bluuebunny/crossref_metadata_2025 huggingface dataset:
Parental Participation in the Care of Hospitalized Children
Authors: Kristensson‐Hallström Inger , Elander Gunnel
Published: March 2013

The purpose of this study was to investigate those parts of the care of hospitalized children that their parents perform, the nursing tasks the parents themselves felt they could manage and whether parents' and staff members' opinions coincided. A questionnaire was given to parents of children between one week and five years of age who were hospitalized at a pediatric surgical department during a 6‐week period (n = 40), a similar questionnaire being distributed to all the staff (n = 44). The results indicate that parents stay with their children during hospitalization and that they take responsibility for their children's basic care and needs. Parents and staff members believed that parents might be able to take on a greater share of caring activities if they were given instruction and support, though there was disagreement as to which nursing tasks are appropriate for parents to take on.
Stroke Patients in Long‐Term Care
Authors: Nydevik Ingegerd , Eller Berit
Published: March 2013

The closest relatives of 29 permanently institutionalized stroke patients were interviewed about their relationship to the patient before and after stroke, the functional ability of the patient before and after stroke, and their opinion of an appropriate care setting for the patient. The patients had all been independent before stroke, but were now dependent on help with most primary activities of daily living. Twelve patients had severe communicative difficulties. Most relatives could not suggest a realistic alternative to nursing home care, due to the patients' severe disabilities and extensive need for care. One patient was, however, later discharged to a sheltered living facility in accordance with her relative's wishes. One‐third of the relatives expressed need for more information and support and wanted to take part in a support group. The nursing staff need high competency in providing good care for the patients and offering psychological support to the relatives, and should include the relatives in the overall treatment plan.
Ability to Solve Problems, Professionalism, Management, Empathy, and Working Capacity in Occupational Therapy
Authors: Gullberg Mats T. , Olsson Henny M. , Alenfelt Gunilla , Ivarsson Ann‐Britt , Nilsson Margareta
Published: March 2013

The majority of occupational therapists in Sweden previously worked on large occupational therapy wards. Health care policy has changed over the years and the system has been reorganized accordingly. The employment situation for occupational therapists has also changed. This paper focuses on the perception of professional self among occupational therapists. The objective was to explore the professional self and to suggest components important to the occupational therapist profession. The Professional Self Description Form (PSDF) was used for the exploration of self. The 19 items in the PSDF cover areas relevant to professional functioning and activity. Sixty‐eight employed occupational therapists participated. The results of the PSDF were subjected to factor analysis and five factors were obtained; Ability to solve problems, Professionalism, Management, Empathy, and Working capacity. We believe that these five factors can function as improving domains of the role of the professional occupational therapist in Sweden.
Quality of Care
Authors: Wilde Bodil , Larsson Gerry , Larsson Mayethel , Starrin Bengt
Published: March 2013

In a previous study (Wilde et al. 1993), we developed a model of quality of care from a patient perspective using a grounded theory approach. The aim of the present study was to derive an instrument from this model. A questionnaire, Quality from Patients' Perspective (QPP), was developed which consisted of 56 items. Each item was evaluated in two ways by the respondent; assessment of perceived reality and evaluation of subjective importance (Likert scales). A personal quality of care index was computed on the basis of the relationship between these two scores. The QPP was tested on two samples, patients with infectious diseases (n = 147, mean age: 60 years) and nursing students (n = 103, mean age; 27 years). Patient's scores were factor analysed (principal factoring with oblique rotation) and 17 factors were extracted. Subgroups of patients were compared and correlations were computed between factor scores and self‐rated health and well‐being. Students also responded to a short form of the QPP (41 items) and personality scales. Correlations between these sets of variables were computed. The QPP was discussed in relation to existing scales.
Nursing at Dawn
Authors: Bauer Irmgard
Published: March 2013

Nurses' working hours are known to be one reason for high wastage rates. The early start of work seems to be particularly difficult. The aim of the present study was to examine which nursing tasks were performed during the time from 6:00 to 7:00 a.m. The study was conducted in a general hospital in Germany where such an early start of work is still common practice. An activity analysis was carried out using non‐participant observation. One surgical and one medical ward were used for comparison. The work on the wards was differently organized. The observed tasks were classified into direct care, indirect care, administrative, and other tasks. The distribution of these task categories over one hour and the percentage of time spent on these categories were compared. Both wards showed different working patterns and a different form of initiation of direct care (entering patients' rooms). Some possible reasons for these findings are offered and suggestions for further research are made.
Some Aspects of Colour Perception Among Patients with Alzheimer's Disease
Authors: Wijk Helle , Sivik Lars
Published: March 2013

