bluuebunny/crossref_metadata_2025 huggingface dataset:
Ernest John Christopher Polge. 16 August 1926 — 17 August 2006
Authors: Hunter R. H. F.
Published: June 2008

Christopher Polge achieved distinction at a remarkably early stage of his career in biological research. He made key discoveries when he was in his twenties, and his work was internationally acclaimed when only just into his thirties. His name will always be associated with the deep–freeze preservation of mammalian spermatozoa and the massive boost that this gave to a fledgling artificial insemination industry,especially for the breeding of dairy cattle. Even so, his research contributions were wide–ranging, and their long–term influence onagriculture, medicine and biotechnology cannot be overestimated. Recognition came from many directions, perhaps most significantly as the recipient of the Japan Prize for Science and Technology for Biological Production in 1992.
Junk‐food in marine ecosystems
Authors: Österblom Henrik , Olsson Olof , Blenckner Thorsten , Furness Robert W.
Published: June 2008

The abundance and availability of food are critical determininants of reproductive success and population dynamics of marine top predators. However, recent work has indicated that the quality of the food may also be critically important for some marine predators. The ‘junkfood hypothesis’ was originally suggested as a potential explanation for a dramatic population decline of Stellers sea lions Eumetopias jubatus in the Gulf of Alaska. According to the hypothesis, a dietary switch to prey of low energy content led to detrimental effects on the population of sea lions. A number of observations indicate that the hypothesis is relevant for several population parameters. Recent work on piscivorous seabirds has provided substantial evidence indicating the relevance of this hypothesis in food webs in e.g. the North Pacific, the North Sea and the Baltic Sea. The emergence of ‘junk‐food’ in these systems may be coupled to large scale changes in climatological and oceanographic forcing, although predation, fishing and competition provide additional plausible hypotheses. It may be possible to predict which kinds of animals will be particularly sensitive to food quality; these seem to be species with limited ability to carry food loads, with energetically‐expensive foraging behaviour, and with digestive anatomy evolved to minimize mass at the cost of digestive efficiency. This review suggests that the junk‐food hypothesis is a highly relevant factor in relation to sustaining ecosystem resilience, and is an important consideration in ecosystem management. Sustaining healthy populations of marine top‐predators requires an understanding of the role of food quality, in addition to food abundance and availability.
Evidence of a genetically distinct population of Vrljika softmouth trout Salmo obtusirostris Heckel evolved by vicariance
Authors: Snoj A. , Bogut I. , Sušnik S.
Published: June 2008

Mitochondrial DNA haplotypes (control region, partial cytochrome b and ATPase6 genes) indicate a sister relationship between Vrljika and Neretva softmouth (Adriatic) trout Salmo obtusirostris. This relationship was supported by a tree of individuals based on microsatellite results [allele sharing distances (DAS)], which revealed three distinctive clusters, corresponding to Jadro softmouth, Neretva brown trout Salmo trutta and Neretva softmouth trout. Within the latter taxon, Vrljika trout are clearly separated from other trout. The genetic results contradict the synonymy of Jadro with Vrljika softmouth trout, as recently proposed in the Red Book of Freshwater Fish in Croatia. Vrljika softmouth trout appear to have originated from a vicariance that split a common ancestor into large (Neretva) and small (Vrljika) fragmented populations 135 000–270 000 years ago. Vrljika softmouth trout can be distinguished by an array of derived phenotypic and molecular character states. For conservation, this population should be recognized formally at the same taxonomic level as the other geographically separated populations of softmouth trout.
The species complex Astyanax fasciatus Cuvier (Teleostei, Characiformes) – a multidisciplinary approach
Authors: Pazza R. , Kavalco S. A. F. , Penteado P. R. , Kavalco K. F. , DeAlmeida‐Toledo L. F.
Published: June 2008

Cytogenetic data have provided important clues that the Astyanax fasciatus populations from the Upper Paraná River basin could be a part of a more diverse fish group, usually included on the same taxa. Samples collected in Cachoeira de Emas, SP, in Mogi‐Guaçu River basin, show two major cytotypes presenting 2n = 46 and 2n = 48 chromosomes, with distinct karyotypic formula, despite the fact that the molecular data suggested some degree of gene flow between these cytotypes. Cytogenetic and morphometric analyses were performed in this species, aiming to contribute to the understanding of the natural history from such fish group. Two allopatric populations with distinct standard cytotypes were analysed, and the data obtained suggest the separation into two groups.
The GENIPOL European flounder Platichthys flesus L. toxicogenomics microarray: application for investigation of the response to furunculosis vaccination
Authors: Diab A. M. , Williams T. D. , Sabine V. S. , Chipman J. K. , George S. G.
Published: June 2008

