bluuebunny/crossref_metadata_2025_split huggingface dataset:
Blood exposure: factors promoting health care workers’ compliance with guidelines in connection with risk
Authors: Lymer Ulla‐Britt , Richt Bengt , Isaksson Barbro 
Published: December 2004

Background.  Health care workers compliance with guidelines, universal precautions, in connection with tasks that could involve contact with patient's blood is unsatisfactory. In a previous paper, we identified different forces that undermine compliance. Socialization into infection control, routinization, stereotyping, perceptions of patients’ wishes and the presence of competing values and norms are examples of such forces.Aims and objectives.  The aim of this article is to describe and analyse different forces that promote adherence to universal precautions. Behavioural variations are seen as a consequence of differences between wards with regard to the safety culture. Safety culture is conceptualized as the outcome of a constant interplay between deactivating and reactivating forces. In this article the focus is on the latter.Method.  The grounded theory approach. Data were collected through interviews with nurses and assistant nurses.Results.  The charge nurse, informal leaders, students, infection control nurses, type of work, availability of equipment, blood‐exposure incidents and media‐coverage of infectious diseases are described as potentially important for compliance. The properties these agents must possess in order to be influential are also described.Relevance to clinical practice.  The outcome of an occupationally acquired infection can be fatal. Hence it is important that health care workers take protective measures. The results imply that mere information about safe practices alone is insufficient to achieve that goal. All factors of importance for compliance must be taken in to consideration in clinical work and in education.
Technology – an actor in the ICU: a study in workplace research tradition
Authors: Wikström Ann‐Charlott , Larsson Ullabeth Sätterlund 
Published: December 2004

Background. The present study focuses on human–machine interaction in an intensive care unit in the West of Sweden.Aims. The aim of the present study was to explore how technology intervenes and challenges the ICU staff's knowing in practice.Theoretical perspective. The study's theoretical starting point draws on workplace research tradition. Workplace studies encompass the interaction between the actors’ situated activities and the technological tools that make their activities possible.Method. Fieldwork orin situstudies of everyday practice in an intensive care unit documented in written field notes constituted the data.Results. The findings show first how technology intervenes in the division of labour when the taken‐for‐granted ‘old’ everyday practice is disrupted when a new machine intervenes in the morning's work; secondly, it reveal how technology challenges practical knowing and thirdly, it shows how technology reformulates practice. Staff members’ awareness of routine problems is often connected to the ability to see, which is always related to cultural/contextual competence.Conclusion. It is concluded that it is not talk alone that helps the caregivers to ‘(dis)solve’ the problems. The ability to see the problems, the work environment and to find the relevant supporting tools for ‘(dis)solving’ the routine problems is also crucial. But it is not possible to say that it is the skillful work of humans that solve problems, nor do we claim it is the tools that do so. Humans and tools are interwoven in the problem‐solving process.Relevance to clinical practice. Routine problems in the intensive care unit are not ‘(dis)solved’ through the cognitive work of individual staff members alone. Problems are also ‘(dis)solved’ jointly with other staff members. Staff members ‘borrow’ the knowing from each other and problems are re‐represented through communication. The knowing has to be distributed among the intensive care unit staff to make the everyday work flexible.
Discharge planning: ‘fooling ourselves?’– patient participation in conferences
Authors: Efraimsson Eva , Sandman PO , Hydén Lars‐Christer , Rasmussen Birgit H 
Published: December 2004