The proportion of elderly people in western societies is on the increase. At the same time, demands are being heard for improvements in the quality of health care, including the design of the physical environment. The aim of this study was to call attention to some aspects of colour and the possibilities of using it as an orientational aid for institutionalized demented patients and thereby enhance the quality of their care. A pilot study was carried out to establish whether patients with Alzheimer's disease are different from non‐demented patients regarding certain aspects of colour perception. Twelve hospitalized patients with Alzheimer's disease were compared with a matched control group of non‐demented patients regarding colour naming, colour discrimination and colour preference. No significant differences were found between the groups. In an additional experiment to test short‐term memory it was found that the patients with Alzheimer's disease gained substantial help from colour cues. It is concluded that colour should be taken into account in the designing of the health care environment, particularly geriatric wards.
Acceptance of Ostomy Surgery
Authors: Nordström Gun , Lützén Kim
Published: March 2013

The main purpose of this pilot study was instrument development, focused on personal adjustment following ostomy surgery. Two instruments were used: a translated and revised version of the Acceptance of Disability Scale, Modified (ADM), and Antonovsky's Sense of Coherence (SOC) questionnaire. A sample of 26 patients enrolled consecutively at the Ostomy Care Centre at a Swedish hospital were included in the study. A Cronbach's coefficient alpha of 0.95 was obtained for the ADM Scale, Swedish version, which is consistent with the results of similar studies. A significant difference between the ADM scores and type of ostomy surgery indicated that persons with a continent ostomy had a greater acceptance of ostomy surgery than had subjects with conventional ostomy surgery. A close correlation between ADM and SOC was obtained, indicating that persons who accept ostomy surgery will also have a good sense of coherence. The result of this pilot study indicates that further research using both measures may be useful in order to identify which factors are of relevance for nursing practice.
Challenges of Nurses' Professional Behaviour Change Process
Authors: Lima‐Basto Marta
Published: March 2013

The aim of the study was to complement a project consisting of a planned modification of nurses' professional activities, which showed that nurses did not adopt a problem‐solving approach to care after a specific in‐service training. The aim of the study was to gain a better understanding of the ‘meanings’ that a group of nurses assigned to daily work, and how they perceived the changed situation. The main findings were that the nurses felt they had a limited degree of control over nursing care, a dependence on physicians, and consequently, used defensive strategies. The meaning assigned to nursing care was thus a series of pre‐determined routines, though the nurses wished to increase the extent of interaction with patients. The study highlights the conflict between professional values and work values, as well as the gap between ‘espoused theories’ and ‘theories in use’. It is suggested that the process of change with regard to the nurses' professional behaviour, at unit level, is mediated by intrapersonal as well as by interpersonal factors such as the nurse's role and the nurse‐physician relationship.
Moral Sensitivity in Nursing Practice
Authors: Lützén Kim , Nordström Gun , Evertzon Mats
Published: March 2013

This study reports results of an inquiry into ethical decision making in nursing, focusing on moral sensitivity. The Moral Sensitivity Questionnaire (MSQ), an instrument constructed to measure moral sensitivity in nursing practice was used. The main dimensions of this questionnaire are; interpersonal orientation, structuring moral meaning, benevolence, modifying autonomy, experiencing moral conflict, and trust in medical knowledge and principles of care. The questionnaires were distributed to a total of 419 nurses and completed by 145 nurses employed in psychiatric settings and 150 nurses employed in medical‐surgical nursing areas. The results show significant differences in the two groups and differences concerning age, length of experience and previous education as mental health care workers.
Support of the Experience of Health in Lucid Elderly Nursing Home Patients
Authors: Nyström Anne E. M. , Segesten Kerstin M.
Published: March 2013

As peace of mind has been reported by elderly nursing home patients to be an important aspect of health, registered nurses were asked how they could support the attainment of this state of mind in elderly, lucid patients. Four aspects of nursing support were found: support through instrumental activities, through daily coexistence, through genuine encounters and through empowering supportive interventions. Included in professional nursing was not only the responsibility for all nursing performed in the ward, but also the empowering support, health education (support to acquire a realistic picture of the situation) and support in dealing with situations at hand. It was concluded that these functions in nursing home care needed further attention and research.
The Use of the Modified Norton Scale in Nursing‐Home Patients
Authors: Berglund Britta , Nordström Gun
Published: March 2013

Patients in three nursing‐home wards in Sweden were in 1991 assessed by the Modified Norton Scale (MNS). Of the 71 patients, 38 (49%) were considered to be at risk of developing pressure sores. Six of the patients had a total of eight pressure sores. Five sores were assessed as stage II, two sores as stage III and one sore as stage IV. Only two of the six patients with pressure sores had any preventive equipment in their beds. The nursing and medical documentation of the existing pressure sores was not satisfactory. Individual programs for skin care and routine assessment with a pressure sore prediction instrument, such as the MNS, would serve the dual purpose of directing the relevant measures to the patient groups at the greatest risk and would aid in assessing the efficacy of pressure sore treatment strategies.
The Dialectic in Becoming a Mother: Experiencing a Postpartum Phenomenon
Authors: Sethi Sarla
Published: March 2013

