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Caution
Kinds of Caution Selected AbstractsThe future: genes, physical activity and healthACTA PHYSIOLOGICA, Issue 4 2010F. W. Booth Abstract The assigned title for the Lindhard presentation was to examine the future of genes, physical activity and health. The current review is a summary of this presentation. Caution is expressed that technology is improving so rapidly that a future view is limited to a few years as opposed to the 100 years passing since Lindhard's achievements. The near futuristic opportunities and challenges for four major topic topics are reviewed here. Concerns are expressed over current usage of the terms ,control' group and ,non-responders' in exercise research. Our view is that ,control' needs to be differentiated between its usage for treatments of exercise to restore natural functions in individuals with less than healthy levels of physical activity and the inherited genome's expectation for physical activity levels to maintain normal function. For the second discussed topic, it is proposed that the term ,non-responders' should be replaced by the term ,low sensitivity' as there may be no such human who is a non-responder to every exercise adaptation. The third futuristic topic is exercise prescription as envisioned for individualized medicine. However, numerous limitations and challenges exist to truly optimal exercise medicine at the level of one individual. Finally, preventative physical activity medicine is discussed. Physical activity as a therapy now exists to prevent most of the chronic diseases. The future needs to understand the molecular basis for how the body becomes dysfunctional when its level of physical activity does not match the norm of physical activity that selected our inherited genome. [source] Combining Strategies to Select Reserves in Fragmented LandscapesCONSERVATION BIOLOGY, Issue 4 2004KRISTINA D. ROTHLEY These criteria are assumed to be reasonable surrogates for the true network objectives. Caution is warranted, however, because the relationships between the selection criteria and the reserve-network objectives may be inconsistent. Conflicts are also likely to arise because no single reserve network will be optimal with respect to multiple objectives (or selection criteria) simultaneously. Instead, reserve planners must compromise between conflicting demands. We field tested the relationships between a variety of selection criteria and the objectives of a reserve network for the sandplain natural communities on Martha's Vineyard Island, Massachusetts (U.S.A.). Selection criteria that correlated with the reserve-network objectives were used in a multi-objective integer program to identify the 10-patch reserve networks that were optimal with each objective independently and those that offered optimal tradeoffs between the reserve-network objectives. From these 10-patch networks, one can select a final reserve network that provides the preferred compromise between the objectives. Resumen:,La utilización de criterios de selección, como el tamańo de parche, para clasificar el valor de conservación de los parches de hábitat y evaluar redes de reservas alternativas es un método para identificar redes de reservas en paisajes fragmentados con datos especie-específicos limitados,. Se asume que estos criterios son sustitutos razonables de los verdaderos objetivos de la red. Sin embargo, se requiere cuidado porque las relaciones entre los criterios de selección y los objetivos de la red de reservas pueden ser inconsistentes. Es probable que surjan conflictos porque ninguna red de reservas seráóptima con respecto a objetivos (o criterios de selección) múltiples simultáneamente. Más bien, los planificadores de reservas deben transigir entre demandas conflictivas. Probamos las relaciones entre una variedad de criterios de selección y los objetivos de una red de reservas para comunidades arenícolas naturales en la Isla Martha's Vineyard, Massachussets (E.U.A.). Los criterios de selección que se correlacionaron con los objetivos de la red de reservas fueron utilizados en un programa multi-objetivo integral para identificar las 10 redes de reservas de fragmentos óptimas con cada objetivo independientemente y las que ofrecían compensaciones óptimas entre los objetivos de la red de reservas. De estas 10 redes de reservas de fragmentos, se puede seleccionar una red de reservas final que proporcione el compromiso preferido entre los objetivos. [source] Perioperative Management of Medications for Psoriasis and Psoriatic Arthritis: A Review for the DermasurgeonDERMATOLOGIC SURGERY, Issue 4 2008CLAUDIA HERNANDEZ MD BACKGROUND Psoriasis affects an estimated 3% of the world's population. Many are on chronic immunosuppressive therapy for the cutaneous and joint manifestations of this disorder. The