bluuebunny/crossref_metadata_2025_split huggingface dataset:
Ambulatory blood pressure monitoring in patients with hyperthyroidism before and after control of thyroid function
Authors: Iglesias P. , Acosta M. , Sánchez R. , Fernández‐Reyes M. J. , Mon C. , Díez J. J. 
Published: June 2005

SummaryBackground and Objective Thyroid hormones have pronounced effects on the cardiovascular system. Thyrotoxicosis affects blood pressure (BP), modifying both diastolic (DBP) and systolic (SBP) pressures. There are no studies examining BP with ambulatory blood pressure monitoring (ABPM) in hyperthyroidism before and after control of thyroid function. Our aims were (1) to analyse ABPM in a group of normotensive hyperthyroid patients before and after normalizing circulating thyroid hormones and (2) to compare these results with those obtained in a group of euthyroid subjects.Patients and Measurements We studied 20 normotensive hyperthyroid subjects [18 women; age (mean ± SEM) 49·0 ± 3·0 years] and 15 healthy subjects. Patients were evaluated by ABPM over 24 h, at diagnosis and after therapy (n = 18).Results The average 24‐h, daytime and night‐time SBP was significantly greater in hyperthyroid patients than in controls with no significant differences in DBP. Circadian BP rhythm, estimated by the difference between mean values of SBP, DBP and mean BP during daytime and night‐time, was unchanged. The average 24‐h and daytime SBP significantly decreased after normalizing thyroid function in the 18 hyperthyroid evaluated patients. Daytime SBP and DBP were higher than night‐time values both before and after control of thyroid function. However, no differences in circadian BP rhythm were observed.Conclusions Normotensive hyperthyroid patients exhibit higher ambulatory SBP throughout 24 h than normotensive euthyroid subjects. Control of hyperthyroidism decreases ambulatory SBP values. Mean nocturnal fall in BP is comparable in normotensive hyperthyroid patients and control subjects.
Clinical evidence that hyperinsulinaemia independent of gonadotropins stimulates ovarian growth
Authors: Musso Carla , Shawker Thomas , Cochran Elaine , Javor Edward D. , Young Janice , Gorden Phillip 
Published: June 2005

SummaryObjective  Ovarian enlargement is a constant feature of syndromes of extreme insulin resistance. The objective of this study is to show the role of insulin on ovarian growth in the presence of low gonadotropin levels.Patients  Seven young patients with syndromes of extreme insulin resistance (five with lipodystrophy, one with Type B syndrome and one with Rabson–Mendenhall syndrome) were studied.Measurements  Baseline LH concentrations and luteinizing hormone releasing hormone (LHRH) tests were performed. Total testosterone, insulin and C‐peptide values were measured. Pelvic ultrasounds were performed.Results  Four patients were prepubertal (age range 7–10 years old) and had prepubertal gonadotropin levels, and 2 of the 4 who were tested did not respond to LHRH (NIH 10 and RM‐PAL). Three patients were Tanner stage 4 (age range 13–17 years old) and had low gonadotropins that did not respond to LHRH stimulation test. All seven patients had marked hyperinsulinaemia and 6 of 7 had at least one enlarged ovary. Testosterone values were increased in 4 of 7 patients.Conclusion  This represents the first example of the pathologic role of insulin to stimulate ovarian growth with low circulating gonadotropins. Thus, while ovarian growth and steroidogenesis are normally stimulated by gonadotropins at puberty, hyperinsulinaemia stimulates pathologic growth of the ovary and an androgenic steroid profile that is active at all ages. We suggest that these patients constitute a model to separate the effect of insulin from gonadotropin in stimulating ovarian growth and/or steroidogenesis.
Differentiated thyroid carcinoma with distant metastases at presentation: prognostic factors and outcome
Authors: Haq M. , Harmer C. 
Published: June 2005

