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PubMed1999

Nursing research in Italy.

Nursing in Italy is achieving a higher academic status as a result of decades of efforts in scientific knowledge development. Beginning in the 1980s, Italian nurses, supported by researchers from allied disciplines, have begun to design and implement research at the local, regional, and national level. This study is the first effort ever made to identify the main characteristics of Italian nursing research published in Italian journals. The review covers 14 years (1983-1997). Overall, 240 studies from 11 journals, research reports from books, and several conference proceedings have been considered. Inclusion criteria were based on quality of research design, considering components such as sampling, sample size, and method of data analysis. Each article was analyzed according to an interpretive scheme focusing on method of analysis, scientific merit, and authorship. Of the 240 studies reviewed, journal articles selected from ten Italian journals accounted for 175 (73%), or the majority, of reviewed sources. Sixty-five (26%) research reports complete the remaining number. The major areas of research identified include nursing practice (43%), nursing education (6%), nursing administration and professional issues (34%), and knowledge and perceptions in society and nursing (17%). The majority of the research studies utilized survey models (47%), including several retrospective and longitudinal studies, followed by exploratory or descriptive (36%) and quasi-experimental (17%) designs. Many reports failed to identify the method of sampling used in the research design. However, of those that did, convenience samples were most often used. Random sampling was rarely reported. The majority of studies employed only descriptive statistics (i.e., frequency distribution, central tendency, variability, contingency tables, and correlation). Only few studies made use of advanced statistics for testing hypotheses (parametric and non-parametric tests) among which only a low percentage cited reliability testing. In 42% of the studies, the authors were represented by a group of nurses. Nurses and physicians worked together to author another 30% of the studies. The remaining studies were authored by either individual nurses (24%) or nurses and nonmedical professionals (4%). Much of the reviewed research has been carried out by nurses who have little or no research training.

Humans↗
PubMed1985

Introduction to clinical electrophysiologic studies.

Clinical electrophysiology is an evolving field of increasing complexity. Electrophysiologic testing is an invasive technique requiring proper patient selection, appropriately trained personnel, as well as suitable facilities and equipment for its optimal application. This introductory chapter has addressed several aspects of clinical electrophysiologic studies. The present and evolving status of clinical electrophysiology in the management of patients with rhythm and conduction disorders is reviewed in further detail in subsequent chapters of this book.

Arrhythmias, Cardiac↗
PubMed2005

Vitamin K for upper gastrointestinal bleeding in patients with liver diseases.

BACKGROUND: Upper gastrointestinal bleeding is one of the most frequent causes of morbidity and mortality in the course of liver cirrhosis. Several treatments are used for upper gastrointestinal bleeding in patients with liver diseases. However, supplementary interventions are often used as well. One of them is vitamin K administration, but it is unknown whether it benefits or harms patients with liver disease and upper gastrointestinal bleeding. OBJECTIVES: To assess the beneficial and harmful effects of vitamin K for patients with liver disease and upper gastrointestinal bleeding. SEARCH STRATEGY: We searched The Cochrane Hepato-Biliary Group Controlled Trials Register (February 2004), which comprises references identified from comprehensive electronic database searches and handsearching of relevant journals and abstract books of conference proceedings, The Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library (Issue 1, 2004), MEDLINE (1966 to March 2004), EMBASE (1988 to March 2004), and LILACS (1982 to March 2004). Additional randomised trials were sought from the reference lists of the trials found and reviews identified by the electronic searches. SELECTION CRITERIA: We intended to include randomised clinical trials. DATA COLLECTION AND ANALYSIS: We intended to summarise data by standard Cochrane Collaboration methodologies. MAIN RESULTS: We could not find any randomised trials on vitamin K for upper gastrointestinal bleeding in patients with liver diseases. AUTHORS' CONCLUSIONS: We were unable to identify randomised trials on the safety and efficacy of vitamin K for upper gastrointestinal bleeding in patients with liver diseases. The effects of vitamin K need to be tested in randomised clinical trials.

Antifibrinolytic Agents↗
PubMed1992

Industry as a metabolic activity.

