bluuebunny/crossref_metadata_2025 huggingface dataset:
Interface study of a high-performance W/B4C X-ray mirror
Authors: Siffalovic Peter , Jergel Matej , Chitu Livia , Majkova Eva , Matko Igor , Luby Stefan , Timmann Andreas , Roth Stephan Volker , Keckes Jozef , Maier Guenter Alois , Hembd Alexandra , Hertlein Frank , Wiesmann Joerg
Published: October 2010

A high-performance W/B4C multilayer mirror with 80 periods of nominally 1.37 nm was measured by grazing-incidence small-angle X ray scattering (GISAXS) in order to analyse the lateral and vertical correlations of the interface roughness within the framework of a scaling concept of multilayer growth. A dynamic growth exponentz= 2.19 (7) was derived, which is close to the value predicted by the Edwards–Wilkinson growth model. The effective number of correlated periods indicates a partial replication of the low interface roughness frequencies. A simulation of the GISAXS pattern based on the Born approximation suggests a zero Hurst fractal parameterHand a logarithmic type of autocorrelation function. The as-deposited mirror layers are amorphous and exhibit excellent thermal stability up to 1248 K in a 120 s rapid thermal vacuum annealing process. At higher temperatures, the B4C layers decompose and poorly developed crystallites of a boron-rich W–B hexagonal phase are formed, and yet multilayer collapse is not complete even at 1273 K. Ozone treatment for 3000 s in a reactor with an ozone concentration of 150 mg m−3results in the formation of an oxidized near-surface region of a thickness approaching ∼10% of the total multilayer thickness, with a tendency to saturation.
Through-thickness texture profiling by energy dispersive synchrotron diffraction
Authors: Coelho R. S. , Klaus M. , Genzel Ch.
Published: October 2010

Two new approaches that make use of the advantages of energy dispersive diffraction were applied to investigate through-thickness variations of the crystallographic texture: the `real-space' and the `Laplace-space' methods. The first consists of defining a small gauge volume by adding a pair of slits in the primary and the diffracted beams. Thus the depth resolution is achieved by a decoupledztranslation of the gauge through the sample. The second method is based on the Beer attenuation law, and the depth resolution is achieved by assigning pole figures of different order reflections (e.g.0002, 0004…) to different average information depths. Wrought rolled AZ31 magnesium alloy was selected as a `model' material for the experiments because of the low X-ray absorption of Mg. The through-thickness crystallographic texture variation was generated by sample bending. The results give a first insight into the possibilities of fast texture depth profile investigation applying nondestructive methods and represent a step forward towards a simultaneous evaluation of residual stress and texture gradients.
Prey life‐history and bioenergetic responses across a predation gradient
Authors: Rennie M. D. , Purchase C. F. , Shuter B. J. , Collins N. C. , Abrams P. A. , Morgan G. E.
Published: October 2010

To evaluate the importance of non‐consumptive effects of predators on prey life histories under natural conditions, an index of predator abundance was developed for naturally occurring populations of a common prey fish, the yellow perch Perca flavescens, and compared to life‐history variables and rates of prey energy acquisition and allocation as estimated from mass balance models. The predation index was positively related to maximum size and size at maturity in both male and female P. flavescens, but not with life span or reproductive investment. The predation index was positively related to size‐adjusted specific growth rates and growth efficiencies but negatively related to model estimates of size‐adjusted specific consumption and activity rates in both vulnerable (small) and invulnerable (large) size classes of P. flavescens. These observations suggest a trade‐off between growth and activity rates, mediated by reduced activity in response to increasing predator densities. Lower growth rates and growth efficiencies in populations with fewer predators, despite increased consumption suggests either 1) a reduction in prey resources at lower predator densities or 2) an intrinsic cost of rapid prey growth that makes it unfavourable unless offset by a perceived threat of predation. This study provides evidence of trade‐offs between growth and activity rates induced by predation risk in natural prey fish populations and illustrates how behavioural modification induced through predation can shape the life histories of prey fish species.
Substratum choice for nesting in male Nile tilapia Oreochromis niloticus
Authors: Mendonça F. Z. , Volpato G. L. , Costa‐Ferreira R. S. , Gonçalves‐de‐Freitas E.
Published: October 2010

Four substrata were offered to groups of adult Nile tilapia Oreochromis niloticus (one male and two females) simultaneously: pure sand, a mixture of sand and shells, stones and no substratum. The results showed that males chose to dig nests in a lighter and more homogeneous substratum.
Blood transfusion and the anaesthetist: management of massive haemorrhage
Authors: Thomas D , Wee M , Clyburn P , Walker I , Brohi K , Collins P , Doughty H , Isaac J , Mahoney PF , Shewry L
Published: October 2010

1. Hospitals must have a major haemorrhage protocol in place and this should include clinical, laboratory and logistic responses.

