bluuebunny/crossref_metadata_2025_split huggingface dataset:
Randomized controlled trial comparing Merocel® and RapidRhino® packing in the management of anterior epistaxis*
Authors: Badran K. , Malik T.H. , Belloso A. , Timms M.S. 
Published: July 2005

Objectives:  A prospective non‐blinded randomized controlled trial to compare the efficacy of Merocel® and RapidRhino® nasal packs in the treatment of anterior epistaxis.Methods:  Fifty‐two consecutive participants admitted with anterior epistaxis refractory to digital pressure or nasal cautery were randomized to treatment using one or other of the nasal packs. Patients who required repacking because of continued bleeding, only the first packs were included in the analysis. Haemostatic properties of the packs were measured by grading bleeding during and after removal of the pack (0–4, where four is uncontrollable) and by noting if the nose was re‐packed or not. The difficulty of insertion and removal (graded 0–3 by clinician where 3 is the most difficult) and the participant's perception of discomfort (graded 0–10, where 10 is the worst pain) during insertion and removal of the pack were also measured.Results:  For bleeding, the mean values for Merocel® and RapidRhino® during packing and after pack removal were not significant (P = 0.38 and 0.82 respectively). The mean values of patient discomfort on insertion were 6.9 and 5.0 (P = 0.01), and for discomfort on removal were 4.6 and 3.4 (P = 0.05) respectively. The mean values of insertion graded by the clinician were 1.7 and 0.9 (P = 0.0003), and for removal were 1.4 and 0.4 (P < 0.0001).Conclusions:  RapidRhino® and Merocel® are equally effective in the control of anterior epistaxis but RapidRhino® is significantly more comfortable for the patient and easier for the healthcare worker during insertion and removal.
Physical and psychosocial correlates of head and neck cancer: an update of the literature and challenges for the future (1996–2003)
Authors: Ledeboer Q.C.P. , van der Velden L.‐A. , de Boer M.F. , Feenstra L. , Pruyn J.F.A. 
Published: July 2005

Keypoints• An update of the literature on physical and psychosocial aspects of head and neck cancer, with special emphasis on effects of treatment, patient‐related factors and psychosocial intervention on quality of life (QoL).• QoL deteriorates during and directly after treatment and returns only slowly to pre‐treatment values.• Organ preservation, gender and coping‐strategies are factors related to QoL after treatment.• As prognosis and survival were found to be comparable under different treatment regimes, we noticed a gradual shift in therapy towards organ preservation.• Systematic care, using specific instruments is important for improving the QoL.• We feel that more attention should be given to improving support, in order to optimize the QoL of patients during the palliative stage.
Healthcare workers' hand decontamination practices: compliance with recommended guidelines
Authors: Creedon Sile A. 
Published: July 2005

Aim.  This paper reports a study of healthcare workers' handwashing/hand hygiene practices from a behavioural perspective.Background.  Hospital acquired infection poses a very real and serious threat to all who are admitted to hospital. Pathogens are readily transmitted on healthcare workers’ hands, and hand hygiene substantially reduces this transmission. Evidence‐based guidelines for healthcare workers’ hand hygiene practices exist, but compliance with these is internationally low.Methods.  A quasi‐experimental design with a convenient sample was used. The Predisposing, Reinforcing, Enabling Constructs in Educational Diagnosis and Evaluation Health Education Theory was used as the theoretical framework, and the data were collected in 2001. Healthcare workers’ handwashing practices (observation of behaviour, n = 314) and their predisposition (attitudes, beliefs and knowledge) towards compliance with hand hygiene guidelines (questionnaire, n = 62) were studied. Nurses, doctors, physiotherapists and care assistants involved in direct patient care in the study unit participated in the study. The interventional hand hygiene programme aimed to predispose healthcare workers to adopt hand hygiene behaviour (poster campaign and educational handout), reinforce (feedback on pretest results) and enable the behaviour (provision of an alcohol hand rub beside each patients bedside).Results.  Implementation of the multifaceted interventional behavioural hand hygiene programme resulted in an overall improvement in compliance with hand hygiene guidelines (51–83%, P < 0·001). Furthermore, healthcare workers believed that their skin condition improved (P < 0·001). An increase in knowledge about handwashing guidelines was also found.Conclusions.  In order to be effective, efforts to improve compliance with handwashing guidelines must be multifaceted. Alcohol hand rubs (with emollients) need to be provided at each patient's bedside. Issues surrounding healthcare workers’ skin irritation need to be addressed urgently.
Early 20th century untrained nursing staff in the Rockhampton district: a necessary evil?
Authors: Madsen Wendy 
Published: July 2005