In this study of the phenomenon of the postpartum period grounded theory methodology was used to investigate the experiences of first‐time mothers during the first three months following their deliveries. The sample consisted of 12 primipara women and 3 multipara women. The data were generated by using unstructured interviews and field notes. Each woman was interviewed twice, the first time between 2 and 3 weeks postpartum, and the second time between 10 and 12 weeks postpartum. The final data for analysis consisted of: data generated through interviews, field notes, and the narratives of four mothers found in the non‐fiction literature. Constant comparative analysis resulted in the generation of four categories and corresponding subcategories. These were: (1) Giving of Self; (2) Redefining Self; (3) Redefining Relationships; and (4) Redefining Professional Goals. The categories were not mutually exclusive. All the categories converged to provide support for the core variable ‘Dialectic in Becoming a Mother’. The dialectic perspective demonstrated that, in becoming mothers, the women experienced transition, contradictions, tensions and transformations. A theoretical model was developed to show relationships among these major concepts. The findings of this study will be useful in effecting change in the provision of care to postpartum women and their families.
Some Characteristics of the Quality of Life in Old Age Illustrated by Means of Allardt's Concept
Authors: Nilsson Margareta , Ekman Sirkka‐Liisa , Ericsson Kjerstin , Winblad Bengt
Published: March 2013

This study illustrates some characteristics of the quality of life in old age when ageing is seen as a continued human development. In the Kungsholmen Project 87 healthy elderly persons were asked about the quality of their lives. Allardt's definition of quality of life was used as the conceptual framework for the content analysis. The findings indicate that the dimensions of loving and being, as Allardt describes them, take on a different meaning and the material things in the having dimension become less important. The differences point to another meaning of the quality of life in old age. The emphasis is on health and independence, contentment and a peaceful life, personal integrity in terms of a moral and a caring attitude. The findings tend to be in accordance with the successful ageing as described in Erikson's theory of psychosocial development and in Tornstam's theory of gerotranscendence. To gain a deeper understanding of this complex phenomenon, qualitative methods which go beyond definitions are required.
Nursing‐Care Dependency
Authors: Dijkstra Ate , Buist Girbe , Dassen Theo
Published: March 2013

This article describing the first phase in the development of an assessment scale of nursing‐care dependency (NCD) for Dutch demented and mentally handicapped patients focuses on the background to the study and the content validation of the nursing‐care dependency scale. The scale aims to characterize the patients' nursing‐care dependency as part of the assessment step in the nursing process, and is based on Henderson's 14 human needs. The Delphi technique, using two panels of experts (n = 44), was applied to reach consensus on significant indicators of nursing‐care dependency. The experts' reasoning was used to develop criteria for the assessment of nursing‐care dependency. Ultimately, the Delphi rounds generated 15 NCD items with their descriptions and item criteria. There was no fundamental difference between the NCD scales for demented and mentally handicapped patients. Nevertheless, there are two versions of the NCD scale because of the need to apply specific concepts in the nursing care of either population. The original Dutch version of the NCD scale is also available in English and in Norwegian.
Young Adults' Views on Dental Care—A Qualitative Analysis
Authors: Johansson Gunvi , Fridlund Bengt
Published: March 2013

The aim of the present study was to determine young adults' views on dental care. The gathered data were gleaned from interviews and analysed in accordance with comparative method. It was possible to discern the views from two perspectives: the patients' opinions regarding costs in relation to given functions within dental care, and the attitudes to given functions in dental care per se. Costs for information and service were deemed questionable, whereas the costs for examination and treatment were accepted. The patients' stance was active with respect to information and treatment, whereas a greater degree of passivity prevailed within the areas of examination and service. According to this report, maintaining cheap dental care rates was deemed important. The patients questioned having to pay for information perceived as irrelevant to dental care. They expressed a hidden wish to assume an active role while being given more information, and to exercise greater influence with reference to own dental care, but were not in the habit of stating their views to dental staff. Thus, continuous patient satisfaction studies are vital in order to meet this group's needs. One suggestion for further research is to study how young adults regard dental care based on the theory presented.
Different Paradigms in a New Research Domain
Authors: Heyman Ingrid
Published: March 2013

The aim of this study was to examine doctoral theses written by nurses on the same subject, namely diabetes. The five theses were published during three years. The text analysis emphasized the purposes, theoretical framing, methods for collection and analyzing the data, ways of presenting the texts and, finally, the references in the five theses. The findings indicate that the authors make use of different paradigms. Experimental approach was used in some theses and one thesis was based on grounded theory. Two theses could be said to be more concise than the others because they made use of only one technique each—physiological measurements and an open‐ended interview. The remainder used of a number of methods—in other words, they were eclectic in approach. The conclusion is that there is a freedom for nurse researcher to affiliate to different scientific traditions inside academia—the two in question here are biomedical research and interpretative traditions inside social science. The author encourage all researchers inside the nursing domain to subject herself to criticism and reflection to the same extent as she analyzes other people or phenomena in order to increase the epistemological awareness of the use of research tools, perspectives and theories.
Disentangling the role of connectivity, environmental filtering, and spatial structure on metacommunity dynamics
Authors: Moritz C. , Meynard C. N. , Devictor V. , Guizien K. , Labrune C. , Guarini J.‐M. , Mouquet N.
Published: March 2013