 2. Immediate control of obvious bleeding is of paramount importance (pressure, tourniquet, haemostatic dressings).

 3. The major haemorrhage protocol must be mobilised immediately when a massive haemorrhage situation is declared.

 4. A fibrinogen < 1 g.l−1 or a prothrombin time (PT) and activated partial thromboplastin time (aPTT) of > 1.5 times normal represents established haemostatic failure and is predictive of microvascular bleeding. Early infusion of fresh frozen plasma (FFP; 15 ml.kg−1) should be used to prevent this occurring if a senior clinician anticipates a massive haemorrhage.

 5. Established coagulopathy will require more than 15 ml.kg−1 of FFP to correct. The most effective way to achieve fibrinogen replacement rapidly is by giving fibrinogen concentrate or cryoprecipitate if fibrinogen is unavailable.

 6. 1:1:1 red cell:FFP:platelet regimens, as used by the military, are reserved for the most severely traumatised patients.

 7. A minimum target platelet count of 75 × 109.l−1 is appropriate in this clinical situation.

 8. Group‐specific blood can be issued without performing an antibody screen because patients will have minimal circulating antibodies. O negative blood should only be used if blood is needed immediately.

 9. In hospitals where the need to treat massive haemorrhage is frequent, the use of locally developed shock packs may be helpful.

10. Standard venous thromboprophylaxis should be commenced as soon as possible after haemostasis has been secured as patients develop a prothrombotic state following massive haemorrhage.
Exploring the components of metabolic syndrome with respect to gender difference and its relationship to health‐promoting lifestyle behaviour: a study in Taiwanese urban communities
Authors: Chen Yu‐Chi , Wu Hui‐Ping , Hwang Shinn‐Jang , Li I‐Chuan
Published: October 2010

Aims.  The aim was to explore the prevalence of five components of metabolic syndrome with respect to gender and health‐promoting lifestyle behaviours.

Background.  Age‐ and gender‐specific strategies might be useful as an approach to controlling metabolic syndrome. Prevention or delaying the onset of metabolic syndrome is of utmost importance in terms of chronic disease care in Taiwan.

Design.  This was a cross‐sectional study.

Method.  Participants self‐completed a questionnaire and replied via mail.

Results.  The overall prevalence rate of metabolic syndrome was 24·07%, with men showing a higher rate than women. High blood pressure was the first abnormal component. The genders were significantly different in the prevalence of high blood pressure, hypertriglyceridemia and decreased HDL‐C. Age was also a significant determinant and positively correlated to the total Health‐Promoting Lifestyle Profile II (HPLP II) scale score (r = 0·11*), nutrition (r = 0·14**), physical activity (r = −0·16**) and health responsibility (r = 0·12**).

Conclusions.  Young, employed adult men were most at risk for having metabolic syndrome. It would seem that it is essential to control blood pressure and abdominal obesity to prevent metabolic syndrome; however, accomplishing this by trying to improve the level of physical activity does not seem to be a viable solution. Moreover, lifestyle modification has been proposed using gender‐, age‐ and location‐specific interventions. Nurses should not only strive to investigate the factors that lead to the adoption of unhealthy lifestyle behaviours by using the system approach, but also to empower people to participate in designing health programmes.

Relevance to clinical practice.  By understanding the components of metabolic syndrome, it will be possible to develop more effective strategies for its prevention. Based on this, it will help if healthcare providers focus their efforts on the specific components of metabolic syndrome and on the individuals who are at the greatest risk of developing metabolic syndrome.
The impact of nursing leadership on patient safety in a developing country
Authors: Stewart Lee , Usher Kim
Published: October 2010

Aim.  This article is a report of a study to identify the ways nursing leaders and managers in a developing country have an impact on patient safety.