management of these medications in the perioperative period is controversial. Psoriasis and psoriatic arthritis medications can affect wound healing, hemostasis, and infection risk during cutaneous surgery. OBJECTIVES The objective of this article is to provide a critical review of various medications used for care of the psoriatic patient and their potential effect on cutaneous surgical procedures. CONCLUSIONS This review summarizes current understanding of wound healing, hemostatic effects, and infectious risks regarding many psoriasis medications including nonsteroidal anti-inflammatory drugs, cyclooxygenase inhibitors, corticosteroids, various immunosuppressants, and biologic response modifiers. Recommendations vary depending on the agent in question, type of procedure, and comorbid conditions in the patient. Caution is advised when using many of the medications reviewed due to lack of human data of their effects in the perioperative period. [source] Endovenous Laser Treatment of the Lesser Saphenous Vein With a 940-nm Diode Laser: Early ResultsDERMATOLOGIC SURGERY, Issue 4 2003Thomas M. Proebstle MD BACKGROUND Until now, endovenous laser treatment (ELT) of the lesser saphenous vein (LSV) has not been reported. OBJECTIVE To evaluate efficacy and side effects for ELT of the LSV. METHODS Otherwise unselected patients with an incompetent LSV were included. After perivenous infiltration of tumescent local anesthesia, laser energy (940 nm) was administered endovenously, either in a pulsed fashion or continuously during constant backpull of the laser fiber. Patients were scheduled for duplex follow-up at Day 1 and also at 1, 3, 6 and 12 months, postoperatively. RESULTS Forty-one LSVs were targeted in 33 patients with a median age of 66 years (range, 35 to 93). Seventy-three percent of patients had skin changes (C4). Thirty-six percent had an open or healed venous ulcer (C5,6) and 15% a postthrombotic syndrome (ES AS,D PR). Thirty-nine LSVs (95%) completed ELT successfully. During a median follow-up interval of 6 months (range, 3 to 12 months), no recanalization event could be observed. Apart from one thrombosis of the popliteal vein in a patient with polycythemia vera, only minor side effects, particularly no permanent paresthesia, could be observed. CONCLUSION ELT of the LSV under tumescent local anesthesia is feasible and effective. Caution is warranted with ELT of thrombophilic patients. [source] The assessment of insulin resistance in manDIABETIC MEDICINE, Issue 7 2002T. M. Wallace Abstract Background Insulin resistance exists when a normal concentration of insulin produces a less than normal biological response. The ability to measure insulin resistance is important in order to understand the aetiopathology of Type 2 diabetes, to examine the epidemiology and to assess the effects of intervention. Methods We assess and compare methods of measurement and have undertaken a literature review from 1966 to 2001. Results Quantitative estimates of insulin resistance can be obtained using model assessments, clamps or insulin infusion sensitivity tests. There is considerable variation in the complexity and labour intensity of the various methods. The most well-established methods are the euglycaemic clamp, minimal model assessment and homeostatic model assessment (HOMA). No single test is appropriate under all circumstances. Conclusions There are a number of well-established tests used to measure insulin resistance: the choice of method depends on the size and type of study to be undertaken. Although the so-called ,gold-standard' test, the euglycaemic clamp, is useful for intensive physiological studies on small numbers of subjects, a simpler tool such as HOMA is more appropriate for large epidemiological studies. It is important to be aware that most techniques measure stimulated insulin resistance whereas HOMA gives an estimate of basal insulin resistance. Caution should be exercised when making comparisons between studies due to variations in infusion protocols, sampling procedures and hormone assays used in different studies. [source] Atypical papillary proliferation in gynecologic patients: A study of 32 pelvic washes,DIAGNOSTIC CYTOPATHOLOGY, Issue 2 2005Karyna C. Ventura M.D. Abstract Papillary clusters in gynecologic pelvic washes frequently cause diagnostic challenges because they can be associated with borderline or malignant ovarian tumors, as well as benign pelvic diseases. The objective of our study was to review all pelvic washes with atypical papillary proliferation (APP) and investigate whether cytomorphology and/or immunohistochemistry on cell block could determine their origin. Thirty-two pelvic washes from 31 patients containing APP were reviewed and correlated with their corresponding gynecologic or pelvic disease. Previously obtained cell blocks with immunohistochemical (IHC) stains were reviewed also. Nine of 32 washes (28%) were overcalled as malignant and were from patients with 5 borderline serous ovarian tumors (BSTO), 1 ovarian follicular cyst, 1 serous cystadenofibroma, and 1 endometrial carcinoma with ovarian seromucinous cystadenoma. BSTO and endometriosis were the most common sources of APP. Cell blocks could not discriminate further the etiology of APP. Immunohistochemistry was performed rarely and not fully contributory. Caution in interpreting papillary groups and cytohistological correlation is recommended to prevent a high false positive rate. Diagn. Cytopathol. 