Background.  The aim of discharge planning conferences (DPCs) is to co‐ordinate resources and to enhance patient involvement in care in connection with relocation from hospital. DPCs can be characterized as institutional conversations, and are often executed as standard procedures, but the scientific basis for the activity is weak.Aims and objectives.  The aim of this study was to illuminate and describe the communication at DPCs.Design.  A purposeful and consecutive sample of eight DPCs was collected in which the future care of eight women, aged 70 years or more, was discussed.Methods.  Transcribed video recordings were analysed in two steps. ‘The initial analysis’ aimed at describing the structure and content of the communication. This description constituted the basis for an interpretation, leading to ‘the focused analysis’ aiming at finding evidence for the assumptions made in the interpretation.Results.  The result revealed that the participation of patients was very less the DPCs. The decisions had often already been made, and the women were expected to be pleased with the decision; institutional representatives (IRs) frequently justified their actions by referring to bureaucratic praxis.Conclusions.  The women were both encouraged and excluded from participation by the IRs. This dichotomy occurred because the IRs, as professionals, struggled to simultaneously realize their caring mission and their obligation to enforce the values and rules of the institution, i.e. efficiency and rationality. Thus, IRs and patients were equally imprisoned within the institutional system.Relevance to clinical research.  This result illustrates how conflicting paradigms are imbedded and reproduced by healthcare professionals in their communicative praxis. Awareness of this is a prerequisite for improvements in working procedures congruent with a caring paradigm that support patient participation.
Caring and uncaring encounters in nursing in an emergency department
Authors: Wiman Elisabeth , Wikblad Karin 
Published: December 2004

Background.  Caring is a core characteristic of nursing. Nurses’ caring behaviour has been explored in several studies. When caring for trauma patients, the most important caring behaviour must be the procedures associated with lifesaving. However, it is important not to forget the patient's psychological needs.Aim.  The aim of this study was to highlight encounters between injured patients and nurses in the trauma team and to explore whether the theory of caring and uncaring encounters in nursing and health care is applicable in emergency care.Data collection and analysis.  Data were collected by videotaping caring episodes between slightly injured patients and nurses in the trauma team. Five episodes involving 10 nurses were studied. The analysis was carried out in four steps. First the videotapes were studied several times and then transcribed into narratives, which were reduced into courses of events. These were subsequently classified according to aspects of caring and uncaring.Results.  The nurses’ verbal and non‐verbal communication was poor, and they adopted a wait‐and‐see policy. A new uncaring aspect, instrumental behaviour, emerged from this poor communication. One of the caring aspects, being dedicated and having courage to be appropriately involved, could not be identified. Most encounters included several aspects of caring and uncaring, but the uncaring aspects predominated. The dominance of uncaring aspects indicates a lack of affective caring behaviour.Conclusion.  The result showed that the theory is partly applicable in emergency care. A new aspect, instrumental behaviour emerged. The nurses’ behaviour in the five episodes was labelled as uncaring. Authentic nurse–patient encounters are essential in nursing.Relevance to clinical practice.  The importance of meeting patients’ psychological needs and nurses’ affective caring behaviour should be emphasized in trauma care, trauma courses and nursing education. It is necessary to measure the caring behaviour of trauma nurses.
Older people living in nursing homes or other community care facilities: Registered Nurses’ views of their working situation and co‐operation with family members
Authors: Weman Karin , Kihlgren Mona , Fagerberg Ingegerd 
Published: December 2004

Background.  Little attention has been paid to Registered Nurses’ working conditions and how they experience their working situation in community health care. The nurses’ vocational background is of interest, as well as their apprehension about communicating and co‐operating with the older persons’ family members.Aims and objectives.  The aim of the study was to describe Registered Nurses’ views of their working situation in community health care and of co‐operation with family members of older people living in nursing homes or similar facilities.Design.  The study was carried out in a geographically defined area in the south of Sweden. A questionnaire was sent to all the Registered Nurses (n = 314) working within community health care of whom 210 Registered Nurses replied to the questionnaires.Methods.  Latent content analysis was used on the comments to six questions, in order to illuminate the statistical findings from the statements of the questions measured by the Likert scale.Results.  The results showed that almost half of the Registered Nurses working in care of older people are not satisfied with their working situation. The nurses with less than 5 years working experience find their working situation most stimulating. All of them expressed that it is important that there is co‐operation between themselves and the family members and it was also considered important to develop models that could improve co‐operation. Male nurses believed, to a lesser extent, that family members were a resource in caring, compared with female nurses; however, all male nurses stressed the importance of facilitating informal caregivers. Nurses with more than 5 years of working experience expressed that it was important that family members show engagement in caring for older people. Furthermore, they expressed that it was necessary that the family members took care of the older persons’ interests.Relevance to clinical practice.  The findings that half of the Registered Nurses are dissatisfied with their working situation have relevance in clinical practice because of the risk of losing competent nurses in this area.
Association of psoriasis vulgaris with HLA class I and class II antigens in the Turkish population, according to the age at onset
Authors: Kundakçi N. , Oskay T. , Ölmez Ü. , Tutkak H. , Gürgey E. 
Published: December 2004