Background.  The attempt to address the problem of patient safety in health care is a global issue. Literature addressing the significant impact that nursing leadership has on patient safety is extensive and focuses almost exclusively on the developed world.

Design.  A critical ethnography was conducted with senior registered nursing leaders and managers throughout the Fiji Islands, specifically those in the Head Office of the Fiji Ministry of Health and the most senior nurse in a hospital or community health service.

Method.  Semi‐structured interviews were conducted with senior nursing leaders and managers in Fiji. Thematic analysis of the interviews was undertaken from a critical theory perspective, with reference to the macro socio‐political system of the Fiji Ministry of Health.

Results.  Four interrelated issues regarding the nursing leaders and managers’ impact on patient safety emerged from the study. Empowerment of nursing leaders and managers, an increased focus on the patient, the necessity to explore conditions for front‐line nurses and the direct relationship between improved nursing conditions and increased patient safety mirrored literature from developed countries.

Conclusion.  The findings have significant implications for developing countries and it is crucial that support for patient safety in developing countries become a focus for the international nursing community.

Relevance to clinical practice.  Nursing leaders and managers’ increased focus on their own place in the hierarchy of the health care system and on nursing conditions as these affect patient safety could decrease adverse patient outcomes. The findings could assist the global nursing community to better support developing countries in pursuing a patient safety agenda.
Attitudes to the use of seclusion: has contemporary mental health policy made a difference?
Authors: Happell Brenda , Koehn Stefan
Published: October 2010

Background.  The use of seclusion in mental health services is controversial, and recent Government policy has identified the reduction and, if possible, elimination of seclusion as a national safety priority. As the professional group most likely to initiate seclusion, the attitudes of nurses will influence the extent to which policy translates to practice.

Design.  The Survey of Nurses’ Attitudes to Seclusion Survey was completed by nurses (n = 123) from eight mental health services from Queensland, Australia.

Methods.  Data were analysed using SPSS to provide descriptive statistics for nurses’ attitudes according to the scale. Correlation analysis was used to examine associations between demographic variables and attitudes towards seclusion.

Results.  Participants recognised the negative impact of seclusion on consumers; however, they continue to support its use, particularly in cases of threatened or actual violence to staff and other consumers. The impact of seclusion room on consumers was viewed as significant and yet most participants did not recommend changes other than painting the room for a calming effect. Demographic factors had limited impact on attitudes.

Conclusions.  The continued support of the use of seclusion despite acknowledgement of its detrimental effects appears to reflect a lack of alternative approaches to the management of consumer behaviours such as violence and aggression.

Relevance to clinical practice.  While nurses continue to view seclusion as a necessary intervention, the success of strategies aimed at reducing its use will be limited. The implementation and evaluation of alternative approaches to the care of consumers is necessary to reduce reliance and seclusion and introduce changes to practice.
Feeding with cross‐cut teats has better sucking effects and oxygenation in preterm infants with chronic lung disease
Authors: Kao Hui‐Mei , Lin Chyi‐Her , Chang Ying‐Ju
Published: October 2010

Aim.  To compare effects of single‐hole and cross‐cut teats on feeding performance, oral movement and cardiorespiratory parameters in preterm infants with chronic lung disease.

Background.  Infants’ feeding performance and physiological stability are affected by the shape and hole size of teats because of varied milk flow. The single‐hole teat could facilitate efficient milk intake in healthy preterm infants. In preterm infants with chronic lung disease, few studies have determined which type of teat is suitable for feeding.

Design.  A crossover study design was conducted.

Methods.  Twenty preterm infants with chronic lung disease were studied in a neonatal intensive care unit. During the early stage in transitional period of oral feeding, each infant was provided with a small single‐hole, an intermediate single‐hole and a cross‐cut teat with diameters of 0·45–0·5 mm, 0·7–0·8 mm and 2·0 mm, respectively, for three consecutive feeds in a random order. Feeding performance, oral movement, heart rate, respiratory rate and oxygen saturation (SpO2) were measured.

Results.  Infants fed with single‐hole teats had a shorter duration of feeding time (p < 0·001) and higher feeding efficiency (p < 0·001) compared with the cross‐cut teats. However, infants fed with cross‐cut teats had a higher sucking pressure (p < 0·001), more sucks (p < 0·001) and bursts (p < 0·001), longer sucking duration (p = 0·002) and higher respiratory rate (p = 0·005) and SpO2 (p = 0·014) than infants fed with single‐hole teats.