Dispersal is a key process in metacommunity dynamics, allowing the maintenance of diversity in complex community networks. Geographic distance is usually used as a surrogate for connectivity implying that communities that are closely located are considered more prone to exchange individuals than distant communities. However, in some natural systems, organisms may be subjected to directional dispersal (air or water flows, particular landscape configuration), possibly leading close communities to be isolated from each other and distant communities to be connected. Using geographic distance as a proxy for realised connectivity may then yield misleading results regarding the role of dispersal in structuring communities in such systems. Here, we quantified the relative importance of flow connectivity, geographic distance, and environmental gradients to explain polychaete metacommunity structure along the coasts of the Gulf of Lions (northwest Mediterranean Sea). Flow connectivity was estimated by Lagrangian particle dispersal simulations. Our results revealed that this metacommunity is strongly structured by the environment at large spatial scales, and that both flow connectivity and geographic distance play an important role within homogeneous environments at smaller spatial scales. We thus strongly advocate for a wider use of connectivity measures, in addition to geographic distance, to study spatial patterns of biological diversity (e.g. distance decay) and to infer the processes behind these patterns at different spatial scales.

Synthesis

Everything is connected, but connections are seldom accurately quantified. Biological communities are often studied separately, using observations, experiments and models to unravel local dynamics of organisms interacting with each other. However, regional processes such as dispersal through ocean and air circulation, likely to connect distant communities and influence their local dynamics, are not always accounted for, or, at best, used as an homogeneous and distance‐related factor. Ocean models have being extensively developed and validated during the past decades with the increasing availability of accurate meteorological data. Using such model outputs, precise quantifi cation of exchange rates of organisms between communities was performed in a marine Mediterranean coastal area. Jointly with local environmental and biological data, these results were used to quantify the effects of realistic connectivity on local and regional polychaete community structure, and revealed that the environmental gradient, geographic distance, and connectivity were responsible for community structure at different spatial scales.
The Influence of Neighbors' Family Size Preference on Progression to High Parity Births in Rural Nepal
Authors: Jennings Elyse A. , Barber Jennifer S.
Published: March 2013

Large families can have a negative impact on the health and well‐being of women, children, and their communities. Seventy‐three percent of the individuals in our rural Nepalese sample report that two children is their ideal number, yet about half of the married women continue childbearing after their second child. Using longitudinal data from the Chitwan Valley Family Study, we explore the influence of women's and neighbors' family size preferences on women's progression to high parity births, comparing this influence across two cohorts. We find that neighbors' family size preferences influence women's fertility, that older cohorts of women are more influenced by their neighbors' preferences than are younger cohorts of women, and that the influence of neighbors' preferences is independent of women's own preferences.
Development of ZnO Nanostructured Films via Sodium Chloride Solution and Investigation of Its Growth Mechanism and Optical Properties
Authors: Wee R. Q. , Yang W. F. , Zhou T. J. , Chen R. , Sun H. D. , Wang C. F. , Lee Alex Y. S. , Gong H.
Published: March 2013

The controllable formation of zinc oxide (ZnO) nanostructures and nanowires by a cheap and environmental friendly fabrication method of simply subjecting metallic zinc films in sodium chloride (NaCl) solution at 170°C from 3 to 15 h under hydrothermal conditions is demonstrated in this study. Scanning electron microscopy (SEM) and X‐ray diffraction (XRD) indicate that ZnO films with different morphologies are obtained: from a film with network of circular pores to a film with nanowire‐like network with bigger pores. It is observed that heating duration has an effect on its photoluminescence (PL) properties. Ultraviolet emission is observed for all ZnO films. Green emission surfaces after heating for 6 h, which subsequently disappears after 15 h of heating. It is suggested that the morphology change over different heating durations is responsible for the rise and subsequent decline in green emissions. Lastly, the growth mechanism behind zinc oxidation and morphology change is proposed and investigated with the aid of experimental method. It is verified that pitting corrosion is responsible for the growth mechanism here.
ZrB2–SiC Nano‐Powder Mixture Prepared Using ZrSi2 and Modified Spark Plasma Sintering
Authors: Lee Sea‐Hoon , Choi Si‐Young , Kim Hai‐Doo
Published: March 2013

ZrB2–SiC nano‐powder mixture was synthesized using ZrSi2 source material and a modified spark plasma sintering apparatus. The particle size of ZrB2 and SiC was about 80 and 20 nm, respectively. The molecular‐level homogeneity of Zr/Si source and fast heating/cooling rate by SPS caused the formation of homogeneously intermixed nano‐powders. A strong exothermal reaction occurred at around 860°C, which caused strong agglomeration and growth of the synthesized powder mixture. The rapid reaction could be controlled by adding 20 wt% of NaCl, which acted as an inert filler.
Large Piezoresponse and Ferroelectric Properties of (Bi0.5Na0.5)TiO3–(Bi0.5K0.5)TiO3–Bi(Mg0.5Ti0.5)O3 Thin Films Prepared by Chemical Solution Deposition
Authors: Jeon Yu Hong , Patterson Eric A. , Cann David P. , Mardilovich Peter , Stickel William , Gibbons Brady J.
Published: March 2013