SummaryBackgroundDifferentiated thyroid cancer (DTC) presenting with distant metastases is uncommon. Prognostic factors that affect survival remain unclear.AimTo evaluate factors influencing the survival of patients with DTC presenting with distant metastases.MethodA retrospective study of 111 patients (62 F, 49 M) with DTC who presented with distant metastases (M1) treated at the Royal Marsden Hospital from 1940 to 2002.ResultsThe median follow‐up of living patients was 3·9 years (0·3–48) with a 10‐year cause‐specific survival rate of 31%. Histology identified 46 papillary, 60 follicular and five Hürthle cell cancers. Sites of metastases comprised 54 lung (49%), 27 bone (24%), 21 multiple sites (19%) and nine with other single sites affected (8%). Near‐total, total or completion thyroidectomy was performed in 56% of patients, radioiodine ablation in 76% and radioiodine therapy in 67%. External beam radiotherapy was given to 12 patients and the same number received chemotherapy. Univariate analysis was performed with cause‐specific survival as the main outcome measure. Age over 70, poorly differentiated tumours and Hürthle cell cancers were associated with worse outcomes (P < 0·01). Patients with multiple organ metastases had a worse survival (P = 0·02). Radical surgery did not significantly improve outcome compared to more conservative forms of surgery (subtotal thyroidectomy, hemi‐thyroidectomy or lobectomy) but patients receiving radioiodine ablation and therapy had improved survival (P < 0·01). Multivariate analysis identified age over 70, poorly differentiated tumours and Hürthle cell variant to be the only independent factors associated with worse outcome (P < 0·01). Treatment in the 1991–2002 era was associated with an improved survival compared to all previous decades (P = 0·009).ConclusionsPatients with DTC presenting with distant metastases have a worse outcome if aged over 70, have poorly differentiated tumours or have Hürthle cell variant. Despite their unfavourable prognosis, a dramatic improvement in survival was observed in the most recent era (1991–2002).
Seladin‐1/DHCR24 expression in normal ovary, ovarian epithelial and granulosa tumours
Authors: Fuller Peter J. , Alexiadis Maria , Jobling Tom , McNeilage Jane 
Published: June 2005

SummaryObjective  The human DIMINUTO/DWARF1 homolog seladin‐1/DHCR24 has been recently reported to be up‐regulated in adrenocortical adenomas. Seladin‐1 expression has been reported in the normal ovary. Granulosa cell tumours of the ovary (GCT) as with adrenocortical adenomas arise from a steroidogenic tissue, respond to pituitary hormone stimulation and synthesize steroid hormones.Design  To test the hypothesis that seladin‐1 may also have a role in the pathogenesis of GCT, we determined the expression of seladin‐1 in a cohort of GCT and in mucinous and serous cystadenocarcinomas and in normal ovary.Measurements  Expression was determined by RT‐PCR using gene specific primers and probes combined with Southern blot analysis of the PCR products.Results  Seladin‐1 expression was identified in the normal ovary, mucinous cystadenocarcinomas and serous cystadenocarcinomas of the ovary whereas no expression was observed in the GCT.Conclusions  Based on our results, seladin‐1 is not expressed in the granulosa cells or at least not in those that give rise to GCT.
Health literacy: concept analysis
Authors: Speros Carolyn 
Published: June 2005

