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PubMed2002

Towards clarification of the meaning of spirituality.

BACKGROUND: Rhetoric about spirituality and nursing has greatly increased, as scientific-based approaches are not fully able to address many human problems, such as persistent pain. Despite the renewed interest and growing literature on spirituality, there is no consensus on a definition of this concept. There is also ambiguity on how this concept is incorporated into nursing practice, research, and education. AIM: This paper aims to contribute toward clarification of the meaning of spirituality in relevance to health and nursing today through a conceptual analysis process. METHODS: Information was obtained through dictionary definitions and electronic database searches of literature on spirituality spanning the past 30 years. The criteria for selection included scholarly articles and books with a definition of spirituality, and research studies that investigated the meaning of spirituality to individuals' health. A total of 76 articles and 19 books were retrieved for this analysis. FINDINGS: Spirituality is an inherent component of being human, and is subjective, intangible, and multidimensional. Spirituality and religion are often used interchangeably, but the two concepts are different. Spirituality involves humans' search for meaning in life, while religion involves an organized entity with rituals and practices about a higher power or God. Spirituality may be related to religion for certain individuals, but for others, such as an atheist, it may not be. CONCLUSION: In order to provide clarity and enhance understanding of this concept, this analysis delineates antecedents, attributes, constructed case examples, empirical referents, and consequences of spirituality. A proposed definition of spirituality emerged from this process, which may be applied broadly. Implications for nursing practice, education, and research are discussed.

Holistic Nursing↗
PubMed2006

The open-access high-throughput crystallization facility at EMBL Hamburg.

Here, the establishment of Europe's largest high-throughput crystallization facility with open access to the general user community is reported. The facility covers every step in the crystallization process from the preparation of crystallization cocktails for initial or customized screens to the setup of hanging-drop vapour-diffusion experiments and their automatic imaging. In its first year of operation, 43 internal and 40 external users submitted over 500 samples for a total of 2985 crystallization plates. An electronic booking system for registration, the selection of experimental parameters (e.g. drop size, sample-to-reservoir ratio) and the reservation of time slots was developed. External users can choose from more than 1000 initial crystallization conditions. By default, experiments are kept for six months and are imaged 15 times during this time period. A remote viewing system is available to inspect experiments via the internet. Over 100 stock solutions are available for users wishing to design customized screens.

Crystallization↗
PubMed1994

Indicators of quality medical care for the terminally ill in nursing homes.

PURPOSE: To identify medical care indicators for nursing home terminal care. DATA SOURCES: Studies examining care of terminally ill patients were identified using computer, bibliography, and expert searches; input from nursing home medical directors in Maryland; and input from expert geriatricians. STUDY SELECTION: More than 900 articles, books, and abstracts from meetings covering medical care for terminally ill patients were reviewed. Information from more than 100 publications is included. DATA EXTRACTION: Indicators of medical care for terminally ill patients, which can be used to quantify performance with respect to standards, guidelines, and options, were identified initially through review of the literature. DATA SYNTHESIS: Indicators were refined by input from medical directors of Maryland long-term care facilities and subsequent review by expert geriatricians. CONCLUSIONS: Minimum standards for which 100% performance is expected are communication of advance directives, attention to pain control, and attention to relief of dyspnea. Performance indicators for medical care guidelines and options in terminal care of nursing home patients are also described.

Home Care Services↗
PubMed2006

Meta-analysis of probiotics for the prevention of antibiotic associated diarrhea and the treatment of Clostridium difficile disease.

