Although

Distribution by Scientific Domains


Selected Abstracts


Adipogenic Differentiation of Human Adipose Tissue,Derived Stem Cells Obtained from Cryopreserved Adipose Aspirates

DERMATOLOGIC SURGERY, Issue 7 2010
JUNG EUN LEE MS
BACKGROUND Although frozen adipose tissue is frequently used for soft tissue augmentation, the viability of frozen fat remains a controversy. The cryopreservation of adipose tissue is important for the future use of adipose-derived stem cells (ASCs) and adipocytes. OBJECTIVE To determine whether optimal cryopreservation techniques with regard to the addition of cryopreservative agents and preservation temperature is essential for the long-term storage of adipose tissue and whether ASCs from cryopreserved adipose aspirates are reliable for use in adipogenic differentiation. MATERIALS AND METHODS Adipose tissue was frozen directly or with cryoprotectant at ,20°C or ,80°C for 1 year. The viability of adipose aspirates and the differentiation of ASCs isolated from adipose tissue were evaluated. RESULTS The viability of adipose aspirates frozen with dimethyl sulfoxide at ,80°C was approximately 87% after 2 months of storage. Moreover, ASCs from adipose tissue stored with cryoprotectant survived successfully for 1 year and differentiated into adipocytes, although ASCs were not detected in the directly frozen adipose tissue. CONCLUSION Adipose tissue cryopreserved with cryoprotectant and stored at optimal temperature might prove to be a reliable source of human ASCs and adipocytes. The authors have indicated no significant interest with commercial supporters. [source]


Fractionated Laser Skin Resurfacing Treatment Complications: A Review

DERMATOLOGIC SURGERY, Issue 3 2010
ANDREI I. METELITSA MD
BACKGROUND Fractional photothermolysis represents a new modality of laser skin resurfacing that was developed to provide a successful clinical response while minimizing postoperative recovery and limiting treatment complications. OBJECTIVES To review all of the reported complications that develop as a result of fractional ablative and nonablative laser skin resurfacing. METHODS A literature review was based on a MEDLINE search (1998,2009) for English-language articles related to laser treatment complications and fractional skin resurfacing. Articles presenting the highest level of evidence and the most recent reports were preferentially selected. RESULTS Complications with fractional laser skin resurfacing represent a full spectrum of severity and can be longlasting. In general, a greater likelihood of developing post-treatment complications is seen in sensitive cutaneous areas and in patients with intrinsically darker skin phototypes or predisposing medical risk factors. CONCLUSIONS Although the overall rate of complications associated with fractional laser skin resurfacing is much lower than with traditional ablative techniques, recent reports suggest that serious complications can develop. An appreciation of all of the complications associated with fractional laser skin resurfacing is important, especially given that many of them can be potentially prevented. The authors have indicated no significant interest with commercial supporters. [source]


Detecting Adverse Events in Dermatologic Surgery

DERMATOLOGIC SURGERY, Issue 1 2010
DANIEL PINNEY BS
BACKGROUND Despite increasing awareness of and public attention to patient safety, little is documented about how adverse events (AEs) can or should be monitored in dermatologic surgery. Data to address this shortcoming are needed, although well-defined methodologies have yet to be implemented. OBJECTIVE To summarize current strategies in detecting adverse outcomes of dermatologic surgical procedures. MATERIALS AND METHODS A Medline literature search was conducted using the terms "adverse event,""detection,""reporting,""monitoring," and "surgery." Articles selected addressed the efficacy of one or more AE reporting techniques in surgical patients. RESULTS Prospective and retrospective reporting methods were identified, with morbidity and mortality conference being the most commonly used method of AE reporting. Retrospective medical record review, the retrospective trigger tool approach, and an anonymous electronic reporting system were more sensitive approaches. The Surgical Quality Improvement Program, a program that has successfully translated AE data into lower postoperative morbidity and mortality, was analyzed. CONCLUSIONS Although generally considered safe, dermatologic surgery has no current standard for AE reporting. Standard definitions and high-quality data regarding AEs" currently limit this analysis. Pilot studies are needed to develop feasible measures, with the goal of increasing the sensitivity of AE detection and ultimately improving patient outcomes. The Center for Dermatology Research is supported by an unrestricted educational grant from Galderma Laboratories. [source]


Clinical Trial of Dual Treatment with an Ablative Fractional Laser and a Nonablative Laser for the Treatment of Acne Scars in Asian Patients

DERMATOLOGIC SURGERY, Issue 7 2009
SANGEUN KIM MD
BACKGROUND Many methods have been proposed for the treatment of acne scars, with variable cosmetic results. Nonablative skin resurfacing is one method that has been proposed. Because of a need for more noticeable clinical improvements, the ablative fractional laser was recently introduced. OBJECTIVE To reduce complications and improve the results of ablative fractional laser resurfacing by combining this treatment of acne scars with nonablative lasers. METHODS A series of 20 patients (skin phototypes IV,V) with atrophic facial acne scars were randomly divided into two groups that received three successive monthly treatments with an ablative fractional laser using high (group A) and low (group B) energy on one facial half and an ablative fractional laser with low energy plus a nonablative resurfacing laser on the other facial half. Patients were evaluated using digital photography at each treatment visit and at 3 months postoperatively. Clinical assessment scores were determined at each treatment session and follow-up visit. RESULTS Although the use of the ablative fractional laser with high energy resulted in an improvement in patients' acne scars, the combination of ablative fractional laser resurfacing and nonablative laser resurfacing yielded the best results, as assessed in photographs as well as by the overall appearance of the acne scars. With the combination method, fewer complications were observed. [source]