The GENIPOL cDNA microarray, comprising some 14 000 elements representing 3336 unique expressed sequence tag clusters, was developed for studies on pollutant chemical effects on hepatic gene expression in the sentinel flatfish species Platichthys flesus, the European flounder. This array derived from probes obtained by targeted cloning of xenobiotic metabolising and responsive genes, subtractive suppressive hybridization of pollutant‐treated fish and subtracted normalized cDNA libraries of treated fish has been successfully utilized for diagnosing effects of prototypical pollutants, endocrine disruptors and analysis of environmental effects. In the latter context, it has been recommended by the International Council for Exploration of the Sea that the array is tested in European monitoring programmes for assessment of the biological effects of contaminants. Sequence homology is sufficiently great between P. flesus and other pleuronectid flatfish to enable satisfactory use with other species, including American winter flounder and Japanese flounder, plaice, Atlantic halibut and sole. Elucidation of the effects of pollutants requires knowledge of other affectors of gene expression, and in this context the observed effects of a bacterial infection have been studied. The ‘infection’ was experimentally applied by challenge with a vaccine containing Aeromonas salmonicida, the bacterial agent causing furunculosis in flounder and salmonids. These results show that, despite its currently limited gene coverage, application of this array is not confined to toxicology.
Microarrays for comparative and ecological genomics: beyond single‐species applications of array technologies
Authors: Kassahn K. S.
Published: June 2008

Microarray technology has become an important tool to understand the biological significance of gene regulation. Microarray gene expression profiling has provided insight into development, maturation, infection and the response to pollutants and environmental stressors. However, the development of species‐specific microarrays can be time consuming and costly. Therefore, where a microarray for a closely related species is available, use of a heterologous microarray platform can provide an attractive alternative. Heterologous microarray experiments are also of great interest in comparative studies where the aim is to compare gene regulation across a number of species. This review describes the principles underlying heterologous microarray experiments and discusses some examples of their use that have already helped advance the understanding of fish biology. However, sequence mismatches between the probes on the microarray and the target sequences can confound measures of gene regulation when using microarrays across species. The impact of sequence mismatches on the accurate detection of gene regulation is discussed. Interspecies genomic hybridization experiments comparing genomic DNA from different species can help identify which probes on the microarray can be used reliably to assay gene regulation across species. Finally, a number of recent advances in platform development for transcriptomics are described. These include multispecies microarrays that represent probes derived from multiple species and universal microarrays where the probes are designed to match evolutionarily conserved sequence regions. Next generation sequencing technologies are also likely to find broader application in transcriptomics in the near future.
The Gillies anaesthetic machine*
Authors: McKenzie A. G.
Published: June 2008

The Gillies anaesthetic machine was produced commercially after 1941. It was probably the first British true circle apparatus. Notably it incorporated a vaporiser inside the circle. There were serial modifications culminating in the Mark III apparatus of 1951, which continued in use through the 1960s. From 1955 the superior efficiency in carbon dioxide absorption of a true circle apparatus over the rival Coxeter–Mushin ‘circle’ absorber became realised.
Panton‐valentine leukocidin associated with community acquired methicillin resistant Staphylococcus aureus: a case report and review of interim guidelines
Authors: Baldwin L. N. , Lowe A. D.
Published: June 2008

We report a case of community acquired methicillin resistant Staphylococcus aureus pneumonia. The causative organism was positive for the toxin Panton‐Valentine Leukocidin. This resulted in a severe pneumonia requiring a prolonged stay on our intensive care unit. This infection is becoming more common in the United Kingdom. It can cause a far more aggressive illness than the hospital acquired infection with a high mortality if it becomes an invasive infection. The Department of Health has recently produced interim guidelines for its treatment which we have also reviewed.
Pre‐emptive Novalung‐assisted carbon dioxide removal in a patient with chest, head and abdominal injury
Authors: McKinlay J. , Chapman G. , Elliot S. , Mallick A.
Published: June 2008

A young man sustained traumatic lung, head and abdominal injuries. Despite mechanical ventilation, deteriorating respiratory function resulted in severe hypoxia and hypercapnia, with high Paco2 compounding an already raised intracranial pressure (ICP). The Novalung was pre‐emptively used without anticoagulation, prior to laparotomy, to remove carbon dioxide and to allow for cerebral and lung protective strategies. This facilitated control of ICP thereby limited possible secondary brain injury.
A quantitative review and meta‐analysis of performance of non‐standard laryngoscopes and rigid fibreoptic intubation aids
Authors: Mihai R. , Blair E. , Kay H. , Cook T. M.
Published: June 2008

This quantitative review summarises studies of rigid fibreoptic laryngoscopy systems. In 6622 ‘normal’ patients only the Bonfils and CTrach had homogenous data and first time intubation success rates above 90%. In 1110 patients predicted or known to be difficult to intubate only the Bonfils, CTrach and Glidescope had homogenous data and first‐time success rates above 90%. In comparative studies with the Macintosh‐3 blade, no device had homogenous data in more than one study. Many devices had higher summed performances, but due to data heterogeneity, interpretation is very difficult, if worthwhile at all. The currently available data do not provide strong evidence that these devices should supersede standard direct laryngoscopy for routine or difficult intubation. Further research needs to be of high quality, studying relevant patients to create such evidence. Multicentre collaborations are likely to be needed studying known difficult patients or creating databases reporting the success/failure rate of these devices.
Epidural morphine injections for prevention of post dural puncture headache
Authors: Al‐metwalli R. R.
Published: June 2008