2005;32:76,81. © 2005 Wiley-Liss, Inc. [source] How does variability in alcohol consumption over time affect the relationship with mortality and coronary heart disease?ADDICTION, Issue 4 2010Annie Britton ABSTRACT Objective To examine the relationship between alcohol consumption and risk of mortality and incident coronary heart disease (CHD), taking account of variation in intake during follow-up. Method Prospective cohort study of 5411 male civil servants aged 35,55 years at entry to the Whitehall II study in 1985,88. Alcohol consumption was reported five times over a 15-year period. Mortality, fatal CHD, clinically verified incident non-fatal myocardial infarction and definite angina were ascertained during follow-up. Results We found evidence that drinkers who vary their intake during follow-up, regardless of average level, have increased risk of total mortality (hazard ratio of high versus low variability 1.52: 95% CI: 1.07,2.17), but not of incident CHD. Using average consumption level, as opposed to only a baseline measure, gave slightly higher risk estimates for CHD compared to moderate drinkers at the extremes of the drinking range. Conclusions Multiple repeated measures are required to explore the effects of variation in exposure over time. Caution is needed when interpreting risks of exposures measured only once at baseline, without consideration of changes over time. [source] Storage-associated artefact in equine muscle biopsy samplesEQUINE VETERINARY JOURNAL, Issue 1 2009R. L. Stanley Summary Reasons for performing study: Muscle biopsy is increasingly used in equine veterinary practice for investigating exertional, inflammatory or immune mediated myopathies and unexplained muscle atrophy. Although formalin-fixed samples are often used, for complete evaluation, fresh-frozen tissue is required. Freezing muscle in veterinary practice is impractical: samples sent to specialist laboratories for processing are therefore susceptible to delays, potentially leading to artefact and compromising histological interpretation. Hypothesis: Altered temperature, duration and hydration status influence the severity of storage-induced artefact in equine muscle. Methods: Skeletal muscle obtained immediately post euthanasia was divided into 6 independent samples from each of 8 horses. One sample per horse was frozen immediately in isopentane precooled in liquid nitrogen. Additional samples were stored in conditions designed to mimic possible situations encountered in practice, including increased storage times, temperature and hydration status. Following storage, stored samples were frozen as before. Cryosections were stained using haematoxylin and eosin and ranked for artefact on 2 occasions by 2 blinded observers. The best samples were processed subsequently with a panel of routine stains and immunolabelled for collagen V to enable the measurement of minimum fibre diameters. Results: Both prolonged storage and increased hydration resulted in more storage-associated artefact. Samples stored for 24 h chilled on dry gauze were ranked higher than those stored on damp gauze; however, a panel of routinely-used histochemical staining techniques was unaffected by chilled 24 h storage. There was no significant effect of storage on mean fibre diameter; however, both chilled dry and damp storage for 24 h caused a significant increase in fibre-size variability. Conclusion and potential relevance: Caution should be exercised when interpreting fibre size profiles in shipped samples. Equine muscle biopsy samples are optimally shipped in dry gauze, sealed in plastic containers and shipped on ice packs to be processed within 24 h and can thus be interpreted by the receiving laboratory with minimal artefact. [source] Meta-analysis of standardized incidence and mortality rates of childhood leukaemia in proximity to nuclear facilitiesEUROPEAN JOURNAL OF CANCER CARE, Issue 4 2007P.J. BAKER phd The meta-analysis combined and statistically analysed studies of childhood leukaemia and nuclear facilities. Focus was on studies that calculated standardized rates for individual facilities. Due to variability between study designs, eight separate analyses were performed stratified by age and zone. One