Sentinel Lymph Node Biopsy for High-Risk Nonmelanoma Skin Cancers

DERMATOLOGIC SURGERY, Issue 7 2007
RACHEL E. SAHN
BACKGROUND Although the utility of the sentinel lymph node biopsy (SLNB) in the staging of melanoma is well established, its usefulness in high-risk nonmelanoma skin cancer (NMSC) is yet to be determined. OBJECTIVE The objective was to report our experience with patients who underwent SLNB for the staging of a high-risk NMSC. MATERIALS AND METHODS We identified 13 patients with a high-risk NMSC who underwent SLNB between 1998 and 2006 and conducted a retrospective review of their medical records and tumor pathology. Their status as regards tumor recurrence and survival was obtained when possible. RESULTS Of 13 patients, 9 had squamous cell carcinoma (SCC), 2 had sebaceous gland carcinoma, 1 had porocarcinoma, and 1 had atypical fibroxanthoma. All SLNB were negative for metastatic disease, but 1 appeared to be a false-negative finding. CONCLUSION Compared to melanoma, SCC of the skin are much less predictable as regards their tendency to metastasize to the regional lymph nodes. Although the SLNB appears to be a reliable staging procedure for NMSC (especially SCC), the yield may be too low to justify its routine use in this patient population. More data are needed to determine when a SLNB is justified in the management of NMSC. [source]


Sentinel Lymph Node Biopsy in Cutaneous Squamous Cell Carcinoma: A Systematic Review of the English Literature

DERMATOLOGIC SURGERY, Issue 11 2006
AMY SIMON ROSS MD
BACKGROUND Although most cutaneous squamous cell carcinoma (SCC) is curable by a variety of treatment modalities, a small subset of tumors recur, metastasize, and result in death. Although risk factors for metastasis have been described, there are little data available on appropriate workup and staging of patients with high-risk SCC. OBJECTIVE We reviewed reported cases and case series of SCC in which sentinel lymph node biopsy (SLNB) was performed to determine whether further research is warranted in developing SLNB as a staging tool for patients with high-risk SCC. METHODS The English medical literature was reviewed for reports of SLNB in patients with cutaneous SCC. Data from anogenital and nonanogenital cases were collected and analyzed separately. The percentage of cases with a positive sentinel lymph node (SLN) was calculated. False negative and nondetection rates were tabulated. Rates of local recurrence, nodal and distant metastasis, and disease-specific death were reported. RESULTS A total of 607 patients with anogenital SCC and 85 patients with nonanogenital SCC were included in the analysis. A SLN could not be identified in 3% of anogenital and 4% of nonanogenital cases. SLNB was positive in 24% of anogenital and 21% of nonanogenital patients. False-negative rates as determined by completion lymphadenectomy were 4% (8/213) and 5% (1/20), respectively. Most false-negative results were reported in studies from 2000 or earlier in which the combination of radioisotope and blue dye was not used in the SLN localization process. Complications were reported rarely and were limited to hematoma, seroma, cutaneous lymphatic fistula, wound infection, and dehiscence. CONCLUSIONS Owing to the lack of controlled studies, it is premature to draw conclusions regarding the utility of SLNB in SCC. The available data, however, suggest that SLNB accurately diagnoses subclinical lymph node metastasis with few false-negative results and low morbidity. Controlled studies are needed to demonstrate whether early detection of subclinical nodal metastasis will lead to improved disease-free or overall survival for patients with high-risk SCC. [source]


Distal esophagitis in patients with mustard-gas induced chronic cough

DISEASES OF THE ESOPHAGUS, Issue 4 2006
M. Ghanei
SUMMARY., Although confounded by some factors such as medications or surgical complications, the relationship between esophageal pathology and pulmonary disorders has been the subject of many studies. The present study sought to investigate the said relationship in patients inflicted by respiratory disorders induced by mustard gas (MG). A case group of patients complaining of respiratory complications and chronic coughs following MG exposure, and a control group of patients with chronic coughs but without a history of MG exposure were studied. All the case and control subjects had symptoms of gastro-esophageal reflux disease. Chest high resolution tomography (HRCT) was performed to evaluate the existence of pulmonary disorders. Endoscopy and histological studies were carried out to determine the severity of esophagitis in both groups presenting with gastroesophageal reflux. Ninety male patients, who had met our criteria, along with 40 male control cases underwent the diagnostic procedures. The frequency of endoscopic esophagitis findings in the chemically exposed group was significantly higher than that in the control group (70.0%vs. 42.5%). A pathological evaluation revealed that the frequency of esophagitis in the cases was more than that in the controls (32.3%vs. 14.2%). Chest HRCT evaluation demonstrated that half the case group had more than 25% air trapping in expiratory films, mostly compatible with bronchiolitis obliterans (BO). In addition, they were suffering from asthma, chronic bronchitis and bronchiectasis. Bronchiolitis obliterans, along with other lung disorders, can be considered as contributors in the pathogenesis of esophagitis in MG exposed patients. [source]


Comparing response of SDF systems to near-fault and far-fault earthquake motions in the context of spectral regions

EARTHQUAKE ENGINEERING AND STRUCTURAL DYNAMICS, Issue 12 2001
Anil K. Chopra
Abstract In spite of important differences in structural response to near-fault and far-fault ground motions, this paper aims at extending well-known concepts and results, based on elastic and inelastic response spectra for far-fault motions, to near-fault motions. Compared are certain aspects of the response of elastic and inelastic SDF systems to the two types of motions in the context of the acceleration-, velocity-, and displacement-sensitive regions of the response spectrum, leading to the following conclusions. (1) The velocity-sensitive region for near-fault motions is much narrower, and the acceleration-sensitive and displacement-sensitive regions are much wider, compared to far-fault motions; the narrower velocity-sensitive region is shifted to longer periods. (2) Although, for the same ductility factor, near-fault ground motions impose a larger strength demand than far-fault motions,both demands expressed as a fraction of their respective elastic demands,the strength reduction factors Ry for the two types of motions are similar over corresponding spectral regions. (3) Similarly, the ratio um/u0 of deformations of inelastic and elastic systems are similar for the two types of motions over corresponding spectral regions. (4) Design equati ns for Ry (and for um/u0) should explicitly recognize spectral regions so that the same equations apply to various classes of ground motions as long as the appropriate values of Ta, Tb and Tc are used. (5) The Veletsos,Newmark design equations with Ta=0.04 s, Tb=0.35 s, and Tc=0.79 s are equally valid for the fault-normal component of near-fault ground motions. Copyright © 2001 John Wiley & Sons, Ltd. [source]


Melanism in a larval Lepidoptera: repeatability and heritability of a dynamic trait