A prospective, randomised, double‐blind trial was conducted to study the effect of epidural morphine in prevention of post dural puncture headache in 25 parturients after inadvertent dural puncture. Women were randomly allocated to receive two epidural injections, 24 h apart, of either 3 mg morphine in 10 ml saline (morphine group) or 10 ml saline (saline group). The incidence of headache and need for therapeutic epidural blood patch were reported. There was a significant difference in the incidence of headache between the two groups: 3/25 (12%) in the morphine group and 12/25 (48%) in the saline group (p = 0.014). Therapeutic epidural blood patches were required in six patients in the saline group and none of the patient in the morphine group (p = 0.022). It was concluded that epidural morphine appears to be a simple and effective technique for prevention of post dural puncture headache after accidental dural puncture in high risk obstetric patients.
The effect of intravenous lidocaine on QT changes during tracheal intubation
Authors: Owczuk R. , Wujtewicz M. A. , Sawicka W. , Piankowski A. , Polak‐Krzeminska A. , Morzuch E. , Wujtewicz M.
Published: June 2008

Laryngoscopy and tracheal intubation may provoke changes of cardiac repolarisation. The aim of this study was to assess the effect of intravenous lidocaine on the ECG changes induced by laryngoscopy and tracheal intubation. Forty‐three female patients were randomly allocated to receive lidocaine (1.5 mg.kg−1) or placebo immediately after induction of anaesthesia and changes in the ECG and arterial blood pressure were recorded. Correction of QT interval was calculated using Bazett’s formula (QTcb), Fridericia’s correction (QTcf), and Framingham formula (QTcF). Transmural dispersion of repolarisation (TDR) was determined as Tpeak‐Tend time. There were no changes in the QTc value in the lidocaine group. In the placebo group, significant increases in QTcb, QTcf and QTcF values were observed after intubation compared to either control measurements or to comparative measurements in the lidocaine group. There were no significant differences in TDR either between or within the groups. Lidocaine diminishes prolongation of QTc, induced by tracheal intubation but there is no effect of intubation on TDR.
Red ginseng for treating erectile dysfunction: a systematic review
Authors: Jang Dai‐Ja , Lee Myeong Soo , Shin Byung‐Cheul , Lee Young‐Cheoul , Ernst Edzard
Published: June 2008

AIMS

Korean red ginseng (unskinned Panax ginseng before it is steamed or otherwise heated and subsequently dried) is one of the most widely used herbal remedies. This systematic review evaluates the current evidence for the effectiveness of red ginseng for treating erectile dysfunction.

METHODS

Systematic searches were conducted on 20 electronic databases without language restrictions. Hand‐searches included conference proceedings and our files. All randomized clinical studies (RCT) of red ginseng as a treatment of erectile dysfunction were considered for inclusion. Methodological quality was assessed using the Jadad score.

RESULTS

Seven RCTs met all the inclusion criteria. Their methodological quality was low on average. Six of the included RCTs compared the therapeutic efficacy of red ginseng with placebo. The meta‐analysis of these data showed a significant effect (n = 349, risk ratio, 2.40; 95% CI of 1.65, 3.51, p < 0.00001, heterogeneity: tau2 = 0.05, χ2 = 6.42, p = 0.27, I2 = 22%). Subgroup analyses also showed beneficial effects of red ginseng in psychogenic erectile dysfunction (n = 135, risk ratio, 2.05; 95% CI of 1.33, 3.16, p = 0.001, heterogeneity: χ2 = 0.08, p = 0.96, I2 = 0%).

CONCLUSIONS

Collectively these RCTs provide suggestive evidence for the effectiveness of red ginseng in the treatment of erectile dysfunction. However, the total number of RCTs included in the analysis, the total sample size and the methodological quality of the primary studies were too low to draw definitive conclusions. Thus more rigorous studies are necessary.
Efavirenz concentrations in HIV‐infected patients with and without viral hepatitis
Authors: Pereira Sofia A. , Caixas Umbelina , Branco Teresa , Germano Isabel , Lampreia Fátima , Papoila Ana L. , Monteiro Emília C.
Published: June 2008

WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT

• HIV‐1 co‐infection with HBV/HCV is the most important factor determining efavirenz‐induced liver toxicity. Higher efavirenz plasma concentrations have been reported in these patients facilitating concentration drug‐related adverse effects.

• It is not known whether changes in efavirenz disposition are due to the hepatitis infection/inflammation or to liver failure. As a consequence, the guidelines for the application of therapeutic drug monitoring of efavirenz in HBV/HCV co‐infected patients have not been established.

WHAT THIS STUDY ADDS

• The present study has shown that HBV/HCV infection in itself does not predispose to higher efavirenz plasma concentrations. In the absence of hepatic failure, the risk of efavirenz concentration‐dependent toxicity is not increased.

• Thus, therapeutic drug monitoring indications in co‐infected patients with hepatic function within the normal range should be the same as in HIV‐1 mono‐infected patients.

AIMS

Data on efavirenz in HIV/viral hepatitis co‐infected patients is non‐consensual, probably due to liver function heterogeneity in the patients included.