hundred and thirty-six sites were used in at least one analysis. Unadjusted, fixed effects and random effects models were used. Meta-rates greater than one were found in all models at all stratification levels often achieving statistical significance. Caution must be used when interpreting these results. The meta-analysis was able to show an increase in childhood leukaemia near nuclear facilities, but does not support a hypothesis to explain the excess. Each type of model utilized has limitations. Fixed effects models give greater weight to larger studies; however, population density may be a risk factor. Random effects models give greater weight to smaller studies that may be more likely to be affected by publication bias. A limitation of the overall study design is that standardized rates must be available for individual sites which led to exclusion of studies that only calculated rates for multiple sites and those that presented other statistical methods. Further, dose-response studies do not support excess rates found near nuclear facilities. However, it cannot be ignored that the majority of studies have found elevated rates, although not usually statistically significant. [source] Bilateral Tubal Ectopic Pregnancy: A Tale of CautionACADEMIC EMERGENCY MEDICINE, Issue 10 2000Mary T. Ryan MD Abstract. Diagnosis of ectopic pregnancy continues to be an important challenge facing emergency physicians. The authors present a case of bilateral tubal ectopic pregnency and discuss its clinical features and diagnositc difficulties. A review of the English-language literature on the subject is discussed. Suggestions are made on ways to increase diagnostic accuracy, reduce complications, and preserve future fertility in this group of patients. [source] Apply with Caution: Introducing UK-Style In-Work Support in Germany,FISCAL STUDIES, Issue 1 2007Peter Haan Estimates of the labour supply effects of recent UK reforms in the area of direct taxes and benefits show that policy can have significant influence on the level of employment. We confirm this in a simulation of an in-work support system introduced into the German tax and benefit system. Our simulation results suggest that introducing in-work tax credits in Germany would increase the employment of single individuals by over 105,000 but would result in a reduction of labour supply among individuals living in couples by about 70,000, among both women and men. The result found for men is especially important as it is markedly different from all results for the UK, where the net response among men has always been found to be positive. Our estimation results call for a high degree of caution as far as ,importing' UK-style tax credits to Germany is concerned. In-work support based on family income would reinforce the existing work disincentives for secondary earners, reducing the employment levels of both men and women living in couples. [source] Ruptured pseudoaneurysm of the internal maxillary artery complicating CT-guided fine-needle aspiration in an irradiated, surgical bedHEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 12 2007John C. Oh BA Abstract Background. CT-guided fine-needle aspiration (FNA) is a safe procedure, but major complications can occur rarely. Pseudoaneurysm rupture in the head and neck region following CT-guided FNA is an emergency that can result in life-threatening hemorrhage. This case emphasizes the salient risk factors for pseudoaneurysm formation and rupture in the head and neck region following CT-guided FNA. Methods. A patient was seen with oral and facial hemorrhage as a result of a ruptured pseudoaneurysm 11 weeks following CT-guided FNA in a previously irradiated surgical bed. Results. The patient was treated with coil embolization in and around the pseudoaneurysm and discharged without any further complications. Conclusions. Although CT-guided FNA is a safe and effective procedure, some patients may be at increased risk for rare but major complications. Caution should be used in proceeding with CT-guided FNA in an irradiated surgical bed of the head and neck. © 2007 Wiley Periodicals, Inc. Head Neck, 2007 [source] Is Eradication of Helicobacter pylori With Colloidal Bismuth Subcitrate Quadruple Therapy Safe?HELICOBACTER, Issue 2 2001Rosemary H. Phillips ABSTRACT Background. When standard triple therapy fails to eradicate Helicobacter pylori, quadruple ,rescue' therapy is often used which, in Europe, generally comprises colloidal bismuth subcitrate (CBS) based triple therapy and a proton pump inhibitor. Since hypochlorhydria could greatly increase absorption of the toxic bismuth ion from CBS, we investigated the bismuth status of patients receiving anti- H. pylori quadruple therapy. Materials and Methods. In a prospective open label study 34 patients with nonulcer dyspepsia or peptic ulcer disease, who