Aim.  This paper reports an analysis of the concept of health literacy in order to clarify its meaning, reduce ambiguities associated with references to it, and promote consistency in using the concept in nursing dialogue and research.Background.  Health literacy is a relatively new concept in health promotion research. Only within the last decade have researchers identified the problems associated with health literacy, the role it plays in an individual's ability to comprehend health and self‐care information, and its relationship to health outcomes. Clarifying the concept is essential so that nurses develop an awareness of the phenomenon and its relationship to the outcomes of their communication and health education efforts.Method.  The method used for this concept analysis was that of Walker and Avant (1995).Findings.  Health literacy empowers people to act appropriately in new and changing health‐related circumstances through the use of advanced cognitive and social skills. The defining attributes of health literacy are reading and numeracy skills, comprehension, the capacity to use information in health care decision‐making, and successful functioning as a healthcare consumer. Antecedents of health literacy are literacy and a health‐related experience. Consequences of health literacy include improved self‐reported health status, lower health care costs, increased health knowledge, shorter hospitalizations, and less frequent use of health care services. Empirical referents of the concept are the Test of Functional Health Literacy in Adults and the health literacy component of the National Assessment of Adult Literacy.Conclusions.  An analysis of the concept of health literacy enhances nurses’ ability to assess more accurately their clients’ levels of health literacy, thus identifying those at risk for misunderstanding health care instructions, shame associated with inadequate reading skills, and inability to adhere to health care recommendations.
Transforming the obstetric nursing workforce in NE Brazil through international collaboration
Authors: Girot Elizabeth A. , Enders Bertha Cruz , Wright Joyce 
Published: June 2005

Aims.  This paper seeks to analyse the content, people and process of transformational change to introduce new ways of working for specialized obstetric nurses in northeast Brazil, and identify the lessons learned.Background.  Countries across the globe are beginning to focus on improving the nursing workforce through new ways of working. High numbers of caesarean sections coupled with high indices of maternal mortality in northeast Brazil prompted the introduction of a British Council Higher Education Links scheme to work collaboratively to transform the role of the specialist obstetric nurse and introduce the principles of Safe Motherhood. The concept of a normal birth had not been widely accepted, with the birth process viewed as a medical condition requiring pharmaco‐therapeutic interventions rather than as a natural process.Method.  Between 2000 and 2003, a more woman‐centred approach to childbirth was introduced through the local delivery of two in‐house education programmes and the qualification of 38 nurse‐midwives.Discussion.  In spite of its slow progress, the success of the Higher Education collaboration has been recognized nationally, a new philosophy is guiding practice and new ways of working have been established.Conclusion.  Lessons learned include the need to set achievable goals (content), respond to the emotional needs of those involved in the change (people) and make best use of reciprocal visits to rally the teams and sustain the focus for change (process). Although the Higher Education link is complete, funds are being sought for formal evaluation and dissemination. Overall, the process and outcomes of this collaboration suggest that to embrace such an opportunity to learn from each other can lead to real improvements in service and the lives of women.
Influence of policies on nursing practice in long‐term care environments for older people
Authors: Tolson Debbie , Maclaren William , Kiely Sian , Lowndes Andrew 
Published: June 2005

Aim.  This paper reports a study exploring nurses’ awareness of, access to and use of policies within long‐term care environments for older people in Scotland.Background.  The provision of the highest quality of nursing care for older people with continuing care needs is facilitated through a number of strategic mechanisms. These encompass regulatory systems, national and local policies and care guidance. Failure of practitioners to engage with the ‘policy context’ may compromise care standards.Method.  This was a two‐stage investigation. A Delphi approach with 33 panel members was used to generate consensus as to the 10 most important current policies in this area of practice. A postal survey was undertaken with 2072 nurses to identify the practice impact of policies, including the 10 identified items.Findings.  Identification of the 10 most important policies proved challenging for panel members. Initially they identified 137 policy items, which were reduced after clustering and two further rounds to 10 items (consensus agreement 57%). Completed questionnaires were returned by 986 (48%) nurses. A long list of problems limited access to policy information. Nurses reported little time to keep up to date, compounded by communication inefficiencies and limited access to the internet. Awareness of the 10 selected items ranged from 46 to 83% and clarity of the practice message was high (85–94%); however, the reported influence on practice varied, with 10–26% of respondents indicating no effect. Professional priorities did not coincide with the priorities of older people themselves.Conclusion.  Nurses appear bewildered by the number and status of policy items. Current methods to provide nurses with information and keep them up to date were not ideal. Processes need to be developed that will engage nurses in policy and pursue closer alignment with the priorities of older people. Strategies are required to identify key policies and promote their implementation.
Day treatment programme for patients with eating disorders: randomized controlled trial
Authors: Kong Seongsook 
Published: June 2005