Conclusions.  For preterm infants with chronic lung disease, cross‐cut teats facilitate feeding coordination and physiological stability during the early stage of the transition from tube to oral feeding.

Relevance to clinical practice.  Cross‐cut teat can be considered for preterm infants with chronic lung disease to increase safety and self‐regulation in the early stage of the transition from tube to oral feeding.
Inter‐rater and intra‐rater reliability of nursing process records for patients with schizophrenia
Authors: Chung Min‐Huey , Chiang I‐Jen , Chou Kuei‐Ru , Chu Hsin , Chang Hsiu‐Ju
Published: October 2010

Aims.  This study explored the inter‐rater and intra‐rater reliability to evaluate the consistency of nursing process records for patients with schizophrenia.

Background.  By writing accurate and complete nursing process records, nurses can quickly communicate the care that has been delivered. However, little is known about the accuracy of nursing records to reflect the patients’ problems, especially in psychiatry.

Design.  A prospective observational study.

Methods.  Two nurses with similar work experience in psychiatric wards assessed patient records produced by 14 psychiatric nurses to compute inter‐rater reliability of nursing diagnoses and their defining characteristics. Collecting the records and the time spans between the first and the second data collection took one month to compute the intra‐reliability of the nursing diagnoses by the same nurse.

Results.  The greatest intra‐rater consistency was in identifying ‘disturbed thought processes’ (kappa = 0·77, 95% CI: 0·56–0·98). A moderate level of inter‐rater agreement among nurses was observed for the nursing diagnoses of ‘disturbed thought process’ and ‘disturbed sleep pattern’ from 0·41–0·53. Furthermore, the inter‐rater agreement of among nurses with less work experience (less than four years) showed greater higher consistency on ‘disturbed thought process’ (kappa = 0·56, 95% CI: 0·23–0·89) and ‘disturbed sleep pattern’ (kappa = 0·41, 95% CI: 0·07–0·73) than that observed among nurses with more work experience (more than four years).

Conclusions.  Overall, intra‐rater reliability was greater than inter‐rater reliability for psychiatric nursing process records. Furthermore, more inter‐rater and intra‐rater agreement were observed among records from less experienced nurses than among records produced by more experienced ones. To evaluate the consistency of nursing process records, both the intra‐rater reliability and the inter‐rater reliability show the importance of using standardised terms and more detailed nursing records.

Relevance to clinical practice.  Our results clearly indicate that using standardised terms to describe patient symptoms and more detailed descriptions of the nursing process could improve the accuracy of nursing records.
Barriers to research utilisation among nurses in Turkey
Authors: Uysal Aynur , Temel Ayla Bayik , Ardahan Melek , Ozkahraman Sukran
Published: October 2010

Aim and objective.  This study was conducted to identify barriers to research utilisation in practice among nurses in Turkey.

Background.  It is clear from the nursing literature that there are several factors that can impede the use of research in practice. It is important that these are identified and addressed.

Design.  Survey.

Method.  This descriptive study was carried out with 216 nurses from government and private hospitals in Izmir between January–April 2007. The data collection instrument used for the study consisted of the Barriers to Research Utilization Scale and a self‐administered questionnaire form that contained demographic data, educational background and nurses’ involvement in research activities.

Results.  More than half of the nurses did not receive research education before graduation, and 85·2% did not receive an in‐service education. Only 58·3% of nurses give great importance to research, and 24·5% are interested in research. Involvement in research activities is inadequate. Five out of the top 10 barriers were related to ‘setting’, three to ‘nurse’ and two to ‘presentation’. Educational level, undergraduate research education and involvement in research activities were predictor factors of perceived barriers to research utilisation.

Conclusions.  Identifying the barriers to research utilisation is the first step in overcoming the barriers. It is hoped that research capability in the health care field in Turkey can be enhanced. Creating an organisational climate that values research use and supports nurses to participate in such activities is crucial.

