the control group. Quality of life was not affected by the intervention.Conclusions  Educating GPs in the French adaptation of the SDM programme improves glycaemic control in a primary care setting, without significantly increasing healthcare costs.
Educational outreach in diabetes to encourage practice nurses to use primary care hypertension and hyperlipidaemia guidelines (EDEN): a randomized controlled trial
Authors: New J. P. , Mason J. M. , Freemantle N. , Teasdale S. , Wong L. , Bruce N. J. , Burns J. A. , Gibson J. M. 
Published: May 2004

AbstractObjective  To determine the effectiveness of specialist nurse delivered education in primary care to improve control of hypertension and hyperlipidaemia in patients with diabetes.Design and setting  Practice‐level randomized controlled trial, Salford, England.Subjects  From 44 practices, 10 303 subjects presenting in general practice with raised blood pressure (= 140/80 mmHg), raised total cholesterol (= 5.0 mmol/l) or both.Interventions  Practices were randomized to receive either the intervention for hyperlipidaemia or for hypertension; practices acted as control for the intervention not received. Specialist nurses arranged a schedule of visits with general practitioners and general practice nurses, reminding them of diabetes protocols and clinical targets. They provided educational materials and protocols used in secondary care for nurse and doctor interventions including stepping up pharmacotherapy when necessary. Practices received a list of patients in their practice who were poorly controlled at their last annual review; new and recalled patients were targeted.Outcome measures  At subsequent annual review, blood pressure and total cholesterol values were obtained from the Salford electronic diabetes register for patients from participating practices.Results  Overall, specialist nurse‐led educational outreach to primary care was associated with no improvement in patients achieving target after 1 year—odds ratio (OR): 1.03 (95% CI 0.95–1.11; P = 0.52). Similar results were achieved with hyperlipidaemia OR: 1.04 (95% CI 0.88–1.23; P = 0.62) and hypertension OR: 1.01 (95% CI 0.80–1.27; P = 0.93).Conclusion  This study provides evidence that the use of specialist nurses to perform educational outreach to improve target adherence to patients with diabetes in primary care is not effective.
An increase in insulin sensitivity and basal beta‐cell function in diabetic subjects treated with pioglitazone in a placebo‐controlled randomized study
Authors: Wallace T. M. , Levy J. C. , Matthews D. R. 
Published: May 2004

AbstractAims  To investigate the effect of treatment with pioglitazone on beta‐cell function and insulin sensitivity in Type 2 diabetes.Methods  Thirty subjects with diet‐controlled Type 2 diabetes were randomized to 3 months treatment with pioglitazone (n = 19) or placebo (n = 11). All subjects underwent basal sampling for homeostatic model assessment (HOMA), followed by an intravenous glucose tolerance test and hyperglycaemic clamp, followed by an euglycaemic hyperinsulinaemic clamp; at baseline and after treatment.Results  All results are expressed as mean (sem). Pioglitazone increased basal insulin sensitivity by 24.7% (7.8) HOMA‐%S vs. 2.1% (5.9) in the placebo group (P = 0.02). Stimulated insulin sensitivity, M/I, increased in the pioglitazone group compared with placebo: +15.1 (2.8) l kg−1 min−1 vs. +3.2 (2.9) l kg−1 min−1, respectively (P = 0.009). Pioglitazone increased adiponectin by 39.3 (6.3), ng/ml compared with a decrease of 0.8 (1.3) ng/ml with placebo (P = 0.00004). HOMA‐%B increased with pioglitazone, +11.5% (4.8) vs. −2.0% (4.8) with placebo (P = 0.049), but there was no change in stimulated beta‐cell function as determined by hyperglycaemic clamps. There was a significant reduction in the proinsulin/insulin ratio in the pioglitazone group, −0.057 (0.02) compared with placebo, +0.004 (0.02) (P = 0.03). There was a significant reduction in HbA1c of 0.6% (0.1) in the pioglitazone group compared with placebo (P = 0.003). There was no significant weight gain associated with pioglitazone therapy: +0.7 (sem 0.6) kg vs. +1.1 (sem 0.5) kg in placebo group (P = NS).Conclusions  Basal beta‐cell function and insulin sensitivity improved following pioglitazone therapy. The improvement in proinsulin to insulin ratio suggests that beta‐cells are under less stress.
Familial hyperinsulinaemia associated with epilepsy and mental retardation—a syndrome of familial insulin resistance
Authors: Idris I. , Miller D. , Page S. R. 
Published: May 2004

AbstractBackground  Variants of type A insulin resistance, characterized by female hyperandrogenism and ‘acromegaloid’ features, have been ascribed to genetic defects of the insulin receptor or post‐receptor pathways via autosomal dominant or recessive inheritance patterns. Whilst a variety of congenital syndromes of insulin resistance are identified by their characteristic clinical phenotypes, an association with epilepsy and mental retardation has not previously been reported.Case report  We describe three female siblings (aged 12, 19 and 21) with fasting hyperinsulinaemia (116–443 pmol/l; normal range < 80 pmol/l) and mental retardation. Two siblings also have epilepsy. The eldest has features of severe insulin resistance with dyslipidaemia, acanthosis nigricans, ‘acromegaloid features’ and diabetes requiring high dose insulin therapy in combination with a glitazone. Their mother has fasting hyperinsulinaemia (113 pmol/l), mental retardation and epilepsy. None had clinical or biochemical features of hyperandrogenism or evidence of pigmentory retinopathy, deafness or renal insufficiency. Autoantibody screens were negative. Interestingly, there is no evidence of mental retardation or epilepsy among males in the family.Conclusion  This family suggests the presence of a yet‐undefined syndrome of familial insulin resistance affecting female kindred. Further studies are being undertaken to clarify the genetic defects and mode of inheritance.
Catching the Celtic Tiger by Its Tail
Authors: FERREIRA M. LUISA , VANHOUDT PATRICK 
Published: May 2004