Aim.  This paper explores the role of untrained nursing staff within the nursing services of the Rockhampton region, Queensland, Australia, throughout the early 20th century. It details who these nurses were, where they worked and how their work was affected by factors such as legislation and social changes.Background.  Despite the increasing prevalence of trained nurses from the late 19th century, nurses who had never undergone any formal training continued to gain work in hospitals, institutions and their local communities.Method.  This paper is an historical analysis of a wide range of primary source material relating to untrained nursing staff. The primary source material used related specifically to a limited geographical region in Australia.Findings.  Untrained nursing staff primarily worked as private duty nurses at the beginning of the 20th century. However, as the century progressed, their opportunities to work as untrained nursing staff tended towards institutions dealing with the chronically ill and the aged. As a result of this transition, their profile altered from that of a married/widowed woman living at home with dependents to one who could live on‐site at the institution with no dependents. Furthermore, the level of autonomy of the untrained nurse decreased dramatically throughout this period from being relatively independent to being under the control of a trained nurse within the institution.Conclusion.  Consideration of the historical evolution of untrained nursing staff challenges some of the assumptions made about this category of nurse, assumptions that can affect current relationships between professional nurses and others who undertake nursing work.
Strengthening women's health visiting work with women
Authors: Pritchard Jacqueline E. 
Published: July 2005

Aims.  The aim of the paper is to show how life events contributed to ways in which health visitors related to women in their professional work.Background.  Health visiting work has been labelled ‘invisible’ and since, ‘invisibility’ is an issue in feminist literature, this concept was explored in relation to health visiting.Methods.  A qualitative research design was developed, with a conceptual framework based in feminist and educational literature. Semi‐structured, tape‐recorded interviews were conducted with a purposeful sample of 35 women health visitors. A systematic approach to data analysis took place, through which key themes and analytic categories were identified.Findings.  The findings showed three levels of interaction between health visitor and client that overlapped in the working relationship. First, the public face of the work is exemplified in the planned purposes of the health visiting contact. Secondly, during this contact, health visitors may draw on their lay knowledge of ‘life events’, that is, their private knowledge of the situation being described by the client. Thirdly, and at the same time, health visitors manage hidden personal feelings that arise within the interaction.Conclusions.  The invisible private knowledge gained in life events can have a transforming effect for both health visitors and clients. However, there is no educational model which legitimizes private and personal knowledge as a resource for use by health visitors. Understanding women's own position as ‘women in a gendered society’ would enhance the way in which health visiting is conducted and could lead to more productive outcomes in public health work.
Coping with a possible breast cancer diagnosis: demographic factors and social support
Authors: Drageset Sigrunn , Lindstrøm Torill Christine 
Published: July 2005