ECOLOGICAL ENTOMOLOGY, Issue 2 2006
Kwang Pum Lee
Abstract., 1.,Although it is well established that the deposition of melanin pigment in the cuticle of larval Lepidoptera is influenced by both environmental and genetic factors, few studies have examined intra-individual regional variation in the degree of melanism or the ontogenetic dynamics of this trait. Here, heritable and density-dependent effects on within-individual and stage-specific variation in melanism were examined in caterpillars of the Egyptian cotton leafworm, Spodoptera littoralis (Boisduval). 2.,Using quantitative spectrometric methods, it is shown that cuticular melanism changes dramatically within larval stadia, showing the highest and lowest levels of melanism early (first day) and late (final day) in each larval stadium respectively. However, solitary-reared caterpillars were significantly paler than those reared gregariously at all stages of development and maintained greater levels of variation in melanism. This variation in melanism was repeatable and exhibited a significant heritable component (narrow sense heritability based on offspring,parent regressions: h2 = 0.18,0.30). 3.,The degree of melanism was correlated negatively with larval body weight in solitary caterpillars, but not gregarious ones. Melanism also varied spatially, with the lateral longitudinal band being consistently darker than the dorsal or dorso-lateral bands. Crowd-rearing increased melanism in all regions of larval cuticle, but the extent of crowding-induced melanism was more pronounced in the dorsal and dorso-lateral bands than in the lateral one. 4.,These results indicate that although cuticular melanism is a highly dynamic trait, ontogenetic changes in relative cuticular melanism are both predictable and repeatable within individuals and genotypes. This has implications for our understanding of the evolution of melanism and for applying artificial selection on the basis of colour. [source]


Inter- and intra-observer reliability of radiographic scores commonly used for the evaluation of haemophilic arthropathy

HAEMOPHILIA, Issue 3 2008
M. SILVA
Summary., Although the severity of haemophilic arthropathy is commonly assessed using established radiographic scoring systems, there is limited available information about their inter- and intra-observer reliability. The purpose of the present study was to establish the inter-observer reliability (IEOR) and intra-observer reliability (IAOR) of three different methods available for the classification of haemophilic arthropathy, including the Arnold and Hilgartner classification, a modification to the Arnold and Hilgartner system described by Luck et al., and the classification described by Pettersson et al. Antero-posterior and lateral radiographs of 54 haemophilic joints were included for the analysis. To determine the IEOR for each one of the three radiographic systems, the radiographs were randomly evaluated by four observers, including two orthopaedic surgeons, one orthopaedic resident and one haematologist. For the determination of IAOR, all four reviewers repeated the assessment in a similar fashion, after a period of at least 2 weeks. IEOR and IAOR for the three classification systems was established using kappa (,) statistics. A Spearman rank correlation was used to determine the similarities between each reviewer's own interpretative scales. The IEOR was low for the Arnold and Hilgartner system (, = 0.35, P , 0.001) and the Luck system (, = 0.38, P , 0.001), but even lower for the Pettersson system (, = 0.06, P = 0.1). For the Pettersson system, particularly low , values were observed for the presence or absence of osteoporosis (, = 0.11, P = 0.0027), enlarged epiphysis (, = 0.10, P = 0.0039), erosion of joint margins (, = 0.11, P = 0.0018), and joint deformity (, = 0.16, P = 0.00001). However, a relatively high Spearman rank correlation for all three scales [rs = 0.75 (P < 0.001) for Arnold and Hilgartner system, rs = 0.74 (P < 0.001) for the Luck system and rs = 0.81 (P < 0.001) for Pettersson system] indicated an overall, general agreement among the reviewers with regard to the severity of the haemophilic arthropathy. There was a moderate IAOR value for both, the Arnold and Hilgartner system (, = 0.57, P = 0.00001) and the Luck system (, = 0.62, P = 0.00001) with a low IAOR value for the Pettersson system [, = 0.22, P = 0.00001). Currently available radiographic scoring systems for haemophilic arthropathy have low inter- and intra-observer reliability rates. Improvements, either through education or modification of the scoring systems, are critical in an era where correlations between clinical and radiographic scores have received significant attention. [source]


Continuous infusion of factor concentrates in children with haemophilia A in comparison with bolus injections

HAEMOPHILIA, Issue 3 2006
C. BIDLINGMAIER
Summary., Although the concept of continuous infusion (CI) of factor concentrates is well known, prospective paediatric data are rare. We present a prospective open-labelled non-randomized study focusing on safety, efficacy and factor VIII (FVIII) usage compared with bolus injections (BI) in children. In 43 consecutive patients (0.5,17 years; median: 9.6) undergoing different operations, CI was started with an initial FVIII-bolus of 70 IU kg,1 bodyweight, followed by a median infusion rate of 4.4 IU kg,1 h,1 (range: 2.8,9.5) dose adjusted for daily FVIII levels (target: 60,80%). No direct serious adverse events occurred; however, two out of 43 patients, both from the group of four patients with less than 20 exposure days (ED) before starting CI, developed a high-responding inhibitor. Two CI patients showed mild thrombophlebitis or rash. Infusion rates needed to achieve adequate FVIII levels were highly predictable and could be reduced because of decreasing FVIII clearance. Bleeding, requiring additional boli, was observed in eight out of 43 patients. Therapy duration and factor usage of CI were influenced by the procedure, but not by the product used or thrombophilia. Twelve of these CI patients were compared with 12 contemporary consecutive age- and procedure-matched BI patients. Compared with BI patients, CI patients saved 30% FVIII (812.9 vs. 563.2 IU kg,1, P < 0.006). We conclude that CI forms a safe and effective method for perioperative care in children and reduces factor usage. Because of the unknown risk of inhibitor development, we will use CI only in patients beyond 20 ED. [source]