had failed to eradicate H. pylori with standard triple therapy, were subsequently treated with CBS, omeprazole, amoxycillin and metronidazole (BOAM). A further 35 patients received triple therapy for the eradication of H. pylori: CBS, amoxycillin and metronidazole (BAM) (n = 18); placebo bismuth, amoxycillin and metronidazole (AM) (n = 9); or omeprazole, amoxycillin and metronidazole (OAM) (n = 8). Whole blood bismuth levels were determined before and within 24 hours of completing treatment. Analysis of bismuth was by inductively coupled plasma mass spectrometry, and concentrations were compared between groups and with the Hillemand ,alarm level' for blood bismuth (50,100 µg/l). Results. BOAM gave higher blood bismuth levels than BAM (difference in means 13.1, CI 6.0,20.2, p < .001); three (8.8%) patients taking BOAM had concentrations within the Hillemand alarm level at 54.2, 64.7 and 91.8 µg/l. OAM and AM did not alter baseline blood bismuth levels. Conclusions. Caution should be observed in prescribing CBS with gastric acid suppression, and alternative bismuth preparations should be considered. [source] Lack of renal improvement with nonselective endothelin antagonism with tezosentan in type 2 hepatorenal syndrome,,HEPATOLOGY, Issue 1 2008Florence Wong Renal vasoconstriction is a key factor in the development of hepatorenal syndrome (HRS) and may be secondary to increased activities of endothelin-1, a potent renal vasoconstrictor. To assess the effects of tezosentan, a nonselective endothelin receptor antagonist, on renal function in patients with type 2 HRS, six male patients, 56.3 ± 2.5 years old, with cirrhosis and type 2 HRS were treated with tezosentan; ascending doses of 0.3, 1.0, and 3.0 mg/hour, each for 24 hours, were used for the initial 2 patients, but a constant dose of 0.3 mg/hour for up to 7 days was used for the remaining 4 patients. The glomerular filtration rate, renal plasma flow, 24-hour urinary volume, mean arterial pressure (MAP), heart rate, tezosentan levels, and vasoactive hormones were measured daily. Albumin was given as required. The study was stopped early because of concerns about the safety of tezosentan in type 2 HRS. Five patients discontinued the study early; one stopped within 4 hours because of systemic hypotension (MAP < 70 mm Hg), and 4 patients stopped at ,4 days because of concerns about worsening renal function (serum creatinine increased from 180 ± 21 to 222 ± 58 ,mol/L, P > 0.05) and decreasing urine volume (P = 0.03) but without a significant change in MAP. The plasma tezosentan concentrations were 79 ± 34 ng/mL at a steady state during infusion at 0.3 mg/hour. The plasma endothelin-1 concentrations increased from 2.7 ± 0.3 pg/mL at the baseline to 19.1 ± 7.3 pg/mL (P < 0.05). Conclusion: An endothelin receptor blockade potentially can cause a deterioration in renal function in patients with cirrhosis and type 2 HRS. Caution should be taken in future studies using endothelin receptor antagonists in these patients. (HEPATOLOGY 2007.) [source] Ergonomic issues in team liftingHUMAN FACTORS AND ERGONOMICS IN MANUFACTURING & SERVICE INDUSTRIES, Issue 3 2005R.S. Barrett In this article we review and critique the current body of scientific knowledge regarding the use of team lifting including: (a) psychophysical studies of team lifting capacity, and (b) studies of manual handling, patient handling, and stretcher carriage performed by lifting teams. The consensus of the research literature is that team-lifting capacity is greater than the lifting capacity of an individual, but that the capacity of lifting teams is less than the summed capacity of individual team members. Further, biomechanical, psychophysical, and physiological stress tends to be reduced compared to the equivalent lifts and transfers performed by individuals. However, the stress associated with team lifting depends on a broad range of individual team member, load, task and environmental factors, which can interact in unexpected ways. Caution is therefore recommended against making broad assumptions regarding the use of team lifting. Future studies are needed to examine how effort and load are distributed among lifting team members, with emphasis on identifying factors that may increase the risk of injury. © 2005 Wiley Periodicals, Inc. Hum Factors Man 15: 293,307, 2005. [source] Treatment of late-stage Sézary syndrome with 2-ChlorodeoxyadenosineINTERNATIONAL JOURNAL OF DERMATOLOGY, Issue 6 2002Saskia A. Bouwhuis MD Background, 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. [source] Food applications of trans fatty acid substitutesINTERNATIONAL JOURNAL OF FOOD SCIENCE & TECHNOLOGY, Issue 5 2007Paul Wassell Summary The review outlines the increasing need to reduce trans fatty acids, and addresses the functionality issues of various trans free solutions through