CONTEXT: Antibiotic-associated diarrhea (AAD) is a common complication of most antibiotics and Clostridium difficile disease (CDD), which also is incited by antibiotics, is a leading cause of nosocomial outbreaks of diarrhea and colitis. The use of probiotics for these two related diseases remains controversial. OBJECTIVE: To compare the efficacy of probiotics for the prevention of AAD and the treatment of CDD based on the published randomized, controlled clinical trials. DATA SOURCES: PubMed, Medline, Google Scholar, NIH registry of clinical trials, metaRegister, and Cochrane Central Register of Controlled Trials were searched from 1977 to 2005, unrestricted by language. Secondary searches of reference lists, authors, reviews, commentaries, associated diseases, books, and meeting abstracts. STUDY SELECTION: Trials were included in which specific probiotics given to either prevent or treat the diseases of interest. Trials were required to be randomized, controlled, blinded efficacy trials in humans published in peer-reviewed journals. Trials that were excluded were pre-clinical, safety, Phase 1 studies in volunteers, reviews, duplicate reports, trials of unspecified probiotics, trials of prebiotics, not the disease being studied, or inconsistent outcome measures. Thirty-one of 180 screened studies (totally 3,164 subjects) met the inclusion and exclusion criteria. DATA EXTRACTION: One reviewer identified studies and abstracted data on sample size, population characteristics, treatments, and outcomes. DATA SYNTHESIS: From 25 randomized controlled trials (RCTs), probiotics significantly reduced the relative risk of AAD (RR = 0.43, 95% CI 0.31, 0.58, p < 0.001). From six randomized trials, probiotics had significant efficacy for CDD (RR = 0.59, 95% CI 0.41, 0.85, p = 0.005). CONCLUSION: A variety of different types of probiotics show promise as effective therapies for these two diseases. Using meta-analyses, three types of probiotics (Saccharomyces boulardii, Lactobacillus rhamnosus GG, and probiotic mixtures) significantly reduced the development of antibiotic-associated diarrhea. Only S. boulardii was effective for CDD.

Anti-Bacterial Agents↗
PubMed2006

Sexual behaviour and risk in Vietnamese men living in metropolitan Sydney.

OBJECTIVE: To describe sexual risk in Vietnamese men who have sex with female sex workers by describing the prevalence of sexual risk behaviours among Vietnamese men living in inner Sydney and comparing this prevalence with national data. METHOD: Telephone interviews were completed with a random sample of 499 Vietnamese men, selected from the electronic telephone book using a list of common Vietnamese surnames. RESULTS: Of the 761 eligible men contacted, data were obtained from 499 men, giving a response rate of 66%. 20% reported having had sex with a sex worker, including 12% of Vietnamese men who had had sex with a sex worker outside Australia, predominantly in Vietnam. Of the men who had had sex with a sex worker in the past year, 28% had unprotected vaginal or anal sex at their most recent commercial sexual encounter. Ever having paid for sex was significantly associated with a higher lifetime number of sexual partners (p<0.001), history of a sexually transmitted infection (p<0.001) and ever having an HIV test. 1% of respondents reported injecting non-prescription drugs. Less than 1% said they had had sex with another man. CONCLUSION: Vietnamese men living in Sydney generally show lower levels of sexual and related risk behaviours than other Australian men. However, sex with a sex worker is common among Vietnamese men in Sydney and also when they travel outside Australia. Unprotected vaginal sex with sex workers is surprisingly common. Programmes are needed to deal with vulnerabilities in these areas.

Adolescent↗
PubMed1994

Recommended guidelines for the management of autologous and allogeneic bone marrow transplantation. A report from the Eastern Cooperative Oncology Group (ECOG)

OBJECTIVE: To define the basic state-of-the-art medical care of the patients after bone marrow transplantation as practiced by the Eastern Cooperative Oncology Group. DATA IDENTIFICATION: Studies examining the role of bone marrow transplantation in the care of neoplastic disorders identified using computer and bibliographic searches. STUDY SELECTION: More than 500 articles, book chapters, and abstracts from meetings, covering all therapeutic and diagnostic aspects of the patient having bone marrow transplantation were critically reviewed; information from over 200 publications is included. RESULTS OF DATA ANALYSIS: Enormous progress has been made in understanding the biology, therapy, and prophylaxis strategies of bone marrow transplantation and in extending the range of potential marrow donors to include unrelated persons. Dramatic advances have occurred in the prevention of serious infection, including cytomegalovirus infection, formerly a cause of a high rate of mortality. The advent of newer-combination, high-dose chemotherapy regimens and advances in cryopreservation and in vitro marrow purging techniques have led to increased use and greater efficacy of autologous transplantation. Recent advances using recombinant hematopoietic growth factors and autologous peripheral stem cells are likely to reduce morbidity and mortality and significantly shorten the length of hospitalization and the cost of bone marrow transplantation. CONCLUSIONS: Bone marrow transplantation now is a common procedure done throughout the world. Cooperative groups have assumed a major role in conducting clinical trials. A standardized approach defining basic standards of care will assure uniformity of management, better interpretation of data, and continued progress in the care of the patient who has had a bone marrow transplantation. Basic research and clinical trials are ongoing to define better methods for the treatment and prevention of graft-versus-host disease and hepatic veno-occlusive disease.