Asking fathers: a study of psychosocial adaptation

HAEMOPHILIA, Issue 5 2004
E. K. Herrick
Summary., Although few contemporary studies specifically address paternal adaptation, the theme of paternal estrangement from medical care and from family relationships is pervasive in the psychosocial literature on haemophilia. This estrangement has been shown to have a negative effect on fathers' psychological well-being, marital relationships and the adaptive outcome of their sons who have haemophilia. The goals of this study were to provide contemporary data on the psychosocial adaptation of fathers of boys with haemophilia and to examine specific variables that might influence their adjustment. Eighty-three eligible fathers returned a survey instrument that collected demographic and medical information, as well as scores on self-measures of adaptation in marital and parenting roles. Statistically significant direct correlations (P < 0.01) were found between fathers' scores on the Marital Adjustment Test and the Parenting Sense of Competence subscales (parenting efficacy and satisfaction). Variables specific to rearing a son with haemophilia that negatively affected fathers' marital adjustment scores included: feeling left out of medical decision making by their wives or partners, worry about their sons' having limited activity, and the presence of a secondary diagnosis in the affected child. Scores on the parenting efficacy subscale of the PSOC were statistically significantly reduced (i.e. fathers felt less effective in the parenting role) in men who ,rarely' or ,never' infused their sons (42/80, 53%). Variables that negatively affected scores on the parenting satisfaction subscale included frustrating interactions with medical staff and concern about their sons' potential to contract an infection or secondary diagnosis. This paper presents a model to examine the interrelationships among the data and discusses the clinical implications. [source]


Cranial Magnetic Resonance Imaging Findings in Patients With Migraine

HEADACHE, Issue 2 2004
Eren Gozke MD
Objective.,To investigate the frequency of cranial magnetic resonance imaging abnormalities in patients with migraine and their relationship to type, duration, and frequency of migraine attacks. Methods.,Forty-five patients (43 women, 2 men) with migraine whose ages ranged between 19 and 53 years (mean, 40.91 [SD, 7.69]) were evaluated. Of the 45 patients, 20 had migraine with aura and 25 had migraine without aura, according to the diagnostic criteria of the International Headache Society. Results.,In 13 (28.8%) of 45 patients, white matter foci were present on magnetic resonance imaging. Eight of these patients (61.5%) had migraine with aura, and 5 patients (38.4%) had migraine without aura. The presence of white matter foci was significantly higher in the patients with aura (8 [40%] of 20) than in those without aura (5 [20%] of 25). It was found that as the frequency of attacks per month increased, the number of patients with white matter foci also increased. Although the mean duration of migraine was longer in patients with white matter foci (149.5 months [SD, 87.9]) than in those without white matter foci (134.1 months [SD, 88.3]), there was no significant difference (P > .05). Conclusion.,Although there are no specific magnetic resonance imaging findings peculiar to migraine, detection of white matter foci should be taken into consideration in patients with migraine (especially migraine with aura). Frequency of attacks is an important indicator of existence of white matter foci. [source]


Prevalence of Head Trauma in Patients With Difficult Headache: The North Norway Headache Study

HEADACHE, Issue 1 2003
Svein Ivar Bekkelund MD
Objective.,To test whether chronic headache (>3 days/week) is more prevalent than episodic headache (<3 days/week) in patients with a previous history of significant head trauma. Method.,We included 903 consecutive patients referred to a specialist center for headache during a period of 2 years. As the main parameter, we selected self-reported history of previous significant head trauma defined as loss of consciousness or hospitalization due to head trauma. Results.,One hundred eighty-nine out of 903 patients with difficult headache referred to a neurologist had a previous history of head trauma (21%). We identified 297 patients with headache 3 days or more per week (33%). Of these patients with chronic headache, 68 (23%) reported previous significant head trauma compared with 121/714 (17%) in other patients with headache (P = .18). Shorter length of education was associated with chronic headache; however, age, sex, or specific headache syndromes such as migraine or tension headache were not related to chronicity. Conclusion.,Although the incidence of previous head trauma was prevalent in this highly selected group of patients with headache, such a history was not a predictor of chronicity. [source]


Maternal distress: a concept analysis

JOURNAL OF ADVANCED NURSING, Issue 9 2010
Elizabeth Emmanuel
emmanuel e. & st john w. (2010) Maternal distress: concept analysis. Journal of Advanced Nursing,66(9), 2104,2115. Abstract Aim., This paper is a report of an analysis of the concept of maternal distress. Background., Although not well-developed, the concept of maternal distress has offered an important viewpoint in nursing and midwifery practice since the mid-1990s. Traditionally, understanding of maternal distress has been based on the medical model and dysfunction. The concept of maternal distress needs development so that it describes responses ranging from normal stress responses to those indicating mental health problem/s. Data sources., The SCOPUS, CINAHL and Medline databases were searched for the period from 1995 to 2009 using the keywords ,psychological distress', ,emotional distress' and ,maternal distress'. Review methods., Steps from Rodgers' evolutionary concept analysis guided the conduct of this concept analysis. Results., Four attributes of maternal distress were identified as responses to the transition to motherhood, with the level of each response occurring along a continuum: stress, adapting, functioning and control, and connecting. Antecedents to maternal distress include becoming a mother, role changes, body changes and functioning, increased demands and challenges, losses and gains, birth experiences, and changes to relationships and social context. The consequences of maternal distress are compromised mental health status, maternal role development, quality of life, ability to function, quality of relationships and social engagement. The extent of the impact depends on the level of maternal distress. Conclusion., Clearer interpretation of maternal distress offers a comprehensive approach to understanding maternal emotional health during the transition to motherhood. Acknowledging women's experiences and providing more appropriate support could alleviate some of the struggles and hardships experienced by mothers. [source]


Nurses' perceptions of individualized care

JOURNAL OF ADVANCED NURSING, Issue 5 2010
Riitta Suhonen
suhonen r., gustafsson m.-l., katajisto j., välimäki m. & leino-kilpi h. (2010) Nurses' perceptions of individualized care. Journal of Advanced Nursing,66(5), 1035,1046. Abstract Title.,Nurses' perceptions of individualized care. Aim., This paper is a report of a study of nurses' perceptions of individualized care, the factors associated with these perceptions, and nurses' perceptions of the provision of individualized care in different types of healthcare organization. Background., Although individualized care has been an internationally-challenging and long-standing research topic in nursing, the current literature on individualized care from the perspective of nurses is limited. Methods., A cross-sectional, descriptive and exploratory design using a questionnaire (Individualised Care Scale,Nurse) was employed to survey a stratified sample of 544 nurses (response rate 59%) working as Registered or Enrolled Nurses in one hospital district in Finland in 2008. Data were analysed using descriptive and inferential statistics (General Linear Model, one-way analysis of variance) and Cronbach's alpha coefficients for reliability analysis. Results., Nurses perceived that they supported patient individuality well and that the care they provided took into account patient individuality. Based on the General Linear Model, nurses' background variables were not associated with their perceptions of individualized care delivery. However, between-organization differences were found in all study variables: mental health ward nurses had the most positive perceptions, and nurses working in primary health centre long-term care wards the lowest. Conclusion., Healthcare organizations and work environments need to be evaluated as they may have an influence on individualized care provision. The Individualised Care Nurse instrument is sensitive to healthcare working environments and can be used in evaluating nurses' perceptions of individualized care. [source]