discussion of hydrogenation, interesterification, and fractionation, and their influence on fat crystallisation and solid fat content. Caution is urged not to focus solely on physio-chemical aspects, but to approach trans free designing for specific food applications from a multidisciplinary angle. Examples of specific applications; margarines, shortenings and frying oils are given. The review also offers a glimpse into what the future trans free trends may hold. [source] Prolonged imatinib-induced myelosuppression in chronic myeloid leukaemia with an unusually long survivalINTERNATIONAL JOURNAL OF LABORATORY HEMATOLOGY, Issue 1 2008D. P. Busuttil Summary A case of Philadelphia chromosome positive chronic myeloid leukaemia (CML) with the longest survival ever reported in the medical literature is presented. The duration of the chronic phase was 29 years, the overall survival being 31 years. The clinical course, when challenged with imatinib in the later stages of the disease, was at variance with what is to be expected from the experience in similar situations. Lifelong myelosuppression resulted that interfered with further therapy and contributed to the demise of the patient from sepsis three years later. Caution is suggested with the use of imatinib in fibrotic CML with a low platelet count. [source] Addressing the imbalance: empowering older people in disaster response and preparednessINTERNATIONAL JOURNAL OF OLDER PEOPLE NURSING, Issue 1 2010BSc(Hons), Nursing Adv Dip Ed., Pat Deeny RN Deeny P., Vitale C.T., Spelman R. & Duggan S. (2010) Addressing the imbalance: empowering older people in disaster response and preparedness. International Journal of Older People Nursing 5, 77,80 doi: 10.1111/j.1748-3743.2009.00204.x This paper explores the role of the nurse in empowering older people at all stages in the disaster cycle. Evidence points to the need to increase the level of consultation and inclusivity of older people on this topic. Caution is called for in relation to classifying older people as a vulnerable group in disasters without first recognising that older people are probably the richest resource within any culture when it comes to emergency planning and\or coping with disasters. Practical advice on how nurses can best assist older people is presented. [source] Courage Versus Caution: A Dialogue on Entering and Prospering in IRINTERNATIONAL STUDIES REVIEW, Issue 3 2004Ersel Aydinli First page of article [source] Service quality in hospital wards with different nursing organization: nurses' ratingsJOURNAL OF ADVANCED NURSING, Issue 2 2009Ingeborg S. Sjetne Abstract Title.,Service quality in hospital wards with different nursing organization: nurses' ratings. Aim., This paper is a report of a study to assess: (1) the relations between nursing organization models in hospital wards and nurses' perception of the quality of patient care and dimensions of the practice environment, and (2) if these relations were modified by variations in local conditions at the ward level. Background., Previous literature is inconclusive concerning what model of nursing organization maximizes the quality of nursing services. Method., A cross-sectional survey was carried out in a representative sample of Norwegian hospital wards in 2005. Intra-ward organization models were classified as: (1) Team leader (n = 30), characterized by extensive responsibilities for team leaders, (2) Primary nurse (n = 18), with extensive responsibilities for named nurses, and (3) Hybrid (n = 37), (1) and (2) combined. We prepared multilevel regression models using scales describing quality of patient care, learning climate, job satisfaction, and relationships with physicians as dependent variables. As independent variables, we used variables representing local ward conditions. Results., Eighty-seven wards and 1137 nurses (55% response rate) provided complete data. The ward level proportion of variance ranged from 0·10 (job satisfaction) to 0·22 (relationships with physicians). The univariate effect of organization models on quality ratings was not statistically significant. Introducing local ward conditions led to a statistically significant effect of primary nurse organization on relationships with physicians, and to a substantial proportional reduction in ward level variance, ranging from 32% (quality of patient care) to 24% (learning climate). Conclusion., Caution is needed about using service quality arguments when considering the possible benefits and drawbacks of different organizational models. [source] Cox-2 Inhibitors and Fracture Healing: Arguments for Such an Effect and a Suggestion About Caution in UseJOURNAL OF BONE AND MINERAL RESEARCH, Issue 3 2003Thomas A. Einhorn No abstract is available for this article. [source] Stem cells: A minireviewJOURNAL OF CELLULAR BIOCHEMISTRY, Issue S38 2002Kathyjo A. Jackson