Bone Marrow Transplantation↗
PubMed1998

Provider sponsored organizations: emerging opportunities for growth.

As providers struggle to identify mechanisms to serve the Medicare population, the Medicare program continues to evolve. Of course, providers may serve the beneficiaries through traditional Medicare, Medicare HMOs, or a Medicare Select product, but as this book shows, under the appropriate conditions, the best way may be through the formation of a PSO.

Capitation Fee↗
PubMed2000

The genetics of spondyloarthropathies.

INTRODUCTION: Spondyloarthropathies are a heterogeneous group of rheumatic disorders that commonly present with axial skeleton or sacroiliac joints involvement. Ocular involvement like uveitis, iritis and conjunctivitis can be present in up to a third of the patients. Genetic factors play a part in the pathogenesis of spondyloarthropathies. Association with the HLA-B27 gene, especially that between ankylosing spondylitis and HLA-B27 antigenic positivity, is one of the strongest association seen between a disease and a Class I antigen. This paper aims to review the frequencies of HLA-B27 gene and its subtypes in different population groups, possible mechanisms leading to the development of joint inflammation and the risk it confers for development of spondyloarthropathies. METHODS: The MEDLINE database was searched using keywords: HLA-B27, spondyloarthropathy, molecular mimicry, arthritogenic peptides, reactive arthritis and ankylosing arthritis. Related articles for selected papers were also consulted. Books on HLA-B27 and spondyloarthropathy were obtained through the NUS Medical Library's LINC system. RESULTS: The genetic subtypes and susceptibility to development of disease vary in different population groups. Other HLA genes and non-HLA genes also play a part in the development of spondyloarthropathies, especially in those who are HLA-B27 negative. HLA-B27-positive relatives of spondyloarthritics have a higher risk of developing a similar condition. The presence of the HLA-B27 gene may serve as an aid to diagnosis or prognosis for clinicians. In juvenile arthritic patients, it is a poor prognostic factor, predicting for disease severity. It is also associated with poor outcomes for patients with anterior uveitis. However screening of asymptomatic individuals for the HLA-B27 gene is not recommended. CONCLUSION: The polygenic nature of the disease needs further elucidation and study.

Arthritis↗
PubMed2005

Pietro Motta's latest studies on the microanatomy of menopause: revised concepts on the beauty of aging.

Menopause signs a hallmark in women's life. When compared to traditional two-dimensional techniques, scanning electron microscopy (SEM) allows to discover the impressive microcosm of the human body and offers original views of the real three-dimensional ultrastructure of reproduction. On the basis of Prof. Motta's last and original book, herein we show a selection of microscopic images that characterize the 3D changes taking place on the surface epithelia of the aging woman's reproductive tract. Biopsies of ovaries, tubes, uteruses, cervices and vaginas were obtained from women (45-72 years old) during surgical or endoscopical procedures and after the informed consent of the patients. Samples were processed for SEM as reported elsewhere. Reproductive aging is associated to epithelial flatness, higher stromal density, absence of ovarian follicles, thickening of vascular walls and lack of glandular secretion. The uterus and the tube show a morphodynamic sequence of gradual microvilli shortening, patchy to complete deciliation and formation of microplicae like structures. The formation of microplicae like structures is interpreted as an adaptive mechanical response of the genital epithelia to the new microenvironment. We can propose that these structures may represent the initial stage of a physiologic metaplasia. In conclusion, imaging of menopause through the use of SEM allows a better understanding of the morphological and physiopathological bases of female aging and represents a perfect blend of art and aesthetics: a further confirmation of the endless beauty of our inner microscopic anatomy.

Aged↗
PubMed2000

Co-ordinated multidisciplinary approaches for inpatient rehabilitation of older patients with proximal femoral fractures.