AbstractBackground Association of psoriasis vulgaris with HLA antigens reference to age at onset has been reported in different racial or ethnic populations.Objective Our purpose was to determine the distribution of HLA markers in the Turkish population according to the age at onset of the psoriasis vulgaris.Methods HLA class I and class II antigens were performed by serologic methods in a group of 100 Turkish patients with psoriasis and 201 control subjects. Patients with psoriasis were subdivided into two groups based on age at onset (below or above 40 years of age) and family history.Results The frequency of HLA A30, Cw3, Cw6, DR7, DR14, DQ8, and DQ9 antigens were significantly increased in the Turkish psoriatic patients whereas HLA A66, Cw2, Cw4 and DR11 were found to be negatively associated with psoriasis. However, there were striking differences in HLA antigens according to the age at onset of the disease. Type I, early onset was associated with a high frequency of A30, B50, Cw6 and DR7 antigens whereas patients with type II, late onset had an increased frequency of Cw7.Conclusions We conclude that psoriasis is probably a genetically determined disease and suggest that HLA‐Cw6 antigen seems to associate commonly with early onset of psoriasis in Turkish patients.
Treatment of late‐stage Sézary syndrome with 2‐Chlorodeoxyadenosine
Authors: Bouwhuis Saskia A. , El‐Azhary Rokea A. , McEvoy Marian T. , Gibson Lawrence E. , Habermann Thomas M. , Witzig Thomas E. , Pittelkow Mark R. 
Published: December 2004

AbstractBackground  2‐Chlorodeoxyadenosine (2‐CdA), a purine adenosine analog, is safe and effective chemotherapy for patients with hairy cell leukemia and low‐grade lymphomas. Adverse effects include neutropenia, lymphocytopenia, and infectious complications. Our objective was to evaluate the efficacy of 2‐CdA (2–6 seven‐day cycles) in the treatment of late‐stage, recalcitrant Sézary syndrome.Methods  Retrospective review of medical records of six patients with Sézary syndrome who had received 2‐CdA cycles at Mayo Clinic, Rochester between March 1995 and March 2000. Variables assessed from the records included improvement in global appearance, extent of erythroderma, size of lymph nodes, pruritus, and leukocyte, lymphocyte, and absolute Sézary cell counts.Results  Two patients, both with stage III Sézary syndrome, whose previous treatment consisted of only two modalities, responded well to the treatment, with moderate to total clearing of erythroderma and pruritus associated with a significant decrease in Sézary cell counts. The other four patients had only a partial response (one patient) or no response (three patients) to 2‐CdA. The mortality rate was 50%. All three patients died of Staphylococcus aureus sepsis. However, only one patient was receiving 2‐CdA treatment when he died. The other two patients died 8 and 9 weeks after the last 2‐CdA cycle. This high mortality rate is attributed to infectious complications after 2‐CdA treatment in patients with recalcitrant disease.Conclusion  2‐Chlorodeoxyadenosine shows efficacy in stage III Sézary syndrome, but it also carries a substantial risk of septic complications and mortality. It can be used if no other suitable alternatives are available. Caution should be exercised in all these patients regarding skin care and avoidance of infections or sepsis.
Bullous erythema nodosum leprosum (bullous type 2 reaction)
Authors: Sethuraman Gomathy , Jeevan Divakaran , Srinivas Chakravarthy Rangachary , Ramu Gopal 
Published: December 2004