METHODS

A case control study was performed on 27 HIV‐infected patients, with controlled and homogenous markers of hepatic function, either mono‐infected or co‐infected with HBV/HCV, to ascertain the influence of viral hepatitis on efavirenz concentrations over a 2‐year follow‐up period.

RESULTS

No differences were found in efavirenz concentrations between groups both during and at the end of the follow‐up period: control (2.43 ± 1.91 mg l–1)vs.co‐infected individuals (2.37 ± 0.37 mg l–1).

CONCLUSION

It was concluded that HBV/HCV infections in themselves do not predispose to an overexposure to efavirenz.
Effect of metformin, orlistat and pioglitazone treatment on mean insulin resistance and its biological variability in polycystic ovary syndrome
Authors: Cho L. W. , Kilpatrick E. S. , Keevil B. G. , Coady A. M. , Atkin S. L.
Published: June 2008

Context  Mean insulin resistance (IR) is greater and it is also more variable in overweight women with polycystic ovarian syndrome (PCOS) compared to weight matched controls. Whilst treatment will reduce the mean IR, it is not known if the IR variability is also reduced.

Objective  To compare the change in IR and its variability before and after treatment with insulin sensitization through metformin and pioglitazone, compared to that induced by weight loss with orlistat.

Design  Randomized, open labelled parallel study.

Setting  Endocrinology outpatient clinic at a referral centre.

Patients  Thirty obese PCOS patients [BMI 36·0 ± 1·2 kg/m2 (mean ± SEM)] participated in the study.

Intervention  The change in biological variability (BV) was assessed by measuring IR (homeostasis model assessment method) at 4‐day intervals on 10 consecutive occasions before and 12 weeks after randomization to metformin, pioglitazone or orlistat.

Outcome measured  The primary end point of the study was a change in BV of IR.

Results  Treatment with pioglitazone, orlistat and metformin reduced the overall IR by 41·0 ± 4·1%, 19·7 ± 6·4% and 16·1 ± 6·8% (P = 0·005, P = 0·013, P = 0·17, respectively) and IR variability by 28·5 ± 18·0%, 41·8 ± 11·6% and 23·7 ± 17·0 (P = 0·20, P = 0·015 and P = 0·28, respectively). Free androgen index reduced significantly with all treatments.

Conclusion  Only orlistat reduced both IR and its variability significantly, though all three drugs were effective in reducing hyperandrogenism within the 12‐week period of the study.
Eugonadal male patients with adrenal incidentalomas and subclinical hypercortisolism have increased rate of vertebral fractures
Authors: Chiodini Iacopo , Viti Raffaella , Coletti Francesca , Guglielmi Giuseppe , Battista Claudia , Ermetici Federica , Morelli Valentina , Salcuni Antonio , Carnevale Vincenzo , Urbano Filomena , Muscarella Silvana , Ambrosi Bruno , Arosio Maura , Beck‐Peccoz Paolo , Scillitani Alfredo
Published: June 2008

Objective  Subclinical hypercortisolism (SH) is suggested to exert a deleterious effect on bone. This effect and the role of gonadal status in male subjects are not fully elucidated. We evaluated bone mineral density (BMD) and prevalence of vertebral fractures in eugonadal male subjects with adrenal incidentalomas (AI) and without SH.

Design  This 12‐month observational multicentre study was performed between January and December 2006 on inpatient basis in three referral Italian centres.

Patients  Eighty‐eight consecutive eugonadal male patients with AI and 90 matched control subjects were studied.

Measurements  All subjects underwent the determination of BMD by dual‐energy X‐ray absorptiometry at lumbar spine (LS) and femoral neck (FN), and spinal radiograph. In AI patients SH was diagnosed in the presence of two of the following: urinary free cortisol > 193·1 nmol/l, cortisol after 1 mg dexamethasone suppression test > 82·8 nmol/l, ACTH levels < 2·2 pmol/l.

Results  As compared to patients without SH (SH–, n = 66) and controls, patients with SH (SH+, n = 22) had lower BMD at LS (Z‐score: SH+, –1·04 ± 1·84; SH–, 0·19 ± 1·34, Controls 0·20 ± 1·28, P = 0·001 and FN (Z‐score: SH+, –0·63 ± 1·01; SH–, 0·01 ± 1·01, Controls 0·26 ± 1·06, P = 0·002) and higher prevalence of fractures (SH+, 72·7%; SH–, 21·2%, Controls 20·0%, P = 0·0001). Multivariable analyses showed that SH was associated to BMD at LS (β = –0·378, P = 0·0001) and vertebral fractures (OR = 7·81, 95% CI 1·96–31·17, P = 0·004).