Bulk ceramic 72.5 mol%(Bi0.5Na0.5)TiO3–22.5 mol%(Bi0.5K0.5)TiO3–5 mol%Bi(Mg0.5Ti0.5)O3 (BNT–BKT–BMgT) has previously been reported to show a large high‐field piezoelectric coefficient (d33* = 570 pm/V). In this work, the same composition was synthesized in thin film embodiments on platinized silicon substrates via chemical solution deposition. Overdoping of volatile cations in the precursor solutions was necessary to achieve phase‐pure perovskite. An annealing temperature of 700°C resulted in good ferroelectric properties (Pmax = 52 μC/cm2 and Pr = 12 μC/cm2). Quantitative compositional analysis of films annealed at 650°C and 700°C indicated that near ideal atomic ratios were achieved. Compositional fluctuations observed through the film thickness were in good agreement with the existence of voids formed between successive spin‐cast layers, as observed with electron microscopy. Bipolar and unipolar strain measurements were performed via double laser beam interferometry and a high effective piezoelectric coefficient (d33,f) of approximately 75 pm/V was obtained.
The phenomenon of hate crimes in the United States
Authors: Cheng Wen , Ickes William , Kenworthy Jared B.
Published: March 2013

This review examines the phenomenon of hate crimes in the United States. Findings derived from the FBI data for the period 1996–2008 revealed that the incidence of anti‐racial hate crimes varied among different racial groups, that antireligious hate crimes were committed toward Jews and Muslims more than toward others, and that antisexual orientation hate crimes focused on male homosexuals more than others. Antireligious hate crimes were more likely to be directed against property, whereas anti‐racial and antisexual orientation hate crimes were more likely to be directed against people. We discuss these findings in the light of some relevant theoretical perspectives from social psychology. Potential solutions to hate crimes could be developed by focusing on the most relevant predictive factors.
The Effect of Antiarrhythmic Medication Management on Atrial Fibrillation Ablation Outcomes
Authors: DUKES JONATHAN W. , CHILUKURI KARUNA , SCHERR DANIEL , MARINE JOSEPH E. , BERGER RONALD D. , NAZARIAN SAMAN , CHENG ALAN , SPRAGG DAVID D. , CALKINS HUGH , HENRIKSON CHARLES A.
Published: March 2013

The Effect of Antiarrhythmic Drugs Ablation Outcomes

Background

Patients commonly present for atrial fibrillation (AF) ablation while taking antiarrhythmic (AA) medications. It is unknown if AA use at the time of ablation affects procedural outcome. This study compares the AF ablation outcomes of patients who underwent ablation while on AA medications to those who were not on AA medications.

Methods and Results

A total of 180 consecutive patients who underwent their first catheter ablation of AF were identified from the Johns Hopkins Hospital AF registry and divided into 2 cohorts: those On AA at the time of ablation (127 patients, mean follow‐up 24.6 months) and those Off AA at the time of ablation (53 patients, mean follow‐up 20.3 months). Follow‐up was performed to identify recurrent AF. There was no statistically significant difference in the percentage of patients without a recurrence of symptomatic AF (single procedure success rate) in the On and Off AA groups at 6 months postablation (53.5% vs 50.1%, P = 0.75), or by the end of follow‐up (37.8% vs 41.5%, P = 0.64). For those patients who had symptomatic AF recurrence, the average time to recurrence was 6.2 ± 9.0 months in the On AA group and 4.2 ± 7.2 months in the Off AA group (P = 0.27).

Conclusions

There was no statistically significant difference in the rate of symptomatic AF recurrence between the On AA and Off AA groups in this study. The use of AA medications at the time of ablation does not appear to affect procedural outcomes in this population.
Fluctuating viability selection on morphology of cliff swallows is driven by climate
Authors: Brown C. R. , Brown M. B. , Roche E. A.
Published: March 2013

The extent to which fluctuating selection can maintain evolutionary stasis in most populations remains an unresolved question in evolutionary biology. Climate has been hypothesized to drive reversals in the direction of selection among different time periods and may also be responsible for intense episodic selection caused by rare weather events. We measured viability selection associated with morphological traits in cliff swallows (Petrochelidon pyrrhonota) in western Nebraska, USA, over a 14‐year period following a rare climatic event. We used mark‐recapture to estimate the annual apparent survival of over 26 000 individuals whose wing, tail, tarsus and bill had been measured. The fitness functions associated with tarsus length and bill dimensions fluctuated depending on annual climate conditions on the birds' breeding grounds. The oscillating yearly patterns may have slowed and occasionally reversed directional change in trait trajectories, although there was a trend over time for all traits except tarsus to increase in size. The net positive directional selection on some traits, despite periodic climate‐associated fluctuations, suggests that cliff swallow morphology in the population is likely to keep changing and supports recent work contending that selection in general does not fluctuate enough to be an effective driver of stasis.
Clinical studies of innovative medical devices: what level of evidence for hospital‐based health technology assessment?
Authors: Boudard Aurélie , Martelli Nicolas , Prognon Patrice , Pineau Judith
Published: March 2013