Abstract The identification of adult-derived stem cells which maintain plasticity throughout the course of a lifetime, has transformed the field of stem cell biology. Bone marrow derived hematopoietic stem cells (HSC) are the most well-characterized population of these multipotential cells. First identified for their ability to reconstitute blood lineages and rescue lethally irradiated hosts, these cells have also been shown to differentiate and integrate into skeletal muscle, cardiac myocytes, vascular endothelium, liver, and brain tissue. Various populations of HSC are being studied, exploiting cell surface marker expression, such as Sca-1, c-kit, CD34, and lin,; as well as the ability to efflux the vital dye Hoecsht 33342. Detection of engrafted donor derived cells into various tissue types in vivo is a laborious process and may involve detection of ,-galactosidase via colorimetric reaction or antibody labeling or green fluorescent protein (GFP) via fluorescence microscopy, as well as in situ hybridization to detect the Y-chromosome. Using these techniques, the search has begun for tissue specific stem cells capable of host tissue regeneration, self renewal, and transdifferentiation. Caution is urged when interpreting these types of experiments because although they are stimulating, limitations of the technologies may provide misleading results. J. Cell. Biochem. Suppl. 38: 1,6, 2002. © 2002 Wiley-Liss, Inc. [source] Value of ADAMTS13 activity and inhibitor in the postmortem diagnosis of thrombotic thrombocytopenic purpuraJOURNAL OF CLINICAL APHERESIS, Issue 3 2009Denis M. Dwyre Abstract Background and Objectives: Thrombotic thrombocytopenic purpura (TTP) is a clinical diagnosis that can be difficult to establish in severely ill patients. We report a case of fulminant TTP in a woman who died before receiving plasma exchange. An autopsy plasma sample was analyzed for ADAMTS13 activity and inhibitor for correlation with the diagnosis of TTP. Recognizing that hemolysis in postmortem blood samples could interfere with ADAMTS13 activity, plasma samples from four additional decedents not suspected of having TTP were analyzed and correlated with their autopsy results. The purpose of this study was to assess whether testing postmortem samples for ADAMTS13 is useful in the postmortem diagnosis of TTP. Material and Methods: Plasma samples from the index case and four non-TTP decedents were analyzed for ADAMTS13 activity, ADAMTS13 inhibitor levels, and plasma free hemoglobin (PFH). Autopsy tissues were evaluated for evidence of platelet microthrombi in all five cases. Results: The ADAMTS13 activity level in the index patient was <4%, and the inhibitor level was 1.0 inhibitor unit. Microthrombi were prominent in the heart, kidneys, pancreas, and adrenal glands, consistent with the clinical diagnosis of TTP. ADAMTS13 activity levels in the four non-TTP decedents ranged from 4 to 82% (3/4 , 26%), and inhibitor was present in two of the four samples. Postmortem PFH levels in the four non-TTP decedents ranged from 64 to 3,917 mg/dL. No microthrombi were observed. Conclusion: Low postmortem ADAMTS13 activity and evidence of inhibitor can occur in decedents without clinical or histologic evidence of TTP. Postmortem ADAMTS13 activity levels may not be valid in establishing a diagnosis of TTP, and high inhibitor levels in this setting may be related to elevated PFH. Caution must be used in the interpretation of ADAMTS13 testing in the presence of hemolysis. J. Clin. Apheresis 2009. © 2009 Wiley-Liss, Inc. [source] Focal Regression-Like Changes in Dysplastic Back Nevi :A Diagnostic Pitfall for Malignant MelanomaJOURNAL OF CUTANEOUS PATHOLOGY, Issue 1 2005A. Hassanein Regression in melanoma can be complete or partial. Melanocytic nevi may show focal regression-like changes (RLC). We studied the incidence of RLC in a total of 777 melanocytic back nevi. These included 17 cases of blue nevi, 28 cases of compound nevi, 385 cases of compound dysplastic nevi, 34 cases of congenital compound nevi, 26 cases of congenital intradermal nevi, 58 cases of intradermal nevi, and 229 cases of junctional dysplastic nevi. The dysplastic nevi were categorised according to the associated cytologic atypia (mild, moderate, and severe). 