Relevance to clinical practice.  The study findings provide key factors and the top barriers to research utilisation to nurse administrators in developing strategies to increase the utilisation of research findings in clinical practices.
The modified self: family caregivers’ experiences of caring for a dying family member at home
Authors: Carlander Ida , Sahlberg‐Blom Eva , Hellström Ingrid , Ternestedt Britt‐Marie
Published: October 2010

Aim.  The aim of this study was to explore situations in daily life that challenge caregivers’ self‐image when caring for a dying family member at home.

Background.  Caregiving affects the health and daily lives of family caregivers. Patterns of challenging situations may provide insight into the home caregiving experience, thus contributing to our understanding of the influence it has on the caregivers’ self‐image.

Design.  Qualitative descriptive study.

Methods.  Ten family caregivers who cared for a dying family member at home with support from an advanced home care team were interviewed 6–12 months after the death of the family member. The interviews were analysed with interpretive description.

Result.  Three patterns characterised the experiences of caregivers’ daily lives in caring for a dying family member at home: challenged ideals, stretched limits and interdependency. These patterns formed the core theme, the modified self. Situations that challenged the caregivers’ self‐image were connected to experiences such as ‘forbidden thoughts’, intimacy and decreasing personal space.

Conclusions.  The caregivers met challenging situations in their daily lives that created a modified image of self. It is important to recognise the impact of caring for a dying family member at home.

Relevance to clinical practice.  This study argues for supporting family caregivers to maximise their potential to handle the demanding everyday life with a dying family member at home. This study contributes to understanding situations in the home that may challenge caregivers’ self‐image and points out the importance of talking about caregiving experiences. From a clinical perspective, this study emphasises the significance of creating a climate, which allows family caregivers to express thoughts and feelings. Sharing experiences such as ‘forbidden thoughts’ can be one way of handling the profoundly changed every day life.
An exploration of factors affecting Hong Kong ICU nurses in providing oral care
Authors: Yeung Ka Yi , Chui Ying Yu
Published: October 2010

Aim and objectives.  This paper aims to explore the factors that affect Hong Kong intensive care unit nurses in providing oral care.

Background.  The literature shows that evidence‐based oral care prevents ventilator‐associated pneumonia. Nevertheless, not all intensive care unit nurses provide such care. Although several studies have been undertaken to identify factors that affecting the provision of oral care, none of these studies looked at the situation in Hong Kong.

Design.  An exploratory qualitative design was adopted, with audio‐taped interviews.

Methods.  A convenience sample of 10 registered nurses with 3–14 years of intensive care unit working experience was recruited from the intensive care unit of one regional hospital in Hong Kong. Transcribed interviews were analysed by means of content analysis.

Results.  The participants’ descriptions of their oral care practices covered oral health assessment, cleansing the oral cavity and care of the surrounding areas. Findings revealed the following significant factors that influenced intensive care unit nurses in providing oral care: their perceptions of the purpose of oral care; their fears about providing it; the priority of oral care; and inadequate support for oral care.

Conclusions.  The findings indicate that nurses’ oral care practices were not evidence based. Factors that affected the provision of oral care were consistent with those found in previous studies.

Relevance to clinical practice.  Study findings indicate that present oral care training should be revised. The findings also highlight the influence of ward culture on nurses’ priorities in providing oral care. Appropriate materials, adequate staffing levels and the establishment of an evidence‐based oral care protocol may facilitate the provision of oral care in the intensive care unit.
Knowledge, attitudes, perceived vulnerability of Chinese nurses and their preferences for caring for HIV‐positive individuals: a cross‐sectional survey
Authors: Chen Wei‐Ti , Han Mei
Published: October 2010

Aims.  The study was to assess HIV/AIDS knowledge, attitudes and perceived vulnerability with potential factors.

Background.  HIV/AIDS is a public health catastrophe in China. Nurses are expected to care for nurture, comfort and advocate for all patients regardless of their condition. However, in the area of HIV/AIDS, nurses suffer as a result of expectations put on them by their professional roles.

Design.  This was a descriptive, cross‐sectional design that used a survey approach.

Method.  Data were collected from Summer 2003–Winter 2004.

Results.  Nurses reported significant perceived severity of risk from occupational exposure. Many nurses were frequently exposed to being stuck by needles (86%) and being splashed by body fluids and more than half of them (59·7%) were concerned about contracting HIV/AIDS. Nurses who had experience of finger pricks worried about potentially contacting HIV and being unaware of it (odds ratio= 0·444, p = 0·004). Nurses demonstrated a lack of knowledge and training in infectious diseases which may be a result of the fact that the study location is not considered a ‘concentrated area’ for infectious disease transmission; therefore, the need for the infectious diseases training has not been considered urgent.