Rationaleaims and objectives

Like health technology assessment (HTA) agencies, hospitals are faced with requests for innovative and costly medical devices. However, local decision makers are frequently confronted with a lack of high‐quality clinical data when assessing the effectiveness of innovative medical devices. The aim of this study was to quantify the level of evidence available for innovative medical devices in the context of hospital‐based HTA.

Methods

We searched the Medline, Embase and Cochrane Library databases for articles, letters and reports relating to 32 innovative medical devices requested at our hospital between January 2008 and March 2012. All clinical studies retrieved were screened and classified according to the Sackett 5‐point level‐of‐evidence scale.

Results

We screened and classified 217 studies: 215 clinical trials and 2 cost‐effectiveness studies. Only 47 of the 215 clinical studies (22%) provided high‐level clinical evidence (levels 1–2); 33 (15%) were randomized controlled trials (RCTs). More than half of the 215 studies (52.1%) included fewer than 30 patients. Only 14 of the 47 high‐quality studies reported the amount of missing data. For implantable medical devices, 84 (71.8%) studies specified the follow‐up period and the mean follow‐up period was 18.9 months. Finally, methodological quality did not increase with the risk level of the medical device.

Conclusions

Our findings confirm that only a few studies of innovative medical devices provide high‐level clinical evidence. Nevertheless, RCT may be the ‘gold standard’ for drugs, but it is not always appropriate for medical devices. Changes to the European regulation of medical devices, with the requirement for a demonstration of clinical efficacy and safety before release onto the European market, have raised expectations.
Guideline‐based development and practice test of quality indicators for physiotherapy care in patients with neck pain
Authors: Oostendorp Rob AB , Rutten Geert M , Dommerholt Jan , Nijhuis‐van der Sanden Maria W , Harting Janneke
Published: March 2013

Rationale, aims and objectives

Little is currently known about the quality of physiotherapy care for patients with musculoskeletal pain. Neck pain was used as an example. The aim is to develop a set of quality indicators, including a practice test.

Methods

A systematic method is used to develop potential process and outcome indicators. An expert and user panel is used to appraise the potential quality indicators regarding clarity, relevancy, feasibility, acceptability and improvement potential. An invitation to participate in the practice test was sent to physiotherapy practices. The resulting algorithm is used to calculate the degree to which physiotherapists met these indicators (0–100%). Differences in valid outcomes are tested for significance (Student's t‐test; α = 0.05) and compared with established values for clinical relevance [minimal clinically important change (MCIC)].

Results

A representative set of 40 quality indicators (28 process indicators and 12 outcome indicators) is selected from 44 initial guidelines and literature‐based recommendations. The process indicators (n = 28) are classified per step of the clinical reasoning process of physiotherapy care. Of the 106 potential participants from 27 practices, 38 physiotherapists (35.8%) submitted data on 96 patients with non‐specific neck pain. On average, the participating physiotherapists showed a 55.6% adherence to process indicators with a great variation in scores per step of the clinical reasoning process. The outcomes for ‘pain’, ‘headache’ and ‘daily functioning’ were significantly better compared with baseline, and the mean differences exceeded established values for MCICs.

Conclusion

Guardedly, we can conclude that a systematic approach is a valuable means to develop a preliminary set of process and outcome indicators for physiotherapy care for patients with non‐specific neck pain, and a practice test should be an intrinsic part of such a systematic approach as it provides valuable information on the key attributes of the set indicators.
Comparative Analysis of Extended Producer Responsibility Policy in the United States and Canada
Authors: Hickle Garth T.
Published: March 2013

This article analyzes the policy choices and programmatic elements of extended producer responsibility (EPR) as implemented in the United States and Canada. The article traces the historical development of EPR in each country and defines common features of EPR in each nation. The U.S. states and the Canadian provinces have assumed the primary role, rather than the federal governments, for enacting producer responsibility requirements in their respective countries. However, the paths taken demonstrate several fundamental differences, including the prevalence of individual versus collective responsibility and the financing mechanisms implemented for EPR. Given the deepening experience with EPR and the breadth of its application to a widening array of products in the United States, the Canadian model for EPR is starting to receive more examination from policy makers in the United States, indicating that the policy and programmatic differences between the two nations may eventually be narrowing.

The comparative policy analysis is illustrated through the lens of EPR regulatory efforts for waste electronics, with particular profiles of the programs in the State of Minnesota and Province of Ontario. Both approaches broadly reflect many of the policy considerations and governance and programmatic themes that dominate EPR programs in each country.