Aim.  This paper reports a randomized controlled trial to compare the effects of day treatment programmes for patients with eating disorders with those of traditional outpatient treatment.Background.  Eating disorders are common, especially in adolescents, and their worldwide prevalence is increasing. Treatment interventions for patients with eating disorders have traditionally been offered on an outpatient or inpatient basis, but the recent introduction of day hospital programmes offers the possibility of greater cost‐effectiveness and relapse‐prevention for this population.Methods.  Volunteers from an outpatient clinic for eating disorders were randomly assigned either to a treatment group (n = 21), participating in a modified day treatment programme based on the Toronto Day Hospital Program, or to a control group (n = 22) receiving a traditional outpatient programme of interpersonal psychotherapy, cognitive behaviour therapy and pharmacotherapy. Data were collected from January to December 2002 using the Eating Disorder Examination, Eating Disorder Inventory‐2, Beck Depression Inventory, and Rosenberg Self‐Esteem Scale.Results.  Participants in the day treatment programme showed significantly greater improvements on most psychological symptoms of the Eating Disorder Inventory‐2, frequency of binging and purging, body mass index, depression and self‐esteem scores than the control group. They also showed significant improvement in perfectionism, but the group difference was not significant.Conclusion.  Nurses in day treatment programmes can play various and important roles establishing a therapeutic alliance between patient and carer in the initial period of treatment. In addition, the cognitive and behavioural work that is vital to a patient's recovery, that is, dealing with food issues, weight issues and self‐esteem, is most effectively provided by a nurse therapist who maintains an empathic involvement with the patient.
Producing the magnum opus: a metaphor for nephrology nursing expertise acquisition
Authors: Bonner Ann , Greenwood Jennifer 
Published: June 2005

Aim. This paper elucidates the nature of metaphor and the conditions necessary to its use as an analytic device in qualitative research, and describes how the use of metaphor assisted in the analytic processes of a grounded theory study of nephrology nursing expertise.Background. The use of metaphor is pervasive in everyday thought, language and action. It is an important means for the comprehension and management of everyday life, and makes challenging or problematic concepts easier to explain. Metaphors are also pervasive in quantitative and qualitative research for the same reason. In both everyday life and in research, their use may be implicit or explicit.Methods. The study using grounded theory methodology took place in one renal unit in New South Wales, Australia between 1999 and 2000 and included six non‐expert and 11 expert nurses. It involved simultaneous data collection and analysis using participant observation, semi‐structured interviews and review of nursing documentation.Findings. A three stage skills‐acquisitive process was identified in which an orchestral metaphor was used to explain the relationships between stages and to satisfactorily capture the data coded within each stage.Conclusion. Metaphors create images, clarify and add depth to meanings and, if used appropriately and explicitly in qualitative research, can capture data at highly conceptual levels. Metaphors also assist in explaining the relationship between findings in a clear and coherent manner.
Discourse analysis: towards an understanding of its place in nursing
Authors: Crowe Marie 
Published: June 2005

Aim.  This paper describes how discourse analysis, and in particular critical discourse analysis, can be used in nursing research, and provides an example to illustrate the techniques involved.Background.  Discourse analysis has risen to prominence in the 1980s and 1990s in disciplines such as the social sciences, literary theory and cultural studies and is increasingly used in nursing. This paper investigates discourse analysis as a useful methodology for conducting nursing research. Effective clinical reasoning relies on employing several different kinds of knowledge and research that draw on different perspectives, methodologies and techniques to generate breadth of knowledge and depth of understanding of clinical practices and patients’ experiences of those practices.Discussion.  The steps in a discourse analysis include: choosing the text, and identifying the explicit purpose of the text, the processes used for claiming authority connections to other discourses, construction of major concepts, processes of naming and categorizing, construction of subject positions, construction of reality and social relations and implications for the practice of nursing. The limitations of discourse analysis, its relationship to other qualitative approaches and questions for evaluating the rigour of research using discourse analysis are also explored. The example of discourse analysis shows how a text influences the practice of nursing by shaping knowledge, values and beliefs.Conclusion.  Discourse analysis can make a contribution to the development of nursing knowledge by providing a research strategy to examine dominant discourses that influence nursing practice.
Graduated compression stockings as prophylaxis for flight‐related venous thrombosis: systematic literature review
Authors: Hsieh Hsiu‐Fang , Lee Feng‐Ping 
Published: June 2005