Aim.  This paper reports a study examining the relationships between demographic characteristics, social support, anxiety, coping and defence among women with possible breast cancer.Background.  Awaiting a possible breast cancer diagnosis is an anxiety‐provoking situation that demands coping. Social support and demographic characteristics have been reported to influence coping and well‐being, but the interconnection is insufficiently understood.Design.  A survey design was used, and self‐administrated questionnaires were returned by a convenience sample of 117 women in Norway who had undergone breast biopsy. The data were collected from September 1998 to February 2000.Instruments.  The instruments consisted of: the Social Provisions Scale, State‐Trait Anxiety Scale, Utrecht Coping List and Defence Mechanisms Inventory. In addition, data on age, level of education, employment, marital status, and household status were collected.Results.  Social support was positively related to instrumental‐oriented coping and emotion‐focused coping, unrelated to cognitive defence and defensive hostility. Educational level was positively related to instrumental‐oriented coping. Educational level, employment and marital status were negatively related to cognitive defence. Educational level was the most important contributor to social support. Attachment and education were the most important contributors to instrumental‐oriented coping, with education as the strongest predictor.Conclusion.  Better coping was linked primarily to education, and secondly to attachment. Unemployment, low level of education and single/divorced/widowed status were related to greater use of cognitive defence. Women who used a defensive hostile style tended to receive poor social support. Nurses need to be aware of the influence of demographic characteristics on social support, coping and defence and to identify poor copers, as these patients are most in need of professional support.
Requirement for 100% oxygen before and after closed suction
Authors: Demir Fatma , Dramali Alev 
Published: July 2005

Aim. This paper reports an experimental study to determine whether giving 100% oxygen for 1 minute before and after closed suctioning is required.Background. Some studies suggest that patients receiving closed suction do not require preoxygenation to minimize desaturation.Methods. The study was conducted in 2002, with 30 patients receiving mechanical ventilation who had various positive end‐expiratory levels. Two suctioning methods were used for each patient: one involving administration of 100% oxygen for 1 minute before and after suctioning and the other without hyperoxygenation. Samples of arterial blood gases were taken before and after suctioning. Heart rate, arterial oxygen saturation and mean arterial pressure measures were documented before, immediately after, 30 and 60 seconds after suctioning.Results. Levels of partial oxygen pressure, arterial oxygen saturation and mean arterial pressure were significantly higher in patients who received 100% oxygen for 1 minute before and after suction, whereas partial carbon dioxide pressure and heart rate were similar in the two groups.Conclusions. In patients who did not receive 100% oxygen before and after closed suctioning, no significant falls in partial oxygen pressure and oxygen saturation were seen. A small number of patients were hypoxaemic before suctioning, and giving 100% oxygen might be deleterious for this category.
Frequency and effect of optimal anticoagulation before onset of ischaemic stroke in patients with known atrial fibrillation
Authors: INDREDAVIK B. , ROHWEDER G. , LYDERSEN S. 
Published: July 2005

Abstract.Background.  The aims of the study were (i) to examine which antithrombotic therapy patients with known atrial fibrillation use at the point of time when they suffer an ischaemic stroke, (ii) to evaluate the effects of optimal antithrombotic treatment on outcome and severity of the stroke.Methods.  Patients with known atrial fibrillation before onset of acute ischaemic stroke, and age >60 years were included. Antithrombotic therapy on admission was classified into four groups: no antithrombotic therapy, aspirin, sub‐optimal anticoagulation (warfarin and international normalized ratio, INR < 2.0) and optimal anticoagulation (warfarin and INR ≥ 2.0). Primary outcome: modified Rankin Scale (mRS) 5 or 6 at day 7 poststroke. Secondary outcomes: (i) death or discharge to a nursing home, (ii) death, (iii) stroke severity on admission assessed by Scandinavian Stroke Scale.Results.  A total of 394 patients were included. On admission 109 (28%) patients used no antithrombotic therapy, 169 (43%) aspirin, 52 (13%) warfarin and had an INR < 2.0, and 64 (16%) used warfarin and had an INR ≥ 2.0. The proportion of patients with an mRS 5 or 6 and the corresponding odds ratios were: in the warfarin group with INR < 2.0, 16 (31%), OR 3.1 (CI: 1.2–8.0), (P = 0.019), in the group with no antithrombotic therapy 29 (27%), 2.5 (1.1–5.9), (P = 0.034), and in the aspirin group 41(24%), 2.2 (1.0–5.1) (P = 0.054), compared with the warfarin group with INR ≥ 2.0, where eight (13%) patients had a poor outcome. A significantly higher proportion of patients died or were discharged to a nursing home in the warfarin group with an INR < 2.0 (P = 0.014), in the aspirin group (P = 0.018) and in the no‐treatment group (P = 0.035), compared with the warfarin group with an INR ≥ 2.0. No significant differences were found regarding death alone and stroke severity on admission.Discussion.  Few patients with known atrial fibrillation who suffer an ischaemic stroke receive optimal antithrombotic therapy prior to the onset of stroke. Optimal anticoagulation does not only reduce the risk of ischaemic stroke, but also appears to reduce death and severe dependency as well as the need for nursing home care, if an ischaemic stroke occurs.
Clinical characterization of breakthrough bacteraemia: a survey of 392 episodes
Authors: LÓPEZ DUPLA M. , MARTINEZ J. A. , VIDAL F. , ALMELA M. , LÓPEZ J. , MARCO F. , SORIANO A. , RICHART C. , MENSA J. 
Published: July 2005