Finally, the article offers recommendations for collaborative work between the United States and Canada to explore consistency between programs and other complementary strategies to support producer responsibility activities.
STED microscopy of living cells – new frontiers in membrane and neurobiology
Authors: Eggeling Christian , Willig Katrin I. , Barrantes Francisco J.
Published: March 2013

Recent developments in fluorescence far‐field microscopy such as STED microscopy have accomplished observation of the living cell with a spatial resolution far below the diffraction limit. Here, we briefly review the current approaches to super‐resolution optical microscopy and present the implementation of STED microscopy for novel insights into live cell mechanisms, with a focus on neurobiology and plasma membrane dynamics.
Diaper dermatitis care of newborns human breast milk or barrier cream
Authors: Gozen Duygu , Caglar Seda , Bayraktar Sema , Atici Funda
Published: March 2013

Aims and objectives

To establish the effectiveness of human breast milk and barrier cream (40% zinc oxide with cod liver oil formulation) applied for the skincare of newborns in the neonatal intensive care unit on the healing process of diaper dermatitis.

Background

Diaper dermatitis is the most common dermatological condition in newborns who are cared for in the neonatal intensive care unit. Recently, there are several kinds of complementary skincare methods suggested for newborns, such as sunflower oil, human breast milk, etc. Also, some chemical formulations are still being used in many neonatal intensive care units.

Design

Randomised controlled, prospective, experimental.

Methods

This study was carried out with a population including term and preterm newborns who developed diaper rash while being treated in the neonatal intensive care unit of a university hospital in Istanbul between February–October 2010. On completion of the research, a total of 63 newborns from human breast milk (n = 30) and barrier cream (n = 33) groups were contacted.

Results

Genders, mean gestation weeks, feeding method, antibiotic use, diaper area cleansing methods, diaper brands and prelesion scores of newborns in both groups were found to be comparable (p > 0·05). There was no statistically significant difference (p = 0.294) between the groups in terms of mean number of clinical improvement days, but postlesion score of the barrier cream group was statistically significantly lower (p = 0·002) than the human breast milk group.

Conclusion

Barrier cream delivers more effective results than treatment with human breast milk, particularly in the treatment of newborns with moderate to severe dermatitis in the result of the study.

Relevance to clinical practice

This study will shed light on nursing care of skin for newborns who are treated in neonatal intensive care unit.
CONVERTIBLE BOND PRICING MODELS
Authors: Batten Jonathan A. , Khaw Karren Lee‐Hwei , Young Martin R.
Published: March 2013

Convertible bonds are an important segment of the corporate bond market, with worldwide outstandings approaching US$235 billion. Simple pricing models value a convertible bond as being equivalent to a straight bond with an embedded option that enables the bond holder to convert to a specific amount of common stock. The straight bond is subject to both interest rate and credit risk, whereas the option to convert is dependent on the underlying stock price, which exposes the convertible bond holder to equity risk. The complexity of these features means that convertible bonds tend to be treated casually in major derivatives and corporate finance textbooks. This paper presents a survey of the theoretical and empirical aspects of convertible bond pricing. The limitations of these studies are highlighted to identify those areas of research that may improve the valuation process and facilitate the application of these securities for corporate financing.
International Stock Return Predictability: What Is the Role of the United States?
Authors: RAPACH DAVID E. , STRAUSS JACK K. , ZHOU GUOFU
Published: March 2013

We investigate lead‐lag relationships among monthly country stock returns and identify a leading role for the United States: lagged U.S. returns significantly predict returns in numerous non‐U.S. industrialized countries, while lagged non‐U.S. returns display limited predictive ability with respect to U.S. returns. We estimate a news‐diffusion model, and the results indicate that return shocks arising in the United States are only fully reflected in equity prices outside of the United States with a lag, consistent with a gradual information diffusion explanation of the predictive power of lagged U.S. returns.
Informed Trading through the Accounts of Children
Authors: BERKMAN HENK , KOCH PAUL D. , WESTERHOLM P. JOAKIM
Published: March 2013

This study shows that the guardians behind underaged accounts are successful at picking stocks. Moreover, they tend to channel their best trades through the accounts of children, especially when they trade just before major earnings announcements, large price changes, and takeover announcements. Building on these results, we argue that the proportion of total trading activity through underaged accounts (labeled BABYPIN) should serve as an effective proxy for the probability of information trading in a stock. Consistent with this claim, we show that investors demand a higher return for holding stocks with a greater likelihood of private information, proxied by BABYPIN.
Mutual Fund Performance and the Incentive to Generate Alpha
Authors: GUERCIO DIANE DEL , REUTER JONATHAN
Published: March 2013