Dundee Ready Education Environment Measure: psychometric testing with Chinese nursing students

JOURNAL OF ADVANCED NURSING, Issue 12 2009
Jian Wang
Abstract Title.,Dundee Ready Education Environment Measure: psychometric testing with Chinese nursing students. Aim., This paper is a report of the psychometric testing of the Dundee Ready Education Environment Measure with Chinese nursing students. Background., Although the Dundee Ready Education Environment Measure has been widely used to measure educational environments in the healthcare professions, no psychometric evaluation of the measure with Chinese nursing students has been reported. Method., Data from 214 nursing students were collected during a 2-month period between December, 2004 and January, 2005. Exploratory factor analysis, internal consistency reliability and Cronbach's alpha were examined. Results., Five factors were found by principal components analysis with Oblimin with Kaiser Normalization rotation. The original factor names were maintained, but items in each factor changed. These five factors all achieved eigenvalues >1, and in total accounted for 52·186% of the variance. Cronbach's alpha ranged from 0·623 to 0·9 across factors, with an overall alpha of 0·949. Conclusion., The Chinese version of the Dundee Ready Education Environment Measure could be a valuable measurement for nursing educators in professional development programmes and nursing curriculum design. Further studies need in different Chinese nursing schools and larger sample sizes to be conducted to validate its stability and factor structure. [source]


Decision-making about artificial feeding in end-of-life care: literature review

JOURNAL OF ADVANCED NURSING, Issue 1 2008
Els Bryon
Abstract Title.,Decision-making about artificial feeding in end-of-life care: literature review. Aim., This paper is a report of a review of nurses' roles and their perceptions of these roles in decision-making processes surrounding artificial food and fluid administration in adult patients. Background., Of all caregivers, nurses have the closest and most trusting relationship with severely ill patients and their families during the entire end-of-life care process. As a result, nurses become closely involved in complex ethical decision-making processes concerning artificial administration of food or fluids for these patients. Data sources., We searched seven electronic databases (1990,2007) and examined the reference lists of relevant papers. Review methods., This mixed methods review was conducted with guidance of the United Kingdom Centre for Reviews and Dissemination guidelines on systematic reviews. Results., Although their direct impact is limited, nurses play a significant indirect role during decision-making processes. Because of their unique position, they often initiate decision-making processes, function as patient advocates and provide guidance, information and support to patients and families. Although nurses considered their role to be very valuable, they felt that their role was not always defined clearly or appreciated. Whether nurses experience decision-making processes positively depended on several contextual factors. Conclusion., Given their knowledge and practice skills, nurses are in a prime position to contribute valuably to decision-making processes. Nevertheless, they remain sidelined. For nurses to receive sufficient recognition, their decision-making tasks and responsibilities need to be clarified and made manifest to other participants. [source]


The Delphi technique: myths and realities

JOURNAL OF ADVANCED NURSING, Issue 4 2003
Catherine Powell BNSc PhD RGN RSCN RHV
Aim.,To outline the key concepts and principles of the Delphi technique. Methods.,Reference is made to a selection of studies that illustrate a variety of methodological interpretations. Drawing on Heshusius's concept of ,goodness criteria', particular emphasis is given to the question of scientific merit and means of evaluation. Conclusion.,Although the technique should be used with caution, it appears to be an established method of harnessing the opinions of an often diverse group of experts on practice-related problems. [source]


Religion and the secularisation of health care

JOURNAL OF CLINICAL NURSING, Issue 14 2009
John Paley
Aims and objectives., To assess the claim that conceptualisations of religion and spirituality should be grounded in theology, and acknowledge the global resurgence of religion. Background., Although there is widespread agreement in the nursing literature that ,spirituality' is a broader concept than ,religion,' and should be understood generically, this approximate consensus has occasionally been challenged. A recent paper by Barbara Pesut and colleagues argues that the generic view not only empties spirituality of powerful religious symbols and narratives, but underestimates the continuing social influence of religion, and its resurgence on a global scale. Accordingly, these authors suggest three principles for conceptualising spirituality and religion in health care, one of which is that conceptualisations should be grounded in philosophical and theological thinking, and should not ignore the global resurgence of religion. Method., Critical review. Conclusion., The Pesut principle privileges theology, disregarding other disciplines which theorise religion. Arguably, it privileges specifically Christian theology, the history of which suggests a politics of orthodoxy and an epistemology of authority and obedience. The global resurgence of religion is not, in fact, global, as the industrialised countries have experienced a marked shift towards secular-rational values; and the postindustrial phase of development is associated with self-expression values, which represent a challenge not merely to religious institutions (arguably an affirmation of ,spirituality') but to traditional elites and structures of all kinds. Finally, religion ,resurgent' is not an attractive model for health care, since many of its most obvious manifestations are incompatible with the ideology of health professionals. Relevance to clinical practice., In the secular societies of Europe, if not North America, there should be no expectation that nurses provide spiritual care. It is a requirement of the great separation between civil order and religion that the health services, as a public space, should remain thoroughly secular. [source]