Conclusions.  A well‐designed educational programme on occupational hazards and risk behaviour should be implemented to educate nurses in suburban cities and the general public. Hospital administrators should implement on‐site continuing education on HIV/AIDS throughout China. Armed with better knowledge of both transmission routes and precautions, nurses can protect themselves while providing care to patients.

Relevance to clinical practice.  Nurses in China urgently need psychosocial and physical supports from families, friends, communities and their working environments while combating HIV epidemic. With good support system, nurses will better educate patients and their family members on how to prevent transmission not only of HIV/AIDS but of a wide range of other infectious diseases as well.
The impact of fatigue on daily activity in people with chronic kidney disease
Authors: Bonner Ann , Wellard Sally , Caltabiano Marie
Published: October 2010

Aims and objectives. To examine the impact of fatigue on the daily activity levels of people with chronic kidney disease, compare whether being predialysis or receiving different renal replacement therapies had any effect on fatigue and activity and identify whether any items in the fatigue severity scale were more predictive of daily activity levels.

Background. Chronic kidney disease is a complex and long‐term disease where people commonly experience fatigue and reduced levels of fitness; both of which impact on an individual’s ability to carry out routine activities of daily life.

Design. A descriptive cross‐sectional design.

Methods. A convenience sample of 112 people completed the fatigue severity scale and Human Activity Profile. Participants differed in their renal history and were either predialysis or receiving renal replacement therapy.

Results. Women or older participants were significantly more fatigued and less active than men or younger participants. A significant difference between mean fatigue and activity scores was found for type of renal replacement therapy, with participants receiving peritoneal dialysis being the most fatigued and the least active. Additionally, lower levels of albumin were significantly correlated with greater levels of fatigue and the ability to engage in fewer activities.

Conclusion. People with chronic kidney disease regardless of whether they are predialysis or receiving either peritoneal or haemodialysis experience high levels of fatigue and are able to engage in fewer daily activities. The fatigue severity scale and the Human Activity Profile are useful indicators of fatigue and physical activities which can be used in routine assessment practices.

Relevance to clinical practice. Renal nurses are ideally positioned to engage in early identification and regular monitoring of both fatigue and activity levels in people with chronic kidney disease. Individual care plans can be developed to incorporate supportive rehabilitative strategies which aim to reduce fatigue and maximise activity levels.
Paediatric catheterisation: exploring and understanding children’s nurses’ perceptions and practice in an acute setting
Authors: Bray Lucy , Sanders Caroline , Flynn Anita
Published: October 2010

Aims and objectives.  This research study explored the factors which influenced the ability of children’s nurses to urethrally catheterise children in their care.

Background.  There is currently limited evidence to inform the clinical skills training of children’s nurses and the impact of competencies and other educational documents on practice. The project aimed to use data to inform local service provision and the design and development of future training programmes in an acute paediatric hospital.

Design.  A mixed method study using questionnaires and focus groups.

Methods.  Data were obtained through two focus groups (n = 10) and questionnaires (n = 34, response rate 88%) with trained children’s nurses to explore the influencing factors on their ability to conduct this clinical skill.

Results.  The children’s nurses discussed that barriers to being competent and confident to catheterise included a lack of exposure to the clinical skill, increasing awareness of the role of competencies and litigation and the presence of specialist roles. Current catheterisation training was evaluated positively with most nurses stating their knowledge and clinical skills had increased; despite this only 55% (n = 18) identified that would feel able to catheterise a child in their care.

Conclusions.  Comprehensive training of all children’s nurses in an acute care setting may not provide a workforce, which is competent and confident in urethrally catheterising children, and resources for training may be more appropriately deployed to ensure the optimum care of children and families.

Relevance to clinical practice.  This study highlights the difficulties encountered for clinical nurses to remain competent in infrequently used clinical skills. This has relevance to the challenges of providing a multi‐skilled workforce in children’s nursing.
Becoming a coronary artery bypass graft surgery patient: a grounded theory study of women’s experiences
Authors: Banner Davina
Published: October 2010

Aim.  To explore women’s experiences of becoming a coronary artery bypass graft surgery patient.