The concept of "industrial economic metabolism" can provide a bridge to better understanding between environmentalists and industry. In nature each individual or species reacts to natural stimuli, competing with others for resources, extending its domain until it loses comparative advantage and comes to equilibrium with an adjacent competitor. Those species that succeed over time flourish; those that do not, diminish or disappear. Nature's rule book has no moral or ethical ingredient beyond self-interest. Corporate metabolisms are remarkably similar to those of nature. They too react to stimuli, collect and use resources, and grow or perish based on how effectively they compete. Corporate management recognizes and responds naturally and efficiently to cost and price signals. Through them it selects resources and converts them into useful products. The efficiency with which this is done is measured by profit, the lifeblood of the corporation and its means of growth. Profit thus provides a discipline on corporate behavior, encouraging efficient performers, and, by its absence, weeding out others. Unfettered by influences other than economics, the path to corporate success is unlikely to be a compassionate one. The dilemma of the manager is that to do what is socially "right" often conflicts with what must be done to survive and prosper. Fortunately, corporations' behavior can be altered by society when their purely economic role comes into conflict with other human values. The environment and the economy are not separate systems but intertwined to form a complex natural and social setting. The human-designed economic system depends on natural resource inputs, and in turn its metabolic wastes can overload the ecological system, threatening the long-term survivability of both. Increasing concern for the environment now gives the farsighted manager new latitude. There are competitive benefits in some pollution prevention. But there are not sufficiently strong forces to correct all current ills. In addition, we must harness the metabolism of the industrial world to the realities of the natural one by recognizing the immense value of depletable natural resources and ecosystems. Considering these resources as "cheap" or "free" encourages their overuse. What is needed are adjustments that price these resources at their true longterm value. Corporations will respond naturally, quickly, and efficiently to such signals. If we can send our metabolic industry the economic signals it can understand, we can retrofit our human economic system to live in harmony with the natural ecosystem of which we are a part. If we do not, nature assuredly will not accommodate our failure by changing its ways.

Journal Article↗
PubMed2003

Changing patterns in the management and outcome of breech presentation over a 7-year period. Review from a referral hospital in Saudi Arabia.

A retrospective study that was conducted on 755 singleton breech deliveries over a 7-year period between January 1994 and December 2000 at a referral hospital in Saudi Arabia showed that it represented 3.35% of all deliveries. There was a statistically significant trend in caesarean section (P = 0.001) accompanied by a modest linear trend in perinatal mortality (P = 0.049). There were no statistically significant differences in the mean age, parity and birth weight when the women delivered during each year were compared (P > 0.05), but there were statistically significant differences in the gestation at delivery (P < 0.05). Furthermore, statistically significant differences were found in the trends of the preterm breech deliveries and booking status over the period of study (P > 0.05). However, there was no statistically significant linear trend in the birth trauma (P > 0.05). Nineteen cases of the fetal birth trauma (67.8%) were associated with vaginal breech delivery while nine cases (32.2%) were reported from caesarean section. This was statistically significant (P = 0.00074). The role of selective external cephalic version as a way of reducing the caesarean section rate and also trauma during vaginal breech delivery at term in our community is discussed.

Adult↗
PubMed1992

Care of the pregnant asthmatic.

Treatment of asthma in the pregnant female poses a dilemma for the physician who must select medications that will effectively suppress maternal bronchospasm but that will not jeopardize the fetus. To compound the practitioner's problem, the inability to perform human studies with asthma drugs has led the pharmaceutical companies to formally list precautions against the use of antiasthmatic drugs during pregnancy in the Physician's Desk Reference (PDR), a book which is available to the lay public and is often introduced in medicolegal suits as the primary reference for standard of care. This article provides the clinician with the current recommended treatments that are considered acceptable during pregnancy based on the published evidence involving animal studies and the cumulative human experience that is reported in the English language medical literature.

Adult↗
PubMed1995

Maternal-fetal transfer of immunoglobulins.

OBJECTIVE: The goal of this review is to summarize the current knowledge about the transfer of immunoglobulins from the mother to the fetus. Data obtained experimentally and clinically will be discussed, and intervention trials and options will be examined. DATA SOURCE: References are limited to the English language and to human data. Sources include computerized databases and bibliographies of recent articles and books. RESULTS: Electronmicroscopic studies have unveiled the passage route of IgG through the placenta. The placental in vitro perfusion system has become a valuable experimental model, with a crucial role in the preclinical evaluation of trials to manipulate the maternal-fetal passage of immunoglobulins. CONCLUSIONS: Immunoglobulins are transferred through the placenta in an active, selective and affinity-restricted process, which is Fc-gamma receptor mediated and intracellular. Much work is still required to improve our ability to control the rate and the efficiency of this process, but the results of pioneering attempts have been encouraging.