AbstractThe article attempts to assess the major sources behind the exceptional Irish growth performance in the 1990s. Unlike other Tigers, Ireland's growth is due to efficiency gains, rather than capital deepening, but the causes for the swift growth in total factor productivity cannot be pinned down to a single factor. Human capital, foreign direct investment, social partnership agreements, sound budget and economic policies since the late 1980s, EU membership, all seemed to have interacted to produce this high‐growth economy. This article focuses on the two mostly quoted catalysts, i.e. FDI and human capital. It provides evidence that — although crucial as enablers for the Irish economic performance — neither the rapid expansion of the compulsory education system in the 1970s and 1980s nor the sheer volume of FDI inflows can by themselves explain why Ireland has grown so much faster than other world economies. Instead, it argues that higher education, especially the vocational/technical stream of educational provision, and the sector composition of FDI in favour of high‐tech industries, were self‐reinforcing factors and have been decisive for the Republic's extraordinary boom.
Is fearr lán doirn de cheird ná lán mála d’ór  (A handful of skill is better than a bagful of gold)Irish proverb
ASYMPTOTIC STABILITY I: COMPLETELY POSITIVE MAPS
Authors: ARVESON WILLIAM 
Published: May 2004

We show that for every "locally finite" unit-preserving completely positive map P acting on a C*, there is a corresponding *-automorphism α of another unital C*-algebra such that the two sequences P, P2, P3, … and α, α2, α3, … have the same asymptotic behavior. The automorphism α is uniquely determined by P up to conjugacy. Similar results hold for normal completely positive maps on von Neumann algebras, as well as for one-parameter semigroups.These results are operator algebraic counterparts of the classical theory of Perron and Frobenius on the structure of square matrices with nonnegative entries.
Relationship between Complications due to Prostate Biopsy and the Scores of Pain and Discomfort
Authors: Celebi Ilhan , Irer Bora , Kefi Aykut , Kurtulan Erkan , Goktay Yigit , Ergin Tufan 
Published: May 2004

<i>Introduction:</i> Transrectal ultrasound (TRUS)-guided prostate biopsy is routinely performed in the prostate-specific antigen era. In this study, we evaluated morbidity and complications observed in patients undergoing TRUS-guided prostate biopsy following intrarectal lidocaine application and the relation of these complications to pain and discomfort. <i>Patients and Methods:</i> Between January 2000 and August 2002, a total of 128 patients underwent TRUS-guided prostate biopsy. The procedure was carried out following an intrarectal application of 10 cm<sup>3</sup> 2% lidocaine gel. Immediately after the biopsy, pain and discomfort scores were determined using a 10-point linear visual analog scale. The patients were seen 10 days later and questioned for complications. <i>Results:</i> At least one complication was observed in 107 patients (84%). Most frequent complications were macroscopic hematuria (90%), hematochezia (36%), and hematospermia (13%). The mean pain and discomfort scores of the patients were found to be correlated to each other (p < 0.01). The complication-negative group had significantly lower pain and discomfort scores (p < 0.01). The scores of the patients with hematochezia were significantly higher than the scores of the patients with other complications (p < 0.01). <i>Conclusions:</i> Minor complications like hematuria, hematochezia, and hematospermia are frequently seen in patients undergoing TRUS-guided prostate biopsies. The pain and discomfort scores may be predictors of minor complications, particularly of rectal bleeding.
Neutrophil Gelatinase-Associated Lipocalin: A Novel Early Urinary Biomarker for Cisplatin Nephrotoxicity
Authors: Mishra Jaya , Mori Kiyoshi , Ma Qing , Kelly Caitlin , Barasch Jonathan , Devarajan Prasad 
Published: May 2004

<i>Background:</i> Cisplatin is one of the most widely used chemotherapeutic agents, but the risk of nephrotoxicity frequently hinders the use of higher doses to maximize its antineoplastic effects. The lack of early biomarkers has impaired our ability to initiate potential therapeutic or preventive interventions in cisplatin nephrotoxicity in a timely manner. In this study, we have explored the expression and urinary excretion of neutrophil gelatinase-associated lipocalin (NGAL) in a mouse model of cisplatin-induced nephrotoxic injury. <i>Methods:</i> Mice were subjected to intraperitoneal injections of 20 mg/kg (high dose) or 5 mg/kg (low dose) cisplatin. The expression of NGAL was measured in the kidney and urine by Western analysis and immunofluorescence, and compared to changes in serum creatinine and urinary N-acetyl-β-<i>D</i>-glucosaminidase (NAG). <i>Results:</i> Cisplatin resulted in tubule cell necrosis and apoptosis following the high dose, but not the low dose. By Western analysis, NGAL protein was rapidly induced in the kidney within 3 h of high-dose cisplatin. By immunofluorescence, NGAL was induced predominantly in proximal tubule cells in a punctate cytoplasmic distribution, reminiscent of a secreted protein. NGAL was easily detected in the urine by Western analysis within 3 h of cisplatin administration in a dose- and duration-dependent manner. By comparison, changes in urinary NAG or serum creatinine were not evident until 96 h after cisplatin. Using defined concentrations of purified recombinant NGAL, urinary NGAL excretion following cisplatin administration was quantified to be in the 20–80 ng/ml range. <i>Conclusion:</i> The results indicate that NGAL represents an early and quantitative urinary biomarker for cisplatin nephrotoxicity.