Aim.  This paper reports a systematic review whose objective was to evaluate the effectiveness of graduated compression stockings as prophylaxis for flight‐related venous thrombosis, including deep vein thrombosis and superficial venous thrombosis, after air travel in the general population.Background.  Despite the extended history of the use of graduated compression stockings, their application to prevent flight‐related thrombosis was not explored until flight‐related thrombosis was perceived as a preventable illness. Even now, their effectiveness in preventing flight‐related thrombosis remains unresolved.Methods.  Generic terms including stocking/s, sock/s, or hosiery/hosieries were used to search a variety of electronic databases. Based on the selection criteria, decisions regarding inclusion and exclusion of primary studies were made. Using a meta‐analysis software program, relative risk for the incidence of deep vein thrombosis, superficial venous thrombosis, and intention‐to‐treat analysis was calculated.Results.  A total of nine randomized controlled trials were included. In the treatment group, two of 1237 participants developed deep vein thrombosis in comparison with 46 of 1245 in the control group. The weighted relative risk for deep vein thrombosis was 0·08, with fixed 95% confidence interval 0·03–0·23. In the treatment group, four of 826 participants developed superficial venous thrombosis in comparison with seven of 823 in the control group. The weighted relative risk for superficial venous thrombosis was 0·67. with fixed 95% confidence interval 0·24–1·87 (non‐significant difference). Using intention‐to‐treat analysis, the risk for participants in the treatment group was 0·53 times as great as that for those in the control group.Conclusions.  This review demonstrates the effectiveness of medium compression pressure, below‐knee graduated compression stockings in preventing flight‐related deep vein thrombosis but not superficial venous thrombosis in low‐medium‐ or high‐risk participants.
Cognitive variables and depressed mood in adults with intellectual disability
Authors: Esbensen A. J. , Benson B. A. 
Published: June 2005

AbstractBackground  Cognitive theory forms the foundation for cognitive therapy. There has been little research on cognitive theories and cognitive variables associated with depression in individuals with intellectual disability (ID). The current study examined cognitive variables of automatic thoughts, cognitive triad, hopelessness, attributions and self‐esteem associated with two cognitive theories of depression: Beck's Cognitive Triad theory and the Hopelessness theory of depression.Methods  Seventy‐three adults with ID screened for adequate receptive vocabulary were interviewed as part of a larger study. They reported on cognitive constructs relating to depressed mood. In addition, comparisons were made between 12 adults with ID and diagnosed major depression and a matched group of 12 adults with ID and no psychiatric diagnoses in order to determine if these groups differed on the cognitive constructs associated with the two cognitive theories of depression.Results  The cognitive variables examined were all significantly correlated with depressed mood in the direction predicted by their respective cognitive theory. Internal consistencies were good or excellent for most instruments, with the exception of those measuring hopelessness and attributions. In addition, significant differences were obtained between groups of individuals with and without co‐morbid major depression on all variables except for hopelessness.Conclusions  The results indicate that adults with ID screened for adequate receptive vocabulary are capable of reporting on subjective feelings of depressed mood and associated cognition constructs. The instruments used may be suitable for this population as they generally possessed sound internal consistencies. The results support the further examination of cognitive theories of depression among individuals with ID in order to assess the appropriateness of cognitive therapies for this population. Discrepant findings regarding hopelessness are discussed.