Abstract.Background.  Few data are available on the clinical features of patients who develop breakthrough bacteraemia, understood as positive blood cultures despite appropriate antibiotic therapy.Objectives.  To determine the clinical significance and outcome of a large series of breakthrough bacteraemia.Design.  Retrospective analysis of a prospectively collected database.Setting.  Two university‐affiliated hospitals in Catalonia, Spain.Subjects.  A total of 392 individuals who suffered an episode of breakthrough bacteraemia recorded between 1997 and 2002.Interventions.  Demographic characteristics, underlying diseases, origin of infection, sources of infection, microorganisms isolated, McCabe and Jackson prognostic criteria, and mortality were analysed.Results.  Breakthrough bacteraemia was detected in 392 of 6324 (6.1%) episodes of bacteraemia. Eighty per cent of episodes were nosocomial. The most frequent source of infection in breakthrough bacteraemia was endovascular (70%). Coagulase‐negative staphylococci, Staphylococcus aureus, and Pseudomonas aeruginosa were the most significant microorganisms involved. Nosocomial acquisition together with selected sources (central venous catheter, endocarditis and other endovascular foci), underlying conditions (neutropenia, polytraumatism, allogenic bone marrow and kidney transplantation), and particular microbial aetiologies (S. aureus, P. aeruginosa and polymicrobial) were independently associated with increased risk for developing breakthrough bacteraemia. Crude mortality rate was greater in patients with breakthrough bacteraemia (16% vs. 12.3%; P < 0.05), and this condition was an independent predictor of death (OR 1.4, 95% CI, 1–1.9; P = 0.04).Conclusions.  In view of a case of breakthrough bacteraemia it is mandatory to search for an endovascular focus. Empiric treatment should be directed to cover S. aureus, coagulase‐negative staphylococci and nonfermentative Gram‐negative bacilli. Breakthrough bacteraemia is an independent predictor of death.
Prognostic role of C‐reactive protein in very old patients with acute ischaemic stroke
Authors: MASOTTI L. , CECCARELLI E. , FORCONI S. , CAPPELLI R. 
Published: July 2005

Abstract.Background and scope.  Recent literature has demonstrated that inflammation contributes to all phases of atherosclerosis and brain damage caused by stroke. In acute phase of cerebrovascular diseases biochemical markers of inflammation, such as C‐reactive protein (CRP), could represent an indicator of severity of stroke, but few studies have verified this hypothesis, especially in very old patients. The aim of this study was to evaluate the role of CRP on short‐ and long‐term prognosis in 75‐year old and over elderly patients with acute ischaemic stroke.Materials and methods.  We retrospectively evaluated CRP values (nephelometric method), performed within 12 h from hospital admission, in 196 elderly patients (124 females and 72 males with mean age ± SD 83.32 ± 10.46 years), discharged with diagnosis of acute ischaemic stroke, 68 of them with atherothrombotic large vessel stroke, 38 with lacunar stroke and 90 with cardioembolic stroke. We studied the relationship between CRP values and short‐term prognosis [30‐day mortality, length of hospitalization (LOS) and physical disability measured by modified Rankin scale and long‐term prognosis (12‐month mortality and re‐hospitalization)].Results.  Mean values of CRP were significantly higher in patients with cardioembolic stroke compared with atherothrombotic large vessel and lacunar stroke, in patients who died in the first 30 days from the acute event compared with survivors. LOS and physical disability score rose with increasing values of CRP for all subtypes of stroke. Higher CRP values were associated with the 12‐month re‐hospitalization for cerebrovascular events, whereas it did not influence the 12‐month cumulative re‐hospitalization and 12‐month mortality.Conclusions.  Elevation of CRP values at hospital admission could represent a negative prognostic index in elderly patients with ischaemic stroke, in particular, for short‐term prognosis.
Carbimazole induced eosinophilic granulomatous vasculitis localized to the stomach
Authors: SÈVE P. , STANKOVIC K. , MICHALET V. , VIAL T. , SCOAZEC J.‐Y. , BROUSSOLLE C. 
Published: July 2005