21 malignant melanomas of the back were also reviewed for regression. RLC were seen with a striking correlation with the degree of cytologic atypia in dysplastic nevi. RLC were seen in 4.5% of mildly, 9.6% of moderately, and 17.2% of severely dysplastic compound nevi. RLC were seen in 10.3% of mildly, 18.8% of moderately, and 39.3% of severely dysplastic junctional nevi. The incidence of regression in non-dysplastic nevi was much less, ranging from 2.9% to 3.6%. We believe this phenomenon is probably related to trauma/irritation. Caution should be taken before rendering the diagnosis of regressed malignant melanoma on the back since dysplastic nevi may show focal similar changes. [source] Frequencies of Morphological Characteristics in Two Contemporary Forensic Collections: Implications for Identification,JOURNAL OF FORENSIC SCIENCES, Issue 5 2006Debra Komar Ph.D. ABSTRACT: Positive identification relies on comparison of antemortem and postmortem data. Some identifications are based on morphological features such as fracture, pathological condition, and surgical hardware, despite little literature indicating the frequencies of such traits. This study examines whether such features are sufficiently rare as to be deemed individualizing. Data were collected on two modern North American skeletal collections (N=482 individuals). Presence/absence of features was scored by skeletal element and side. Results indicate that frequencies vary by geographic region (higher frequency of fractures and pathological conditions in New Mexico while individuals in Tennessee were more likely to have surgical interventions), many features such as fractures are remarkably common and that even suites of traits may not be individualizing. Caution is warranted when using written data rather than radiographic comparisons as the primary source of identification. The implications of these findings to missing person databases are also discussed. [source] A critical essay on professional development in dietetics through a process of reflection and clinical supervisionJOURNAL OF HUMAN NUTRITION & DIETETICS, Issue 5 2000S. Burton Background The concept of clinical supervision is well known within the nursing profession though numerous definitions and theoretical models proposed for implementation have led to a degree of confusion. The debate within dietetics is just beginning, with the recent formation of a BDA working group seeking to clarify clinical supervision for the profession. Aims This essay provides an overview of clinical supervision together with reflection which is considered to be integral to the process and proposes that clinical supervision can provide a vehicle for supporting continuous professional development for all dietitans. It is perhaps unfortunate that the descriptive ,clinical' is used throughout the literature as this often leads to an incorrect assumption that the scope of the process is limited to acute services. However, as patient care takes many forms within a range of environments, the broader meaning of ,clinical' as pertaining to ,patient care' needs to be acknowledged. Caution in choosing a model for the profession is advised, as any model needs to fit the practice and not vice versa. [source] Botulinum neurotoxin A: An unusual systemic effectJOURNAL OF PAEDIATRICS AND CHILD HEALTH, Issue 6 2007Katherine Howell Abstract: Systemic effects from Botulinum neurotoxin A are uncommon but can have serious consequences. We report the case of a boy with severe cerebral palsy who developed deterioration in respiratory and oromotor function following repeated injections of Botulinum neurotoxin A. Caution is needed in using this treatment in children with severe cerebral palsy and pseudobulbar palsy. [source] Role Playing in Smoking Prevention: Use CautionJOURNAL OF SCHOOL HEALTH, Issue 1 2000Alfred L. McAlister PhD No abstract is available for this article. [source] TEXTURE PROFILE ANALYSIS , HOW IMPORTANT ARE THE PARAMETERS?JOURNAL OF TEXTURE STUDIES, Issue 5 2010ANDREW J. ROSENTHAL ABSTRACT A starch-glycerol gel was subjected to a two-bite compression test using two sample-instrument geometries, various speeds of compression and strain levels, both with lubrication or not. Results were interpreted using the primary characteristic terminology previously defined in Texture Profile Analysis. Compression speeds from 0.1 to 10 m/s showed a logarithmic relationship with hardness, cohesiveness, corrected cohesiveness and adhesiveness. Gels survived compression to strains of 0.90 without failing, strain levels from 0.25 to 0.90 resulted in an exponential rise in hardness with increasing strain and linear reduction in corrected cohesiveness. Lubrication had no significant influence on any of the measured parameters and an application of force with different sample-instrument geometry revealed that parallel plates and plungers only had an influence on gel hardness. Caution is urged when researchers modify the test protocol from 75% deformation with parallel plates. A minimum crosshead speed of 2 mm/s is recommended. PRACTICAL APPLICATIONS Texture Profile Analysis has been widely applied to test solid and semisolid foods; however, some researchers deviate from the original test protocol. This article attempts to show how modifying the parameters in the test protocol can influence the apparent properties of the sample. [source] | ||||||||||||||||||||||||||||||||||||||||||||||