To rationalize the well‐known underperformance of the average actively managed mutual fund, we exploit the fact that retail funds in different market segments compete for different types of investors. Within the segment of funds marketed directly to retail investors, we show that flows chase risk‐adjusted returns, and that funds respond by investing more in active management. Importantly, within this direct‐sold segment, we find no evidence that actively managed funds underperform index funds. In contrast, we show that actively managed funds sold through brokers face a weaker incentive to generate alpha and significantly underperform index funds.
The effect of supplementing leaves of four tannin‐rich plant species with polyethylene glycol on digestibility and zootechnical performance of zebu bulls (Bos indicus)
Authors: Yisehak K. , De Boever J. L. , Janssens G. P. J.
Published: March 2013

The effect of supplementing leaves of four tannin‐rich plant species with polyethylene glycol 6000 (PEG) on nutrient intake and digestibility as well as on weight gain, feed conversion ratio (FCR) and N retention of zebu bulls (Bos indicus) was studied. Leaves of Albizia gummifera, Grewia ferruginea, Prunus africana and Syzygium guineense, containing, respectively, 85, 55, 76 and 172 g condensed tannins (CT) per kg dry matter (DM), were combined with natural pasture hay in a ratio of 40:60 on DM basis. The four diets were fed both without and with addition of PEG, at a dose of 40 g per kg DM, to eight zebu bulls during trials of 25 days in an 8 × 8 randomized crossover design. Supplementation with PEG increased nutrient intake, digestibility, FCR, N retention and average daily gain (p < 0.01). A diet × PEG interaction was observed for nutrient intake as well as for crude protein, neutral detergent fibre and acid detergent fibre digestibility (p < 0.05), but the effect size of PEG addition could not be attributed to the CT content as such, and also digestibility without PEG was not related to CT content of the diets. The reason why the efficacy of PEG addition did not relate to the CT content pointed the need to evaluate other factors that can help to predict the efficacy of PEG, for example, tannin type or interaction with other nutrients.
Promoting Health of Persons With Intellectual Disabilities Using the UN Convention on the Rights of Persons With Disabilities: Early Implementation Assessment in Spain and Hungary
Authors: Brehmer‐Rinderer Barbara , Zigrovic Lucija , Naue Ursula , Weber Germain
Published: March 2013

The article explores the initial achievements in the process of implementation of the Convention on Rights of Persons with Disabilities (CRPD) with a special focus on health of persons with intellectual disabilities (ID) in Spain and Hungary, the first countries to submit and receive a review for their report in the European Union. The CRPD is a major human rights instrument of the United Nations that was adopted in 2006 with the goal of ensuring protection of rights of persons with disabilities by holding governments accountable for the services they provide to this population. It was found that the reports designed to represent official state comments on the situation of human rights of persons with disabilities often do not follow the reporting requirements of the Convention in terms of required data. Moreover, they do not use a unified understanding of disability promoted by the Convention and make no mention of many important health‐related issues. Access to health is generally understood in a purely physical sense of availability and accessibility of services, while no attention is given to specific expectations and needs of persons with disabilities or to the competence of health staff to work with vulnerable groups. In order to be able to implement the Convention, governments need to carefully assess their country's status quo with regard to disability policies and politics, and at the same time need to develop action plans to implement the CRPD.
Identifying the multi‐scale spatial structure of plant community determinants of an important national resource
Authors: Lewis Rob J. , Pakeman Robin J. , Marrs Rob H.
Published: March 2013

Questions

What is the significance of climate and land‐use management as determinants of plant species composition of Scotland's soft coasts, and how are these determinants spatially scaled? What is the relative contribution of different community assembly processes in governing the coastal plant communities of an important national resource?

Location

Scotland, UK.

Methods

We used national‐scale survey data of Scotland's soft coasts, and a subset representative of machair grassland, a conservation priority habitat. Principal coordinates of neighbour matrices (PCNM), an eigenvector‐based method, was used to assess the spatial component of environmental determinants at multiple scales. The variation‐partitioning framework was applied to unravel the scale‐specific importance, relative to the study design (Broad > 50 km, Meso 10–50 km, small + fine 1.5–10.0 km) of each environmental predictor set.

Results

Modelled environmental and spatial predictors captured ca. 20% of the variation for both response matrices. Management predictors captured significant proportions, identifying vegetation structure, proxies for grazing intensity and disturbance as important descriptors of patterns in species composition for both data sets. The spatial scale of management predictors was poorly captured by modelled PCNM variables, suggesting spatially dependent management variables operate at finer spatial scales than this study detected. Climate also captured significant, yet smaller fractions of variation compared to management. Potential evapotranspiration (PET) and humidity were identified as important climatic determinants of species composition operating entirely at the broad spatial scale. Pure spatial fractions across all scales were significant (P ≤ 0.001) for both data sets, alluding to unmeasured, spatially structured environmental variables such as soil chemistry and/or exposure at larger scales, and potentially biotic process such as seed dispersal at the finest detectable scale.

Conclusions

The use of spatial PCNM variables within the variation‐partitioning framework is a valuable tool for dissecting scale‐specific importance of environmental determinants of species composition. This study reveals important climatic and management determinants of Scotland's soft coast and machair vegetation, and will help to better understand the relative scale at which they operate.