BACKGROUND: Hip fracture is a major cause of morbidity in older people and its impact, both on the individual and to society, is substantial. OBJECTIVES: To examine the effects of co-ordinated multidisciplinary inpatient rehabilitation, compared with usual orthopaedic care, for older patients with hip fracture. SEARCH STRATEGY: We searched the Cochrane Musculoskeletal Injuries Group trials register, Medline (up to April 1998), and reference lists of published papers and books. We also contacted colleagues and trialists. SELECTION CRITERIA: Randomised and quasi-randomised trials of postsurgical care using specialised rehabilitation of mainly older patients (aged 65 years or over) with hip fracture. DATA COLLECTION AND ANALYSIS: Trial assignment to included, excluded and awaiting assessment categories, was by consensus. Two reviewers independently assessed trial quality and extracted data. Limited additional information was sought from most trialists. As well as pooling of data from primary outcomes, supplementary analyses were performed to combine clinically relevant outcomes and investigate possible explanatory factors. MAIN RESULTS: In this minor update, one new trial is identified and has been placed in "studies awaiting assessment". Of another three trials previously pending assessment, one has now been excluded. The five included trials involved 1068 patients. The combined outcomes of death or requiring institutional care at final follow-up showed no significant difference between intervention and control groups (Peto odds ratio 0.92; 95% confidence interval 0.71 to 1.18). There was considerable heterogeneity in length of stay and cost data. Using death and deterioration in function as a further combined outcome variable yielded a Peto odds ratio of 0.83 (95% confidence interval 0.64 to 1. 07). This should be interpreted with caution due to heterogeneity. No quality of life measures were reported and the two trials investigating carer burden showed no detrimental effect from the intervention. The review update did not result in any new data for these outcomes. REVIEWER'S CONCLUSIONS: The trials reviewed had different aims, interventions and outcomes. As a consequence, results were heterogeneous and the question of effectiveness of different types of co-ordinated inpatient rehabilitation after hip fracture cannot be answered conclusively. There is a trend to effectiveness when combined outcome variables (death and institutional care, death and deterioration in function) are considered. Future trials of postsurgical care involving inpatient rehabilitation, or other models such as 'early supported discharge' and 'hospital at home' schemes, should aim to establish both effectiveness and cost effectiveness of multidisciplinary rehabilitation overall, rather than attempt to evaluate its components.

Aged↗
PubMed2000

Carbamazepine for cocaine dependence.

BACKGROUND: Cocaine dependence has become a substantial public health problem, developing a significant number of medical, psychological and social problems, including the spread of infectious diseases (e.g. AIDS, hepatitis and tuberculosis), crime, violence and neonatal drug exposure. Although there is no consensus regarding how to treat cocaine dependence, effective pharmacotherapy has a potentially major role to play as part of a broader treatment milieu. The anti-convulsant carbamazepine, a tricyclic medication that is widely used to treat a variety of neurological and psychiatric disorder, has also been used for treatment of cocaine dependence, although its effectiveness has not been established. OBJECTIVES: To determine whether carbamazapine (CBZ) is effective on the treatment of cocaine dependence. SEARCH STRATEGY: Electronic searches of Cochrane Library, EMBASE, MEDLINE, PsycLIT, Biological Abstracts and LILACS; scan of reference list of relevant articles; personal communication; conference abstracts; unpublished trials from pharmaceutical industry; book chapters on treatment of cocaine dependence. SELECTION CRITERIA: The inclusion criteria for all randomised controlled trials were that they should focus on the use of carbamazepine drugs versus placebo on the treatment of cocaine dependence. Trials including patients with additional diagnosis such as opiate dependence were also eligible. DATA COLLECTION AND ANALYSIS: The reviewers extracted the data independently and Odds Ratios, weighted mean difference and number needed to treat were estimated. Qualitative assessments of the methodology of eligible studies were carried out using validated checklists. The reviewers assumed that people who died or dropped out had no improvement and tested the sensitivity of the final results to this assumption. Where possible analysis was carried out according to the "intention to treat" principles. MAIN RESULTS: 5 studies were included in the review, with 455 people randomised. No differences were found regarding positive urine sample for cocaine metabolites. Scores on Spielberg State Anxiety Inventory slightly favoured carbamazepine, but didn't reach statistical significance. Dropouts were high in both groups up to 70% in the placebo group. Less dropout occurred in the Carbamazepine group (RR 0.87 95%CI 0.71-1.06). When no retention in treatment was due to side effects no differences were found. The number of participants presenting at least one side effect, reported in Kranzler (1995), was higher in the carbamazepine group (RR 4.33 95% CI 1.45-12.91). REVIEWER'S CONCLUSIONS: There is no current evidence supporting the clinical use of CBZ in the treatment of cocaine dependence. Larger randomised investigation must be considered taking into account that these time-consuming efforts should be reserved for medications showing more relevant and promising evidence.