Abstract.Vasculitis associated with anti‐neutrophil cytoplasmic antibodies has been reported in patients treated with anti‐thyroid drugs and especially propylthiouracil. We report here a case of granulomatous eosinophilic vasculitis mimicking gastric neoplasm and peripheral eosinophilia in a 27‐year‐old man who was treated with carbimazole for 5 months for Graves’ disease. Clinical and morphologic features resolved within 2 months after stopping the drug, suggesting a causative role for the drug. To our knowledge, this is the first biopsy‐proven granulomatous eosinophilic vasculitis associated with this drug.
Nicotinic acid: the broad‐spectrum lipid drug. A 50th anniversary review
Authors: CARLSON L. A. 
Published: July 2005

Abstract.Nicotinic acid has, like the Roman God Janus, two faces. One is the vitamin. The other is the broad‐spectrum lipid drug. The Canadian pathologist Rudolf Altschul discovered 50 years ago that nicotinic acid in gram doses lowered plasma levels of cholesterol. From the point of view of treatment of the dyslipidaemias that are risk factors for clinical atherosclerosis nicotinic acid is a miracle drug. It lowers the levels of all atherogenic lipoproteins – VLDL and LDL with subclasses as well as Lp(a) – and in addition it raises more than any other drug the levels of the protective HDL lipoproteins. Trials have shown that treatment with nicotinic acid reduces progression of atherosclerosis, and clinical events and mortality from coronary heart disease. The new combination treatment with statin‐lowering LDL and nicotinic acid‐raising HDL is reviewed. A basic effect of nicotinic acid is the inhibition of fat‐mobilizing lipolysis in adipose tissue leading to a lowering of plasma free fatty acids, which has many metabolic implications which are reviewed. The very recent discovery of a nicotinic acid receptor and the finding that the drug stimulates the expression of the ABCA 1 membrane cholesterol transporter have paved the way for exciting and promising new 50 years in the history of nicotinic acid.
Increased risk of hyperthyroidism among patients hospitalized with bipolar disorder
Authors: Thomsen Anders F , Kessing Lars V 
Published: July 2005

Objectives:  Hyperthyroidism has been associated with affective disorder in many cross‐sectional studies, but longitudinal studies in this connection are scarce. We assessed whether hospitalization with depressive disorder or bipolar disorder was a risk factor for development of hyperthyroidism.Methods:  We conducted a historical cohort study using the Danish register data. The observational period was 1977–99. Three study cohorts were identified: all patients with a first hospital admission with resulting index discharge diagnoses of depression, bipolar disorder, or osteoarthritis. The risks of subsequently being readmitted with a resulting discharge diagnosis of hyperthyroidism were estimated in survival analyses.Results:  A study sample of 133 570 patients discharged with an index diagnosis was identified. Exactly 610 patients were later readmitted following diagnoses of hyperthyroidism. Patients with depressive disorder did not have an increased risk of hyperthyroidism, whereas patients with bipolar disorder had an increased of risk on the margin of statistical significance, when compared to patients with osteoarthritis. Patients with bipolar disorder had a significantly increased risk of hyperthyroidism when compared to patients with depression.Limitations:  The results apply only to hospitalized patients. Diagnoses are not validated for research purposes.Conclusion:  Patients hospitalized with bipolar disorder tend to be at greater risk of readmission with hyperthyroidism than suitable control patients.