Evaluation of negative emotional care experiences in burn care

JOURNAL OF CLINICAL NURSING, Issue 14 2008
Björn Wikehult MSc
Aim and objective., To assess recollection of negative emotional experiences during burn care. Background., Patients in intensive care frequently report negative emotional experiences. Patients with severe burns who are treated in intensive care units undergo painful care procedures, but there have been no recent evaluations of their care experiences. Design., Former burn patients (n = 42) were randomly assigned to three groups: postal questionnaire, telephone interview and face-to-face interview. Methods., Assessments included negative care experiences (feelings of uncertainty, powerlessness, being afraid, insecure, being a nuisance, or neglected), severity of injury, patient satisfaction, personality traits and psychological symptoms. Results., Overall, the degree of recalled negative experiences was low and associated with greater severity of injury, more symptoms of post-traumatic stress disorder and lower satisfaction with care. The feeling of powerlessness was the most common, as 67% of participants had such feelings to some extent. Conclusions., Overall, negative care experiences were uncommon and most prevalent among the severely injured. Such experiences were also associated with psychological symptoms and lower patient satisfaction. Relevance to clinical practice., Although relatively uncommon, negative emotional care experiences should be monitored more closely during care. [source]


A review of outcomes of individualised nursing interventions on adult patients

JOURNAL OF CLINICAL NURSING, Issue 7 2008
Riitta Suhonen PhD
Aims and objectives., This review describes the outcomes of individualised nursing interventions on adult patients. Background., Although the delivery of individualised nursing interventions is important there is limited evidence about how these interventions enhance patient outcomes. Methods., A computerised search was undertaken using the Cochrane Library, MEDLINE, CINAHL and PsycINFO. The selection criteria chosen were: reports of individualised nursing interventions focusing on adult patients in a variety of health care settings and using experimental designs. These involved randomised controlled trials, clinical controlled trials and pre- and posttest controlled studies. After a four-stage inclusion strategy 31 documents were accepted for the review. Results., The studies were mostly focused in preventative arenas such as health promotion and counselling. Others were care of older people in the community and in hospital and patients with chronic diseases. Over half of the nursing interventions (58%) involved educational or counselling activities which seem to be more effective than ordinary, standardised or routine education and counselling. Overall, 81% of the studies reported a positive impact of individualised interventions on patient outcomes showing that there is evidence, though limited, that individualised interventions can produce positive patient outcomes. Conclusions., There is sufficient evidence, especially in specific areas such as patient education and counselling, to acknowledge that individualised interventions are superior to non-individualised interventions. Evidence for this effect within clinical nursing interventions on patient outcomes was limited by the scarcity of research in this area. There is a need for additional intervention studies to determine the effect of individualised interventions in a wide variety of contexts. Relevance to clinical practice., Experience of health is individual. Therefore, nursing interventions should also be individualised to each patient. These findings show some promise that individualised interventions may be useful in delivering positive patient outcomes. [source]


Menopausal symptom perception and severity: results from a screening questionnaire

JOURNAL OF CLINICAL NURSING, Issue 7 2008
FAANP, Judith A Berg PhD
Background., Although it is widely acknowledged women experience symptoms during their transition from reproductive to postreproductive stage, there is inconsistency as to the prevalence of symptoms as well as their severity ratings. Aim and objectives., The purpose of this study was to describe symptom perception and severity in mid-life women volunteering for an intervention study for menopause symptom management. Design., A cross-sectional descriptive design was used to provide data on presenting symptoms in a sample of women negotiating the menopausal transition. Methods., A community-based sample of Caucasian women aged 43,55 years was recruited from national nursing media, local media and a variety of local community sources. A screening questionnaire was administered to determine qualification for study entry based upon symptom severity scores from the questionnaire. This report includes results from the screening questionnaire. Results., One hundred and sixty-five women were screened to obtain 110 qualified participants with mean age of 49·3 SD 3·04 years who were 4·7 SD 7 months past their last menstrual period. Sleep difficulties, forgetfulness and irritability were perceived by the highest number of women while sleep difficulties, night sweats, irritability and forgetfulness were rated the most severe. Conclusions., Findings from this study expand understanding of the menopause symptom experience, because few reports include symptom severity reports. All aspects of the symptom experience are necessary to develop appropriate interventions and to evaluate them. Relevance to clinical practice., Providing education about menopause symptoms is central to nursing practice of mid-life women. Therefore, nurses must keep abreast of current knowledge to prepare women for their transition to postreproductive phase or to reassure women who are surprised to find hot flashes are not the only symptoms encountered. [source]


Family support, perceived self-efficacy and self-care behaviour of Turkish patients with chronic obstructive pulmonary disease

JOURNAL OF CLINICAL NURSING, Issue 8 2007
Magfiret Kara Ka
Aim., The purpose of this study was to describe family support, self-efficacy perception and self-care behaviour among patients with chronic obstructive pulmonary disease and to ascertain the relationship between these variables. Background., It is important to work at improving confidence in the patients' ability to follow a self-care regimen by increasing self-efficacy. Family support also plays an important role in self-care activities. Method and design., The study design is descriptive and correlational. Of 230 patients with chronic obstructive pulmonary disease who were recruited for the study, 200 agreed to participate. The patients were recruited by the first author from an outpatient clinic in the Department of Chest Disease of a university hospital and a pulmonary hospital in Erzurum, eastern Turkey. Data were collected by using a demographic data form, the Perceived Social Support from Family Scale, the Chronic Obstructive Pulmonary Disease Self-efficacy Scale and the Alberto Chronic Obstructive Pulmonary Disease Self-care Behaviour Inventory. Results., Although most participants (91·5%) perceived that they had family support and more than three quarters (73·0%) of the participants engaged in an adequate amount of self-care behaviours, only twenty five participants' (12·5%) perceived self-efficacy as high. There were statistically significant positive relationships between family support and self-care behaviour (r = 0·302; p = 0·01) and between self-efficacy and self-care behaviour (r = 0·186; p = 0·01). There was also a statistically significant positive relationship between family support and self-efficacy (r = 0·412; p = 0·01). Conclusion., The results of the study demonstrated weak to moderate, but statistically significant, relationships between family support and self-care behaviours, self-efficacy and self-care behaviour and family support and self-efficacy in Turkish patients with chronic obstructive pulmonary disease. Relevance to clinical practice., The assessment of the family support, self-efficacy and self-care behaviours of the patients with chronic obstructive pulmonary disease should be an essential part of nursing practice. The study also provides the foundation for the conduct of future studies of self-care training for managing patients with chronic obstructive pulmonary disease. [source]