Anticonvulsants↗
PubMed1994

Risk identification for HIV infection in an inner London antenatal population.

This study was carried out to ascertain whether routine antenatal history taking is an effective means of identifying risk factors for HIV infection. Information about risk obtained at routine booking was compared with answers to selected questions obtained at a research interview. The study was conducted at St. Bartholomew's Hospital Homerton, and ran from February 1991 to March 1992. Of the 3729 women interviewed, 1671 had been hand booked (unstructured questionnaire) and 2058 had been computer booked (structured questionnaire). Hand booking failed to identify 77% of risk factors compared with 7% for computer booking. The findings highlight the underdetection of risk activity and confirm the need for intermittent, anonymous sampling to obtain background information against which a decision to implement universal testing may be made.

Female↗
PubMed1980

Effect of a self-care book on physician visits. A randomized trial.

A self-care book that guides patients in seeking home care or physician care for 63 medical problems was assessed in three randomly selected groups of families to determine the book's effect on the number of visits to physicians. The first group was given the book and an optional seminar on its use; the second group was identical to the first but each family was promised $50 if their visits to physicians dropped by one third; the third group was a control group (total, 699 families). The book had no significant effect on the number of physician's visits during six- and 12-month study periods even though one half of the families read most or all of the book, and more than one third used it for a specific medical problem. Large-scale distribution of this self-care book therefore did not result in significantly less dependence on physicians for treatment of acute medical problems.

Activities of Daily Living↗
PubMed2003

The critique of the HRNES in the Handbook of Normative Data for Neuropsychological Assessment.

While providing excellent coverage for the norms used in a number of neuropsychological tests, the Handbook of Normative Data for Neuropsychological Assessment (Handbook) singles out for rejection a single set of norms, the Halstead Russell Neuropsychological Evaluation System (HRNES). The stated grounds for this rejection were not applied to any other of the several hundred sets of norms included in the book. The HRNES was rejected even though it fully meets the Handbook's selection criterion for tests to be included in the book.

Brain Diseases↗
PubMedDate not supplied

The influence of work on the outcome of low-risk pregnancies.

In this study, the relation of white-collar work on the outcomes of low-risk pregnancies was investigated. The medical records of 300 primiparous women whose pregnancy outcomes were known were selected sequentially from prenatal care log books over a 6-month period in three private, group obstetric practices in a university community. The majority of these women worked outside the home and included 220 white-collar workers (73 percent) and 28 blue-collar workers (9 percent). Thirty-four women (11 percent) were homemakers. Within this sample, 197 women (66 percent) met the selection criteria for low-risk pregnancies based on known sociodemographic, medical, and health risk factors. Although the sample numbers were small, comparison of low-risk white-collar workers (n = 141) with low-risk homemakers (n = 24) showed significant differences for rates of Cesarean section for failure to progress (16 percent versus 0 percent, P less than 0.05) and a summary index of poor delivery and/or infant outcome (21 percent versus 4 percent, P less than 0.05). No other adverse outcomes were significantly associated with occupation. This study suggests that increased pregnancy risks may be associated with white-collar work in otherwise low-risk women.

Adolescent↗
PubMed2000

A comparison of drugs versus placebo for the treatment of dysthymia.