Conclusion  In eugonadal male patients with AI, SH is associated with low BMD and high prevalence of vertebral fractures.
A DNA adjuvant encoding a fusion protein between anti‐CD3 single‐chain Fv and AIMP1 enhances T helper type 1 cell‐mediated immune responses in antigen‐sensitized mice
Authors: Lee Byeong Cheol , O’Sullivan Insug , Kim Eugene , Park Sang Gyu , Hwang Seung Yong , Cho Daeho , Kim Tae Sung
Published: June 2008

T helper type 1 (Th1) cell‐mediated immune responses contribute to host defences against intracellular pathogen infections and cancer. Previously, we found that aminoacyl tRNA synthetase‐interacting multifunctional protein 1 (AIMP1) activated macrophages and dendritic cells to enhance Th1 responses. Herein, we manipulated this property to improve Th1 immune responses in vivo by constructing a mammalian expression plasmid (pAnti‐CD3sFv/AIMP1) encoding AIMP1 fused to the anti‐CD3 single‐chain Fv (sFv), the smallest unit of the antibody that interacts with the CD3ε region of the T‐cell receptor. Intramuscular injection of ovalbumin (OVA)‐sensitized BALB/c mice with pAnti‐CD3sFv/AIMP1 DNA adjuvant increased the OVA‐specific, interferon‐γ production by their CD4+ T cells and the levels of anti‐OVA immunoglobulin G2a (IgG2a) isotype in their sera. Furthermore, the pAnti‐CD3sFv/AIMP1 DNA adjuvant decreased interleukin‐4 production and anti‐OVA IgE levels in the OVA‐injected mice. Importantly, the pAnti‐CD3sFv/AIMP1 was more efficient than a mixture of pAnti‐CD3sFv and pAIMP1 in inducing OVA‐specific Th1 immune responses and also in inhibiting OVA‐specific Th2 responses during antigen priming. These studies indicated that the pAnti‐CD3sFv/AIMP1 fusion DNA adjuvant enhanced Th1 immune responses in antigen‐sensitized mice.
Myocardial infarction: psychosocial aspects, gender differences and impact on pre‐hospital delay
Authors: Løvlien Mona , Schei Berit , Hole Torstein
Published: June 2008

Title.  Myocardial infarction: psychosocial aspects, gender differences and impact on pre‐hospital delay.

Aim.  This paper is a report of a study to explore gender differences in psychosocial aspects in the year prior to first‐time myocardial infarction, and the association between these aspects and pre‐hospital delay.

Background.  The time from symptom onset to hospital admission is critical for patient survival; therefore influences on pre‐hospital delay are of interest. The prevalence of stressful psychosocial factors is higher among patients before acute myocardial infarction than among healthy controls.

Method.  Patients diagnosed with first‐time acute myocardial infarction were recruited from five Norwegian hospitals over a 13‐month period in 2003–2004. Of 738 eligible patients, 149 women and 384 men completed a self‐administered questionnaire (response rate 72%).

Findings.  Depression, high family stress, high work stress and major life events had no statistically significant impact on patient delay or total pre‐hospital delay. Depression, sleep disturbances and high family stress were reported among more women than men in the year prior to the event. Women and men aged 65 years and younger were more likely to report major depression and major life events than those older than 65. Low education and low partner education predicted prolonged patient delay in men but not in women. Low partner education also predicted prolonged total pre‐hospital delay in men.

Conclusion.  The process between symptom onset and hospital admittance is complex, and more knowledge about factors influencing this process is vital to reduce pre‐hospital delay. Significant others should be included in information‐giving in relation to myocardial infarction as they seem to play a vital role in patients’ decision‐making processes.
Letting go before a death: a concept analysis
Authors: Lowey Susan E.
Published: June 2008

Title.  Letting go before a death: a concept analysis

Aim.  This paper is a report of a concept analysis of letting go within the context of family caregivers and end‐of‐life care.

Background.  The term ‘letting go’ has been used in an informal manner by nurses and other clinicians working with patients and families with terminal illnesses to depict a lack of acceptance of a loved one’s impending death.

Data sources.  The CINAHL, Ovid Medline and PsychInfo databases were searched for the period of 1995–2007 for literature published in English in peer‐reviewed journals from a variety of disciplines, using the specific keywords letting go or to let go.

Methods.  The Walker and Avant method of concept analysis was used, and the study was guided by Zerwekh’s family caregiving model of core competencies for hospice nurses.

Results.  Letting go before the death of a loved one involves a shift in thinking in which there is acknowledgement of impending loss without impeding its natural progression. An emotional attachment and recognition that everything has been carried out usually precede the concept, followed by a peaceful death and acknowledgement of change.

Conclusion.  The concept of letting go has been explored in many contexts but the core essence of the awareness and work towards the acceptance of an impending loss appears to be a universal domain. Research is needed to further explore and identify patterns of this phenomenon in family caregivers in the context of death of a loved one.
Impressions of nursing before exposure to the field
Authors: O’Brien Frances , Mooney Mary , Glacken Michele
Published: June 2008

Aims and objectives. This paper reports on non‐mature general nursing students’ perceptions of nursing as a career prior to their first clinical placement.

Background. It is widely recognised that the first clinical practice experience serves a dual role, that of validating students’ choice of career and shaping their perceptions of nursing. This study sought to explore 23 first year non‐mature (<23 years) nursing students’ perceptions of nursing as a career prior to their first clinical exposure. The students accessed the programme via two different modes of recruitment.