Stoma coloproctology nurse specialist: a case study

JOURNAL OF CLINICAL NURSING, Issue 6 2007
Ursula Chaney DPSN
Aims and objectives., The aim of this paper is to provide insight into the role of a Stoma Coloproctology Nurse Specialist. This paper presents the findings of an in-depth case study of a stoma coloproctology nurse specialist employed in one health board area in Northern Ireland. This case study was part of a larger study exploring innovative nursing and midwifery roles in Northern Ireland. Background., Specialist nursing roles have evolved and developed in response to changing health care needs, patient expectations, changes in professional regulation and government initiatives. Design., A case study approach was adopted. Method., Semi-structured interviews with the post holder (PH), her line manager and the human resource manager were undertaken. Non-participant observation of the PH's practice was also carried out. Analysis was undertaken on secondary data such as job specification, annual reports and other documentation relating to the post. Results., Findings illustrate the PH's function and the impact of the role on patient care. Examples of innovative practices relating to providing care, support and guidance for patients and their families were identified; however, limitations to her role were also identified. Conclusions., The PH provides an invaluable service to patients, demonstrating a positive impact on care. However, the findings suggest the importance of establishing clear role boundaries, which may lead to professional growth and practice development. Relevance to clinical practice., Although this study provides a valuable insight into the role of a Stoma Coloproctology Nurse Specialist a number of challenges exist, as the CNS role requires policy and appropriate educational preparation to practice at an advanced level. Further research investigating the development of the CNS role in the clinical setting and its relationship to members of the multi-professional team would be beneficial. [source]


Density and habitat associations of Henslow's Sparrows wintering in saline soil barrens in southern Arkansas

JOURNAL OF FIELD ORNITHOLOGY, Issue 4 2008
William C. Holimon
ABSTRACT Although the habitat requirements of breeding populations of Henslow's Sparrow (Ammodramus henslowii) have been examined, less is known about their habitat requirements and ecology during the nonbreeding season. We estimated population densities and quantified habitat associations of Henslow's Sparrows wintering in saline soil barrens in southern Arkansas. Densities of Henslow's Sparrows in the saline soil barrens were similar to those in the Longleaf Pine (Pinus palustris) Ecosystem of the southeastern United States, considered by many to be their primary wintering habitat. Henslow's Sparrows were closely associated with open areas with greater cover of Aristida spp. and globe beaksedge (Rhynchospora globularis), greater stem density at 11,20 cm above ground, more lichens, more herbaceous cover, more bare ground, greater occurrence of little bluestem (Schizacyrium scoparium) as the tallest vegetation, less moss, and less shrub cover than randomly selected sites. In contrast to the results of studies conducted in the Longleaf Pine Ecosystem, the presence of Henslow's Sparrows in our study was not correlated with the height of the tallest vegetation. Our results indicate that saline soil barrens of southern Arkansas support a high density of wintering Henslow's Sparrows and do so for longer postdisturbance periods than longleaf pine savanna. We also found that stem density near the ground was similar to that reported from longleaf pine savanna, but only about half that observed on their breeding grounds. Areas used by Henslow's Sparrows had more lichen and less moss cover, suggesting that those areas were drier than random sites within the barrens. Further research is needed to determine if large populations of Henslow's Sparrows winter in other saline soil barrens and if fire influences habitat associations and densities in the barrens. SINOPSIS Aunque los requisitos de hábitat para las poblaciones reproductivas de Ammodramus henslowii han sido determinadas, se conoce muy poco sobre su ecología y requerimientos de hábitat durante la temporada no-reproductiva. Estimamos la densidad poblacional y cuantificamos el hábitat asociado a Gorrión de Henslow que pasan el invierno en un salitral con suelo empobrecido en el sur de Arkansas. La densidad de las aves en el salitral resultó similar a lo encontrado en Ecosistemas de Pinos (Pinus palustris) en el sureste de los EUA, considerado por muchos como el principal hábitat invernal para la especie. Los gorriones estuvieron altamente asociados a áreas abiertas con covertura de Aristida spp. y Rhynchospora globularis, con mayor densidad de tallos, altura entre 11,20 cm sobre el suelo, mayor cantidad de líquenes, mayor cubierta herbácea, más suelo desnudo, mayor presencia de Schzacyrium scoparium (como la vegetación de mayor tamaño), menos musgos, y menos arbustos que localidades seleccionadas al azar. En contraste a los resultados de estudios conducidos en Ecosistemas de Pinos, la presencia del gorrión en nuestra área de estudio no estuvo correlacionada con la altura de la vegetación de mayor tamaño. Nuestros resultados indican que las salinas en Arkansas sostienen una alta densidad de aves invernales, y lo hacen por periodos más largos, después de disturbios, que en las savanas de pinos. También encontramos que la densidad de tallos, cerca del suelo, era similar a la informada en savanas de pinos, pero tan solo la mitad de lo indicado para lugares en donde las aves se reproducen. Las áreas utilizadas tienen más líquenes, pero menos musgos, lo que sugiere que dichas áreas son más secas que lugares con suelo empobrecido muestreados al azar. Se necesitan más trabajos para determinar si otras grandes poblaciones del gorrión de Henslow pasan el invierno en otras salinas con suelos empobrecidos y si eventos como fuegos incluyen en la asociación del hábitat y densidades en los lugares con suelo empobrecido. [source]