OBJECTIVES: Dysthymia is a depressive disorder of chronic nature but of less severity than major depression, which depressive symptoms are more or less continuous for at least two years. The aim of this review was to conduct a systematic review of all RCTs comparing drugs and placebo for dysthymia. SEARCH STRATEGY: Electronic searches of Cochrane Library, EMBASE, MEDLINE, PsycLIT, Biological Abstracts and LILACS; reference searching; personal communication; conference abstracts; unpublished trials from the pharmaceutical industry; book chapters on the treatment of depression. SELECTION CRITERIA: The inclusion criteria for all randomised controlled trials were that they should focus on the use of drugs versus placebo for dysthymic patients. Exclusion criteria were: non randomised, mixed major depression/ dysthymia (trials not providing separate data) and depression secondary to other disorders (e.g. substance abuse). DATA COLLECTION AND ANALYSIS: The reviewers extracted the data independently. In order to achieve an intention-to-treat analysis, when trials failed to report it was assumed that people who died or dropped out had no improvement. Authors of relevant trials were contacted for additional and missing data. Absence of treatment response as defined by authors was the main measure of outcome used. Relative Risks (RR) and 95% confidence intervals (CI) of dichotomous data were calculated with the Random Effects Model. Where possible, number needed to treat (NNT) and number needed to harm (NNH) were estimated, taking the reciprocal of the absolute risk reduction. MAIN RESULTS: Currently the review includes 15 trials. Similar results were obtained in terms of efficacy for different groups of drugs, such as tricyclic (TCA), selective serotonin reuptake inhibitors (SSRI), monoamine oxidase inhibitors (MAOI) and other drugs (sulpiride, amineptine, and ritanserin). The pooled RR for absence of treatment response was 0. 68 (95% CI 0.59-0.78) for TCA and the NNT was 4.3 (95% CI 3.2-6.5). SSRIs showed similar RR for this outcome: 0.64 (95% CI 0.55-0.74), the NNT being 4.7 (95% CI 3.5-6.9). Concerning MAOIs, the RR was 0. 59 (95% CI 0.48-0.71) and the NNT was 2.9 (95% CI 2.2-4.3). Other drugs (amisulpride, amineptine and ritanserin) showed similar results in terms of absence of treatment response. Using more stringent criteria for improvement - full remission - the results were unchanged. Patients treated on TCA were more likely to report adverse events, compared with placebo. REVIEWER'S CONCLUSIONS: Drugs are effective in the treatment of dysthymia with no differences between and within class of drugs. Tricyclic antidepressants are more likely to cause adverse events and dropouts. As dysthymia is a chronic condition, there remains little information on quality of life and medium or long-term outcome.

Antidepressive Agents↗
PubMed2003

B. F. Skinner's Science and Human Behavior: its antecedents and its consequences.

Skinner's Science and Human Behavior marked a transition from a treatment of behavior that took physics as its reference science to one that emphasized behavior as a fundamental part of the subject matter of biology. The book includes what may be Skinner's earliest statement about the similarity of operant selection to Darwinian natural selection in phylogeny. Other major topics discussed in the book included multiple causation, private events, the self, and social contingencies. Among the important antecedents were Skinner's own Behavior of Organisms and Keller & Schoenfeld's Pincinples of Psychology. Current developments in education, behavioral economics, and some behavior therapies can be attributed at least in part to Skinner's seminal work. The effective behavioral analysis of governmental and religious systems will probably depend on elaborations of our understanding of verbal behavior.

Animals↗
PubMed2006

[Deficient information in developing countries: Internet alone is no solution].

Health-care personnel in developing countries have poor access to information, partly because the books are out of date and journals and Internet access are lacking, and partly because the information that is available is not appropriate for the local situation. There is too little research aimed at the problems of the Third World. This is due to a lack of interest in Western countries and because local scientists have done too little research. Internet solves the problem of access to information for health-care personnel in large hospitals and institutes, but there is still a shortage of relevant information for them as well. The editorial boards of professional journals could make a contribution by facilitating the publication of relevant research. Health-care personnel in rural areas will remain dependent upon basic books. This basic component of the provision of information should continue to receive attention. For the time being, Internet will remain inaccessible for rural health-care personnel. One of the initiatives being undertaken in order to improve the provision of information to health-care personnel in developing countries is the distribution of the 'blue trunk library' of the WHO with a selection of more than 100 basic books in every trunk. A number of journals have also taken action: the BMJ Publishing Group offers access to its journals free of charge to the 118 poorest countries and the Canadian Medical Association Journal provides free copies to libraries in developing countries. Moreover, a number ofwebsites have been started with a view to enlarging the information for health-care personnel in the Third World.

Books↗