Female↗
PubMed1998

Boron neutron capture therapy: principles and potential.

This book on the therapeutic applications of neutrons and high-LET radiations in cancer therapy would not have been complete without a review of the present situation of boron neutron capture therapy (BNCT) and a discussion of its future perspectives. BNCT is a special type of high-LET radiation therapy that attempts to achieve a selectivity at the cellular level. The rationale is to incorporate boron atoms selectively in the cancer cells and then bombard those atoms with thermal neutrons to produce a neutron capture reaction and subsequent decay that emits alpha and lithium particles. The efficiency of the technique depends upon achieving selective incorporation of the boron atoms in the cancer cells and not (or to a lesser extent) in the normal cells. The present status and future directions are described, with emphasis on boron carriers (drugs) and their delivery, as well as physical and treatment planning aspects.

Boron Neutron Capture Therapy↗
PubMed2003

Population structure of São Miguel Island, Azores: a surname study.

The knowledge of a population structure may constitute a powerful tool for mapping genes underlying susceptibility to Mendelian and complex diseases. To obtain a better understanding of the population structure of São Miguel Island (Azorean Archipelago, Portugal), we carried out a surname survey using the surnames listed in the most recent telephone book (2001). We identified 1315 different surnames in a total of 27,621 subscribers. The frequency of the different surnames was used to calculate the following parameters: isonymy (I), random component of inbreeding (FST), genetic diversity according to Fisher (alpha), migration rate according to Karlin-McGregor (v) and Nei's genetic distance. Eleven localities were selected, according to population size and geographic distribution, for analysis using the above parameters. Our results show that 51% of Salga's population and 52% of Sete Cidades's population are represented by six and eight surnames, respectively. These figures demonstrate the effective isolation of these two small places, which are located at opposite ends of São Miguel Island. Salga, Achada, and Sete Cidades present the lowest values of Fisher's alpha, indicating less genetic diversity. In contrast, the capital, Ponta Delgada, presents the highest value of alpha (78.13), indicating more genetic diversity. Our data indicate that the clustering of the localities corresponds to the geographic features of the island, where localities close together tend to share similar surnames. In conclusion, the population of São Miguel is relatively homogeneous and may constitute an ideal model for genetic mapping studies.

Azores↗
PubMed2002

Mental tools for thinking about DNA technologies in new ways.

OBJECTIVE: To investigate the nature of creative thinking in biomedical science with specific applications to molecular pathologies and DNA technologies. DATA SOURCES: Accounts of breakthroughs and inventions contained in autobiographies, biographies, interviews, and archival sources. STUDY SELECTION: Discoveries that have altered, or may yet alter, basic textbook accounts of biomedical sciences for which appropriate data sources exist. DATA EXTRACTION: Approximately 1000 data sources were analyzed, both within appropriate sciences and in other creative fields, such as the arts. DATA SYNTHESIS: The current analysis is based on a framework described in our previous book, Sparks of Genius, which outlines a general approach to understanding creative thinking. CONCLUSIONS: Creative thinking in all disciplines depends on a common mental "toolkit" that consists of 13 fundamental tools: observing, imaging, abstracting, pattern recognition, pattern forming, analogizing, body thinking, empathizing, dimensional thinking, modeling, playing, transforming, and synthesizing. Scientists recognize and solve problems by observing data that break the patterns established by theories; exploring a system by creating an abstract model with which they can play; and transforming data into feelings, sounds, and other forms that create surprising analogies to already-understood principles. The result of such personal thinking is knowledge combined with sensation and emotion--feeling and understanding synthesized into complete awareness. We illustrate some of these modes of thinking with reference to recent breakthroughs in DNA-related areas and suggest ways in which the use of "tools for thinking" can increase the probability of making further discoveries in the biomedical sciences.

Biotechnology↗
PubMed1977

Antibiotic prophylaxis in high-risk obstetrics.