A 35‐year‐old man suffering from lepromatous leprosy with recurrent erythema nodosum leprosum (ENL) (bullous type 2 reaction) was admitted for acute exacerbation of the reaction. He had received regular WHO multibacillary multidrug therapy (WHO‐MB‐MDT) and corticosteroids for 11 months. The dose of corticosteroids could not be tapered below 20 mg/day due to sudden, frequent, and severe relapses of ENL. In hospital, he suddenly developed hypotension for which he was moved to the intensive care unit and managed. On the third day, he developed multiple, flaccid and tense bullae, some of which were hemorrhagic, over the face, trunk, and proximal extremities (Fig. 1). Some of the ENL lesions showed a central bluish hue. Investigations revealed leukocytosis, thrombocytopenia, and hypokalemia. Blood culture yielded coagulase‐negative Staphylococcus aureus. Slit skin smear and smear from the blister fluid showed numerous, fragmented, acid‐fast bacilli (AFB) in clusters and many neutrophils (Fig. 2). Skin biopsy revealed a subepidermal bulla that consisted of neutrophils and macrophage granulomas in the dermis together with perivascular neutrophilic infiltration (Fig. 3); however, there were no features suggestive of vasculitis. Fite's stain demonstrated fragmented AFB. Both direct and indirect immunofluorescence studies did not show features of autoimmune bullous disorders; however, moderately strong discontinuous fibrinogen deposits were seen along the basement membrane and around the blood vessels. There were no deposits of immunoglobulin G (IgG) and C3. He was treated with antimicrobials, potassium chloride, and hydrocortisone, 100 mg intravenously, twice daily, which was subsequently switched to oral prednisolone. He responded well and was discharged. Upon lowering the dose of corticosteroids, he again developed severe ENL with fewer bullous lesions.Multiple, tense, hemorrhagic bullae over the trunkimageSmear from the blister fluid showing numerous, fragmented, acid‐fast bacilli (AFB) and neutrophils (Ziehl–Neelsen stain, × 200)imagePhotomicrograph of the skin biopsy showing subepidermal bulla consisting of neutrophils and macrophage granulomas in the dermis together with perivascular neutrophilic infiltration (hematoxylin and eosin, × 200)image
Flycatcher song in allopatry and sympatry – convergence, divergence and reinforcement
Authors: Haavie J. , Borge T. , Bures S. , Garamszegi L. Z. , Lampe H. M. , Moreno J. , Qvarnström A. , Török J. , Sætre G.-P. 
Published: December 2004

Abstract
The theory of reinforcement predicts that natural selection against the production of unfit hybrids favours traits that increase assortative mating. Whether culturally inherited traits, such as bird song, can increase assortative mating by reinforcement is largely unknown. We compared songs of pied (Ficedula hypoleuca) and collared flycatchers (F. albicollis) from two hybrid zones of different ages with songs from allopatric populations. Previously, a character divergence in male plumage traits has been shown to reinforce premating isolation in sympatric flycatchers. In contrast, we find that the song of the pied flycatcher has converged towards that of the collared flycatcher (mixed singing). However, a corresponding divergence in the collared flycatcher shows that the species differences in song characters are maintained in sympatry. Genetic analyses suggest that mixed song is not caused by introgression from the collared flycatcher, but rather due to heterospecific copying. Circumstantial evidence suggests that mixed song may increase the rate of maladaptive hybridization. In the oldest hybrid zone where reinforcement on plumage traits is most pronounced, the frequency of mixed singing and hybridization is also lowest. Thus, we suggest that reinforcement has reduced the frequency of mixed singing in the pied flycatcher and caused a divergence in the song of the collared flycatcher. Whether a culturally inherited trait promotes or opposes speciation in sympatry may depend on its plasticity. The degree of plasticity may be genetically determined and accordingly under selection by reinforcement.
Significance of renal function in changes in acid–base metabolism after orthotopic bladder replacement: Colon neobladder compared with ileal neobladder
Authors: MIYAKE HIDEAKI , HARA SHOJI , ETO HIROSHI , ARAKAWA SOICHI , KAMIDONO SADAO , HARA ISAO 
Published: December 2004