Method. This qualitative descriptive study used focus group interviews as a means of data collection. Interviews were held within 10 weeks of entry into nursing. Data were analysed using the five stages of framework analysis. Ethical approval was obtained.

Results. Mode of recruitment did not influence students’ perceptions of nursing. The students unanimously identified caring as the essence of nursing. They also acknowledged the role of the media in shaping theirs and society’s perception of nursing. Male students expressed concern regarding the negative connotations associated with their career choice. Student participants could not appreciate the totality of the curriculum content at this stage of their course.

Conclusions. Caring remains the essence of nursing. Educators need to take cognisance of first year students’ abilities to appreciate the link between theory and practice. This may be enhanced by the employment of teaching strategies that role‐model this link for students. Recruiters must be proactive in addressing the challenges facing males in choosing nursing as a career.

Relevance to clinical practice. An insight into how nursing students perceive nursing prior to their first clinical placement is important for clinicians. This information is valuable in terms of providing registered nurses with an understanding of the students’ perspective and the associated supports required by nursing students on first clinical placements.
Hand hygiene practices: nursing students’ perceptions
Authors: Barrett Rachael , Randle Jacqueline
Published: June 2008

Aims and objectives.  The present study examines nursing students’ perceptions of hand hygiene practices in clinical settings. The objectives were to investigate any factors that affect students’ perceptions of their own and healthcare workers’ (HCWs) hand hygiene compliance, and to make recommendations for future practice and hand hygiene training in preregistration nursing courses.

Background.  Effective hand hygiene decontamination can lower the prevalence of healthcare‐associated infections (HCAIs); unfortunately, the prevalence of HCAIs continues to rise and so poses challenges to healthcare providers to reduce such infections. Previous studies have shown that hand hygiene compliance in HCWs is generally low and that any increase in compliance is difficult to sustain. Several barriers to hand hygiene compliance have been identified in the literature.

Design.  A qualitative interpretive design was used to examine nursing students’ perceptions of hand hygiene practices.

Methods.  Ten preregistration students participated in semi‐structured qualitative interviews, which were analysed thematically.

Results.  Hand hygiene compliance was perceived to be effected by specific barriers which included: time and busyness; clinical procedure; skin condition; lack of knowledge and glove use. Importantly, students perceived other HCWs as being the influencing factor for hand hygiene compliance resulting from the perception that they should ‘fit in’ with those working in the clinical area.

Conclusions.  The findings support previous literature and found that respondents emphasised the importance of fitting into the clinical area and role models in shaping hand hygiene compliance.

Relevance to clinical practice.  For nursing students, the influence of other HCWs as role models should not be underestimated.
Chronic illness: the process of integration
Authors: Whittemore Robin , Dixon Jane
Published: June 2008

Aim. The aim of this study was to explore how adults with a chronic illness integrate the illness experience into their life context.

Background. Adults with chronic illnesses are challenged to learn self‐management strategies to prevent complications and achieve an acceptable quality of life. Integration represents the process undertaken by an individual to achieve a sense of balance in self‐managing a chronic illness and living a personally meaningful life.

Design. A mixed‐method descriptive design was employed to recruit English‐speaking adults with a chronic illness. A semi‐structured interview was completed, transcribed verbatim and content analysed. Descriptive data were collected on demographics, co‐morbidity and depressive symptoms. The research was undertaken in Connecticut, USA.

Results. The sample (n = 26) was diverse with respect to age (25–80 years), education (8–24 years), duration of illness (1–39 years), gender (63% female) and ethnicity (63% white). Participants reported a mean of four chronic illnesses and 31% of the sample had increased depressive symptoms. The process of integration was complex and multifactorial. Themes of integration included: shifting sands, staying afloat, weathering the storms, rescuing oneself and navigating life. Numerous factors including treatment side effects, a progressive or uncertain illness trajectory, co‐morbidity, bad days, financial hardships and interpersonal/environmental challenges contributed to a disruption or difficulty in the integration process.

Conclusion. All participants made considerable effort to integrate the illness into their life context and participate in a personally meaningful life. However, it was easy to be consumed with ‘living an illness’ as the daily tasks, the changing symptoms and the fluctuating emotions could be overwhelming. There was a complex co‐existence between ‘living a life’ and ‘living an illness’.

Relevance to clinical practice. There were numerous challenges to the process of integration and ongoing self‐management, psychosocial, vocational and existential support appears indicated, particularly with individuals with multiple chronic illnesses, progressive chronic illnesses and limited resources.
Nursing care in the chronic phase of COPD: a call for innovative disciplinary research
Authors: Jónsdóttir Helga
Published: June 2008

Aim.  The literature on nursing care in nurse clinics that focus on chronic management of chronic obstructive pulmonary disease (COPD) is analysed and synthesised with the purpose of advancing research of practice in nurse clinics.

Background.  Along with the rising prevalence of COPD and a growing recognition of long‐lasting, comprehensive and complex healthcare needs of people with COPD and their families, nurses are challenged to restructure their practice.

Methods.  An integrated review was conducted. The databases searched were NCBI’s PubMed database, Scopus, CINAHL and Web of Science from 1996 to 2006. Terms searched were ‘COPD’ and ‘nurse managed clinic’ with all subheadings. A nurse had to be primary in managing and providing the services and the methodological approach was inclusive.