Unregistered patients, who subsequently had cesarian section for obstetric indications, were placed on prophylactic chloramphenicol in doses of 2-6 gm a day. These were matched with an equal number of randomly selected, similarly unbooked patients not receiving prophylactic antibiotics. These groups were given a fever work-up when sepsis manifested even in those previously on antibiotic therapy.Results showed little or no significant difference in the two groups when length of hospitalization and cost of care were compared. During the period of the study, a sample of booked patients, who subsequently had cesarian section, were also compared. Highly significant differences were noted. In Nigeria, a more rational approach to this group of significantly high-risk patients is advocated. A review of current practices in obstetrics is discussed.

Anti-Bacterial Agents↗
PubMed1979

The problem-oriented system and record keeping in the behavioral therapies.

The Problem-Oriented System (POS) provides systematic guidelines for health care record keeping. Behavioral therapy records share, with health care records in general a quality of inadequacy for contemporary needs. Likewise, behavior therapy training shares with other health care training inadequate attention to record-keeping. This conclusion arises from a search of recent journals and books concerned with behavior therapy issues. This article reviews the POS and proposes that is guidelines and advantages are suited for incorporation into behavioral therapy training. The expected result of such training should be records more amenable to audit or review for such purposes as third party payment, supervision, and peer review. Research is needed to help select the record-keeping training methods that would best meet these contemporary needs for increased quality in the documentation of health care provision.

Ambulatory Care↗
PubMed2005

Boron neutron capture therapy for glioblastoma multiforme.

AIM: Glioblastoma multiforme (GBM) is an incurable disease that can only be managed in a palliative way. The GBM accounts for approximately half of all newly diagnosed primary brain tumors with an incidence of 2-3 cases per 100,000 people each year. Surgery and radiation are the standard options for palliation, and whether there is a place for chemotherapy is still discussed. Boron neutron capture therapy (BNCT) is a promising and possibly curative method of treating GBM. The purpose of this article is to provide an updated review on the current management and future possibilities of treating GBM with BNCT. METHOD: Use was made of computerized searches and of checking cross-references of articles and book chapters. RESULTS: The principle of BNCT uses the high ability of 10B to capture thermal neutrons and to disintegrate immediately into a He nucleus (alpha-particle) and a Li nucleus. To reach a sufficient concentration of 10B in the malignant cells compared to the surrounding healthy tissue, 10B-carriers must be highly tumor-selective. At present, the 10B carriers boronophenylalanine (BPA) and sodium borocaptate (BSH) are used in clinical trials to perform BNCT. CONCLUSION: The BNCT is a promising and possibly curative method of treating GBM, but at present this procedure is far from perfect. Because of the lack of selectivity of the boron carriers, it appears so far that radiation toxicity limits the radiation dose, so that tumor damage is modest. Current investigations and developments are aimed at targeting the boron carriers to the tumor, in order to limit the damage to the healthy, surrounding tissue.

Boron Neutron Capture Therapy↗
PubMed1996

Veterinary practice and occupational health. An epidemiological study of several professional groups of Dutch veterinarians. II. Peak expiratory flow variability, dust and endotoxin measurements, use of respiratory protection devices, and time distribution of professional activities.

Dust and endotoxin exposure was measured in the Spring and Autumn in 96 veterinary practitioners, subdivided in four professional groups ((predominantly working with either swine, cattle, poultry, or companion animals). Furthermore, peak expiratory flow (PEF) variability was measured four times a day over a week in Spring and Autumn in order to detect occupation-related respiratory disorders. The participants kept a log book in which they recorded their activities during these periods. Practitioners working with swine, cattle, or poultry had a significantly higher exposure to dust (+/- 5 times) and endotoxin (+/- 10 times) than companion animal practitioners. PEF variability measurements gave no indications for an increased prevalence of bronchial hyperreactivity related to occupational activities. Respiratory protective devices (RPD) were used selectively. Only a small proportion of the practitioners used them at any time when entering a animal confinement building. Swine and cattle practitioners worked for approximately 3.6 hours per day in animal buildings, whereas poultry practitioners worked in the environment of poultry buildings for approximately 2.8 hours per day.

Animals↗
PubMed1978

A survey of parent training manuals.

Twenty-six commercially available parent training manuals were surveyed with the goal of providing helpful information to the professional for selection of manuals. Included were manuals for parents as well as manuals for professionals for use in conducting individual or group treatment. The following information was given for all manuals: the characteristics of the target populations for whom the manuals were intended, readability levels, use made of technical language, provision of glossary, organization and format of the book, availability of supplementary materials such as leaders' guides, and references to reviews by other authors. In an additional section, the research literature dealing with evaluation of these manuals was reviewed and summarized as a means of acquainting the reader with the available scientific information on their effectiveness. A report on the status of each manual in terms of evaluation was provided in tabular form. The evaluation of manuals by conduct of empirical research to determine their usefulness to the consumer was emphasized.