AbstractBackground:  The objective of this study was to determine whether renal function influences the acid–base metabolism in patients undergoing orthotopic bladder replacement using intestinal segment.Methods:  Acid–base balance, serum electrolytes and renal function were studied in 30 patients with colon neobladder and 18 patients with ileal neobladder. Mean follow up was 51 months. Effects of renal function on acid–base metabolism in both types of bladder replacement were compared. Therapeutic efficacy of the sodium bicarbonate administration was also evaluated in cases with hyperchloremic acidosis.Results:  No significant differences were observed in any of the variables examined between the colon and ileal neobladder groups, except for potassium concentration. Although metabolic acidosis was detected using the Siggard–Anderson acid–base nomogram in eight (26.7%) and seven (38.9%) patients in the colon and ileal neobladder groups, respectively, this difference was not significant. In both the colon and ileal neobladder groups, the serum creatinine concentrations in patients diagnosed with metabolic acidosis were significantly higher than in those diagnosed with a normal metabolic status. Furthermore, as a result of severe metabolic acidosis, three (10.0%) and three (16.7%) patients in the colon and ileal neobladder groups, respectively, were administered sodium bicarbonate and their metabolic status was fully normalized.Conclusions:  Despite there being no statistical difference, patients with ileal neobladder may more easily develop metabolic acidosis compared with those with colon neobladder. In addition, a close association between the serum creatinine level and the degree of metabolic acidosis was observed in both groups. However, even if severe metabolic acidosis occurs, it is relatively easy to correct using sodium bicarbonate. These findings suggest that it might be safe to use a colon segment for orthotopic bladder reconstruction in patients with higher serum creatinine levels, despite no significant difference in acid–base metabolism and detection rates of metabolic acidosis between the colon and ileal neobladder groups.
Combination of a cholinergic drug and an α‐blocker is more effective than monotherapy for the treatment of voiding difficulty in patients with underactive detrusor
Authors: YAMANISHI TOMONORI , YASUDA KOSAKU , KAMAI TAKAO , TSUJII TOSHIHIKO , SAKAKIBARA RYUJI , UCHIYAMA TOMOYUKI , YOSHIDA KEN‐ICHIRO 
Published: December 2004

AbstractAim:  The aim of the present study was to compare the effectiveness of a cholinergic drug, an α‐blocker and combinations of the two for the treatment of underactive detrusor.Methods:  One hundred and nineteen patients with underactive bladder were assigned to three groups: the cholinergic group, consisting of 40 patients taking bethanechol chloride (60 mg/day) or distigmine bromide (15 mg/day); the α‐blocker group, consisting of 38 patients taking urapidil (60 mg/day); and the combination group, consisting of 41 patients taking both a cholinergic drug and an α‐blocker. The effectiveness of each therapy was assessed 4 weeks after initialization of the therapy.Results:  Total urinary symptom scores (International Prostate Symptom Score, IPSS) remained unchanged after the cholinergic therapy, but were significantly lower after the α‐blocker treatment (P = 0.0001) and the combination therapy (P = 0.0001). With regard to the total IPSS, there were significant differences between the cholinergic and the α‐blocker groups (P = 0.0008), and also between the cholinergic and combination groups (P = 0.0033), in favor of the latter. The average and maximum flow rates did not increase significantly after monotherapy with either the cholinergic drug or the α‐blocker, but they significantly increased after combination therapy compared to baseline values (P = 0.0033 and P= 0.0004, respectively). Postvoid residual volume did not decrease significantly after the cholinergic drug therapy, but decreased significantly after the α‐blocker (P = 0.0043) and the combination therapies (P = 0.0008). The percentage of residual urine decreased significantly after therapy in all groups (P = 0.0005, P= 0.0176 and P= 0.0001, respectively).Conclusion:  Combination therapy with a cholinergic drug and an α‐blocker appears to be more useful than monotherapy for the treatment of underactive detrusor.
Towards more effective use of decision support in clinical practice: what the guidelines for guidelines don’t tell you
Authors: Scott I. A. , Denaro C. P. , Bennett C. J. , Mudge A. M. 
Published: December 2004

AbstractThe Brisbane Cardiac Consortium Clinical Support Systems Program used multiple strategies in optimising quality of care of patients with either of two cardiac conditions. One of these strategies was the development and active implementation of decision support systems centred on evidence‐based, locally agreed clinical practice guidelines. Our experience in undertaking this task highlighted numerous operational challenges for which solutions were difficult to extract from existing published literature. In the present article we provide a methodology grounded in both theory and real‐world experience that may assist others in developing and implementing systems of guideline‐based decision support. (Intern Med J 2004; 34: 492−500)