Similarity in the begging calls of nestling Red-winged Blackbirds

JOURNAL OF FIELD ORNITHOLOGY, Issue 3 2008
Ken Yasukawa
ABSTRACT Although individually distinct begging calls may permit parents to recognize their offspring, birds nesting in dense breeding colonies where fledglings intermingle might benefit from additional adaptations. For example, if the calls of all nestlings in a brood were similar, parents would need to recognize only one brood call instead of the identity calls of each nestling. We recorded nestling Red-winged Blackbirds (Agelaius phoeniceus) to determine whether their calls function to identify individuals (identity call hypothesis) or broods (brood call hypothesis). We used spectrogram cross-correlation and dynamic time warping as well as call duration, peak frequency, and frequency range to estimate the similarity of begging calls of nestling Red-winged Blackbirds. We recorded individual nestlings on day 5 and on day 9 of the nestling period to determine whether calls of individuals were more similar than calls of different nestlings, and whether calls of broodmates were more similar than calls of nestlings from different broods. We found that calls of 8-d-old individuals were more similar than calls of different nestlings, but the calls of broodmates were not more similar than those of nestlings from different broods. These results were consistent with the identity call hypothesis. We then compared begging calls of pairs of nestlings recorded separately and together on day 9. We found that the calls of 8-d-old nestlings recorded together were more similar than when they were recorded separately. In addition, using playback of begging calls from normal broods and artificial "broods" constructed from the calls of single nestlings, we found that females returned with food sooner in response to the calls of single nestlings (with enhanced call similarity) than to those of normal broods. Our results suggest that similar begging calls may be beneficial for both nestlings and parents, with broodmates fed at higher rates when their calls are more similar and, after fledging, parents needing to recognize only one brood call instead of the identity calls of each fledgling. SINOPSIS Aunque las diferencias individuales en los llamados de reclamo les pueden permitir a los padres reconocer a su progenie, aves que nidifican en grandes colonias de anidación donde los polluelos pueden mezclarse pueden obtener beneficios mediante adaptaciones adicionales. Por ejemplo, si los llamados de todos los polluelos en el nido son similares los padres necesitarian reconocer solo un tipo de reclamo de los polluelos en vez de identificar llamados individuales de los polluelos. Grabamos polluelos de Agelaius phoeniceus para determinar si sus llamados son usados para identificar individuos (Hipotesis de la identidad del polluelo) o para identificar a la progenie (Hipotesis de la identidad de la progenie). Usamos espectrogramas de correlación cruzada y dinamica del tiempo de combeo al igual que la duración del reclamo, el pico de frecuencia y frecuencia del rango para estimar la similaridad de los llamados de los polluelos de Agelaius phoeniceus. Grabamos polluelos individuales de 5 y 9 días de nacidos para determinar si los llamados de los individuos eran más similares a llamados de otros polluelos y si los llamados dentro de una progenie eran ma similares a llamados de otra progenie. Encontramos que los llamados de polluelos de 8 días de nacidos eran más similares que los llamados de diferentes polluelos, pero los polluelos de una misma progenie no fueron más similares que polluelos de diferentes progenies. Esto resultados concuerdan con la hipotesis de la identidad del polluelo. Después comparamos los llamados de parejas de polluelos grabados por separado y los que fueron grabados juntos el día 9. Encontramos que los llamados de polluelos de 8 días de nacidos grabados juntos fueron mas similares que cuando los polluelos fueron grabados por separado. Adicionalmente, usando playback de llamado de polluelos de progenies normales y progenies "artificales" construidos basado en llamado de un solo polluelo, encontramos que las hembras regresaron más rapidamente con alimento en respuesta al llamado de un solo polluelo (con realzamiento en la similaridad del llamado) que para las progenies normales. Nuestros resultados sugieren que la similaridad en los llamados de los reclamos pueden ser beneficiosos tanto para los polluelos como los padres, en donde las tasa de alimentación es mayor cuando sus llamados son mas similares, y después de abandonar el nido cuando los padres necesitan reconocer un solo llamado de la progenie en vez de tener que identificar llamados individuales de cada volanton. [source]


Family data in Rett syndrome: Association with other genetic disorders

JOURNAL OF PAEDIATRICS AND CHILD HEALTH, Issue 4 2000
H Leonard
Background: Rett syndrome is a neurological disorder, almost exclusively affecting girls. Methodology: Between 1993 and 1995 pedigree data were obtained from families of girls registered with the Australian Rett syndrome database. Results: Although 21 individual disorders were reported to be present in family members of affected girls, there was no apparent clustering of the same disorder in different families. However it was certain that a geneticist had been involved in only 10.9% of cases. Conclusions: Mutations in the MECP2 gene have now been reported in a proportion of sporadic cases. Thus, it will be important to examine this phenotype,genotype correlation in the Australian cohort. Where a mutation is found, prenatal diagnosis in a subsequent pregnancy will be a possibility. Using the Australian population database and in conjunction with the clinical genetic services in each state it is planned to contact families with an affected girl to offer testing and counselling. [source]


Platelet functions beyond hemostasis

JOURNAL OF THROMBOSIS AND HAEMOSTASIS, Issue 11 2009
S. S. SMYTH
Summary., Although their central role is in the prevention of bleeding, platelets probably contribute to diverse processes that extend beyond hemostasis and thrombosis. For example, platelets can recruit leukocytes and progenitor cells to sites of vascular injury and inflammation; they release proinflammatory and anti-inflammatory and angiogenic factors and microparticles into the circulation; and they spur thrombin generation. Data from animal models suggest that these functions may contribute to atherosclerosis, sepsis, hepatitis, vascular restenosis, acute lung injury, and transplant rejection. This article represents an integrated summary of presentations given at the Fourth Annual Platelet Colloquium in January 2009. The process of and factors mediating platelet,platelet and platelet,leukocyte interactions in inflammatory and immune responses are discussed, with the roles of P-selectin, chemokines and Src family kinases being highlighted. Also discussed are specific disorders characterized by local or systemic platelet activation, including coronary artery restenosis after percutaneous intervention, alloantibody-mediated transplant rejection, wound healing, and heparin-induced thrombocytopenia. [source]


Aspirin, 110 years later

JOURNAL OF THROMBOSIS AND HAEMOSTASIS, Issue 2009
C. PATRONO
Summary., Although conceived at the end of the 19th century as a synthetic analgesic agent with improved gastric tolerability vs. naturally occurring salicylates, acetylsalicylic acid (marketed as aspirin in 1899) turned out to be an ideal antiplatelet agent about 90 years later, following the understanding of its mechanism of action, the development of a mechanism-based biomarker for dose-finding studies, and the initiation of a series of appropriately sized, randomized clinical trials to test its efficacy and safety at low doses given once daily. At the turn of its 110th anniversary, aspirin continues to attract heated debates on a number of issues including (i) the optimal dose to maximize efficacy and minimize toxicity; (ii) the possibility that some patients may be ,resistant' to its antiplatelet effects; and (iii) the balance of benefits and risks in primary vs. secondary prevention. [source]