Journal Article↗
PubMed2001

[National socialist "children's euthanasia" program in the province of Westphalia (1940-1945)].

As part of the organization structure of the "Reich committee for scientifically registering genetic and inherent serious illnesses" "childrens' special wards" were established in the province Westphalia in the child-psychiatry St. Johannesstift in Niedermarsberg (end of 1940), and then in the Provinzialheilanstalt Aplerbeck (end of 1941). The establishment thereof and personnel recruiting were done in close operation with provincial authorities. In Niedermarsberg external nurses were also employed. When the activities in the Marsberger ward became public despite efforts to keep them secret, the provincial association felt forced to establish a replacement ward in Dortmund-Aplerbeck. This ward was integrated stronger into the hospital-internal and regional care structures regarding personnel and institutional aspects than the previous ward. The actions of "child euthanasia" were based on a combination of hierarchical decision-making structures, limited responsibility, and scientific justification. The people performing these activities were provided action options withdrawal possibilities. For the affected parents the events were shifted into a psychological grey area which did not force decisions in principle. The internal conditions of the "childrens' special wards", the procedures and the "treatments" of the children were clearly regulated; the "euthanasia" activities themselves can be comprehended only in fragments from testimonies. By analyzing the reception books in connection with the medical files it is possible to make statements regarding the number of deaths, the death rate and cause, and also several social characteristics of the children. The fate of the children in the Westphalian "childrens' special wards" shows that the work in these regional "Reich committee wards" was limited to caring, observing, selecting and killing. The attempts of scientific justification are exposed as cover-ups.

Child↗
PubMed1994

Feminism's healing effect.

Helen Bequaert Holmes and Laura M. Purdy have done medical ethicists and clinical practitioners an enormous favor by publishing in book form their edited collection of 21 essays, Feminist Perspectives in Medical Ethics. This is an anthology of articles applying feminist methods and theories to problems in medical ethics. It is a fitting initiation for healthcare professionals and theorists who have yet to introduce themselves to the methods, analyses, and diverse contributions of feminism. In one simple volume, readers can sample feminist contributions to medical ethics that otherwise would be scattered in books or journals unavailable in most medical libraries.

Aged↗
PubMed2004

Publication, citations, and impact factors of leading investigators in critical care medicine.

INTRODUCTION: Critical care medicine research is reported in major medical journals that can be accessed via computerized search engines such as PubMed (National Library of Medicine) or Web of Science (Thomson ISI [Institute for Scientific Information]). The crediting of report citations to specific journals or individuals is a rapidly developing and highly controversial evaluative process. METHODS: We conducted a citation analysis to measure the research and publication accomplishments of critical care medicine investigators, by tallying their numbers of published reports and numbers of citations to their reports. Major investigators were identified from the author indexes of major critical care medicine publications. From the Web of Science the number of publications and citations of their works were determined for 224 investigators for the period 1997 through August 2003. We calculated the individual researcher's "impact factor" by dividing the number of citations (made by other researchers to a given researcher's reports) by the number of articles that researcher had published. To estimate which countries are producing the most research on mechanical ventilation, we studied the abstract books from the 2001, 2002, and 2003 American Thoracic Society annual international conferences and tallied the number of posters (pertaining to mechanical ventilation) from the various countries. We then calculated a "country factor" as the number of posters per million population of the source country. RESULTS: We considered 44, 576 citations in 3,755 publications. Using criteria selected to recognize original works, J L Vincent published the greatest number of reports (129). M A Matthay received the most citations (2,056). G U Meduri had the highest impact factor (25.32). There was a balance between the number of leading investigators from Europe and North America. Relative to its population size, Canada warrants leadership acknowledgement in critical care medicine, considering its number of leading investigators and poster presentations. CONCLUSIONS: From criteria selected to attribute original work to specific authors we identified 20 leading critical care medicine investigators, as measured by number of publications, citations, and impact factors. We also report a country factor based on posters (on mechanical ventilation) presented at the 2001-2003 international conferences of the American Thoracic Society.

Authorship↗