Results.  Of 385 potentially relevant papers, 20 papers reporting 16 studies met the inclusion criteria. The methodological approach was diverse with randomised controlled trials being most common. Significant benefits from experimental treatments were seldom demonstrated. Nursing care in the chronic phase of COPD has mainly been conceptualised as: home‐based respiratory care; self‐management educational programmes and telephone service with influences of specialisation in respiratory nursing care on patients’ outcomes as an emphasis as well. Family focus was not found in any of the studies.

Conclusion.  Research on nurse clinics that focus on the chronic phase of COPD is in its infancy. Innovative research that addresses the structure and content of the nursing care is essential.

Relevance to clinical practice.  Nursing care in nurse clinics that focus on the chronic phase of COPD needs to be based on nursing knowledge, evidence based, comprehensive, family‐centred, focused on health and the health experience and be situated within the service system. Diversity, creativity and nursing values should prevail when developing nurse clinics for the purpose of creating possibilities to attend to the whole of patients’ and their families’ needs and experiences.
Changes of satisfaction with appearance and working status for head and neck tumour patients
Authors: Liu Hsueh‐Erh
Published: June 2008

Aims and objectives.  The aim of this survey was to examine changes of satisfaction with appearance and working status of head and neck tumour patients after tumour excision and micro‐reconstructive surgery.

Background.  Most research related to head and neck tumour reconstruction deals with surgical techniques and complications. No reports discussed impact on personal appearance and working status.

Design.  This is a retrospective cross‐sectional study design with systematical sampling.

Methods.  One questionnaire which included three instruments was mailed to patients selected systematically from a patient list; 525 questionnaires were mailed to the potential participants and 125 returned. However, only 97 effective questionnaires were analysed. Non‐parametric statistics such as Spearman correlation, Wilcoxon signed rank test, Kolmogorov–Smirnov Z test and Kruskal–Wallis test were performed as the data were not normally distributed.

Results.  Participants reported that they were least satisfied with their face (mean = 2·88 SD 1·34). Compared with presurgery condition, the satisfaction with current appearance was significantly lower (Wilcoxon signed rank test, Z = −6·39, p < 0·001). A total of 35·8% employed participants changed their jobs after cancer treatments. Their major reason for job change was discomfort caused by cancer treatment. Gender, employment status, type of job, type of treatment, age, duration from last radiotherapy and number of treatment modalities had an impact on satisfaction with appearance.

Conclusions.  Compared with presurgery, satisfaction with personal appearance did change negatively even after micro‐reconstructive surgery had been conducted. In addition, certain participants changed their jobs because of cancer treatments.

Relevance to clinical practice.  We should include job rehabilitation and body image into the daily care of head and neck cancer patients. For example, participants could learn how to use cosmetic strategies to improve their facial appearance during OPD follow‐up. Thus, the negative impact might be reduced.
Social support and adaptation of Taiwanese adults with mental illness
Authors: Huang Chiung‐Yu , Sousa Valmi D , Tsai Chun‐Chin , Hwang Mei‐Yi
Published: June 2008

Aims and objectives.  The present study examined the relationships among contextual factors, dimensions of social support, adaptations and psychiatric symptoms among mentally ill Taiwanese adults in a mental health hospital in southern Taiwan. In addition, this study tested the effect of the dimensions of social support on adaptation as well as whether social support moderated the relationship between psychiatric symptoms and adaptation.

Background.  Social support enhances an individual’s ability to cope and adapt to daily life events and stressors. Although the relationships among social support, stress and adaptation have been widely studied in the general population, little is known among individuals with mental illness, especially in Taiwan.

Design.  A cross‐sectional, descriptive correlation design was used.

Methods.  The sample consisted of 129 adults, ranging in age from 21–67, who were diagnosed with a major mental illness (schizophrenia, bipolar disorder, depression, manic depression or organic mental disorder) and who could communicate in Chinese or Taiwanese. A demographic information sheet, the Interpersonal Support Evaluation List (ISEL), the Brief Psychiatric Rating Scale (BPRS) and the Life Skills Profile (LSP), were used to collect data. Data were analysed with Pearson’s correlation and multiple regressions.

Results.  The findings suggest that individuals who were older, male, independent and had higher education, a shorter duration of mental illness and fewer psychiatric symptoms had higher life skills. Three dimensions of social support (belonging, tangible and self‐esteem) moderated the relationship between psychiatric symptoms and number of hospitalisations.

Conclusion.  Life skills and social support play important roles in the adaptation of Taiwanese adults with mental illness in the community as well as in decreasing their psychiatric symptoms and number of hospitalisations.

Relevance to clinical practice.  The findings have implications for Taiwanese clinical nurses who provide care to mentally ill patients and their family. They can provide psycho‐education programs to teach life skills to mentally ill patients. Clinical nurses can also provide positive feedback on the behaviours displayed by mentally ill patients and assist them to develop better life skills to adapt to the community.
The Stroke Self‐Efficacy Questionnaire: measuring individual confidence in functional performance after stroke
Authors: Jones Fiona , Partridge Cecily , Reid Fiona
Published: June 2008

Aims and objectives. The aim was to develop a questionnaire for use by practitioners working in stroke care to measure self‐efficacy judgements in specific domains of functioning relevant to individuals following stroke.

Background. The prevalence of stroke is set to rise across the developed world especially amongst the elderly population. Recovery and adjustment in the longer term can be affected by many different factors. Current objective measures of functional performance used in many stroke programmes may not fully explain the extent of personal levels of confidence that could ultimately influence outcome.

Methods. Three separate studies were conducted to develop the Stroke Self‐Efficacy Questionnaire. A total of 112 stroke survivors, between 2 and 24 weeks, poststroke participated in the study. Development of the scale was undertaken between 2004 and 2006.

Results. The final 13‐item Stroke Self‐Efficacy Questionnaire was found to have good face validity and feasibility to use in the recovery period following stroke. Cronbach Alpha was 0·90 suggesting good internal consistency, and criterion validity was high compared with the Falls Efficacy Scale,r = 0·803,p < 0·001. The Stroke Self‐Efficacy Questionnaire was also able to discriminate between those participants walking and not walking.

Conclusions. Preliminary psychometric testing of the new Stroke Self‐Efficacy Questionnaire has indicated that it is a valid measure of confidence for functional performance and aspects of self‐management relevant for individuals recovering from stroke.

Relevance to clinical practice. The Stroke Self‐Efficacy Questionnaire could assist clinicians and researchers working in acute stroke care and rehabilitation to screen levels of confidence of stroke survivors in relation to functional performance and self‐management. The Stroke Self‐Efficacy Questionnaire could be used as part of battery of stroke outcome measures to provide a more comprehensive overview of factors influencing performance in the individuals recovering from a stroke.
Allostasis and allostatic load: expanding the discourse on stress and cardiovascular disease
Authors: Logan Jeongok G , Barksdale Debra J
Published: June 2008

Aim.  The aim of this discursive paper is to introduce allostasis and allostatic load, which are relatively new concepts proposed to explain physiological responses to stress, and to suggest ways in which allostasis theory can be applied to the development of clinical interventions to increase resilience for producing better health outcome.

Background.  Common explanations of stress have failed adequately to explicate its association with health and chronic illness. Allostasis is the extension of the concept of homeostasis and represents the adaptation process of the complex physiological system to physical, psychosocial and environmental challenges or stress. Allostatic load is the long‐term result of failed adaptation or allostasis, resulting in pathology and chronic illness.

Discussion.  The concepts of allostasis and allostatic load introduced the idea that external challenges initiate allostasis and chronic stress causes allostatic load that can be measured with multiple biomarkers. Finding from several studies suggests that higher allostatic load is associated with worse health outcomes. Resilience represents successful allostasis and strategies can be implemented to enhance resilience and thereby improve health outcomes.

Conclusions.  This theoretical model provides a comprehensive explanation of the human body’s adaptation processes in response to stress and the results of failed adaptation over time. In addition, combining the concepts of allostasis and resilience may help us to understand and implement clinical strategies better to reduce or prevent the debilitating physiological and psychological effects of chronic stress and chronic illness.

Relevance to clinical practice.  Clinical practice should be based on a solid theoretical foundation to improve health outcomes. Strategies to manage stress and increase resilience along with clinical interventions to manage the physiological responses to chronic stress are necessary to assist in preventing and controlling the detrimental effects of chronic disease on human life.
A concept analysis of health‐related quality of life in young people with chronic illness
Authors: Taylor Rachel M , Gibson Faith , Franck Linda S
Published: June 2008

Aims.  To critique existing concept analyses of quality of life and develop a definition applicable for young people with chronic illness.

Background.  Quality of life is a commonly used phrase but there is no universal definition. Five perspectives of quality of life have been proposed: sociological, economic, psychological, philosophical and ethical. However, health has emerged as an important but distinct perspective. The nursing profession has made a substantial contribution to the understanding of the interrelationship of health and quality of life.

Design.  Literature review.

Methods.  A search on electronic databases to April 2007 was made using the terms ‘quality of life’ and ‘concept analysis’. Papers were included in the review if they used a recognised method of concept analysis and were conducted by nurses. A new concept analysis was then performed specifically focusing on young people’s experiences of living with chronic illness.

Results.  Eight concept analyses were identified, all of which had limitations. All the concept analyses were based on adult literature so did not take into consideration developmental changes, language level, or young people’s construction of health and illness. The new concept analysis found that young people living with chronic illness generally view themselves and their lives in the same way as their healthy peers. While their aspirations are often constrained by illness and treatment the relationship between illness and life cannot be seen in isolation of development.

Conclusion.  Previous definitions of quality of life derived from concept analyses with adult populations do not adequately represent the experience of young people with chronic illnesses, but can be made more specific by incorporating important attributes such as developmental stage and the importance of peer group and family.

Relevance to clinical practice.  The current analysis provides a clear definition of quality of life from the health perspective which is specific for use with young people with chronic illness to guide practice and research.