Background.  Coronary heart disease is a leading cause of morbidity and mortality for both sexes worldwide and is associated with significant human, fiscal and personal burden. There are growing numbers of women undergoing coronary artery bypass graft surgery; however, little is known about their experiences of being diagnosed, referred and waiting for surgery.

Design.  Grounded theory.

Methods.  A grounded theory study of 30 UK women with coronary heart disease waiting to undergo coronary artery bypass graft surgery. Data were collected using semi‐structured interviews and were contextualised through informal observation of the main clinical areas.

Results.  Coronary heart disease and associated symptoms had extensive physical, social and emotional ramifications for the women. A substantive theory of the public‐private dialogue around maintaining and renegotiating normality emerged and demonstrated that women faced significant disruption to their lives as they attempted to normalise and make sense of their illness experiences. Six categories emerged from the data: help seeking, diagnosis and referral, conceptualising surgery, living with coronary heart disease and waiting for surgery.

Conclusion.  This study has uncovered women’s experiences of becoming a coronary artery bypass graft patient. It has highlighted the extensive ramifications of heart disease and the need for more gender‐sensitive information and support.

Relevance to clinical practice.  The findings of this study provide health care professionals with a greater understanding of the experiences and needs of women through their journey to becoming a coronary artery bypass graft surgery. The study demonstrates that women need meaningful information particularly in relation to domestic and physical functioning. Nurses are in an important position to contribute to the care and support of women undergoing this process by providing appropriate and gender‐sensitive information that can improve health outcomes and quality of life.
Patients’ experience of open repair of abdominal aortic aneurysm – preoperative information, hospital care and recovery
Authors: Letterstål Anna , Eldh Ann Catrine , Olofsson Pär , Forsberg Christina
Published: October 2010

Aims and objectives.  The aim was to elucidate patients’ lived experience of the care pathway of going through open surgery for abdominal aortic aneurysm.

Background.  Open surgical treatment has a great impact on patients’ health‐related quality of life both before and after treatment. The transition from being independent and asymptomatic to dependent on nursing care can be difficult. To facilitate this process and provide high‐quality care, patients’ needs must be better understood.

Design.  An exploratory descriptive design was chosen to describe and understand patients’ lived experience.

Method.  Audio‐taped interviews were performed three months postoperatively, covering the care pathway before and after surgery. Interviews were analysed with qualitative content analysis.

Results.  The informants made a transition from becoming aware of the deadly risk associated with abdominal aortic aneurysm to gradually understanding the physical and emotional impact of the surgical procedure during the recovery process. The experience of not understanding fully the risks of undergoing surgery or its consequences on daily life made the informants unprepared for complications and limitations during the recovery period. Many concerns emerged, with a need for more dialogue and opportunities to understand their own care than those provided by the health care staff.

Conclusions.  To facilitate the transition process, health care staff should consider patients’ unpreparedness for the physical and emotional impact that can follow diagnosis and treatment for abdominal aortic aneurysm and recognise the need for dialogue to enhance participation during recovery.

Relevance to clinical practice.  Throughout the care pathway, patients’ need for information and for opportunities to reflect on bodily and emotional reactions to the diagnosis and treatment of abdominal aortic aneurysm should be recognised by nurses and physicians to support patients getting realistic expectations of the consequences of treatment and facilitate participation in decisions concerning care and medical treatment.
The significance of routines in nursing practice
Authors: Rytterström Patrik , Unosson Mitra , Arman Maria
Published: October 2010

Aim. The aim of this study was to illuminate the significance of routines in nursing practice.

Background. Clinical nursing is performed under the guidance of routines to varying degrees. In the nursing literature, routine is described as having both negative and positive aspects, but use of the term is inconsistent, and empirical evidence is sparse. In the research on organisational routines, a distinction is made between routine as a rule and routine as action.

Design. A qualitative design using a phenomenological‐hermeneutic approach.

Method. Data collection from three focus groups focused on nurses’ experience of routines. Seventeen individual interviews from a previous study focusing on caring culture were also analysed in a secondary qualitative analysis. All participants were employed as ‘qualified nursing pool’ nurses.

Result. Routines are experienced as pragmatic, obstructive and meaningful. The aim of the pragmatic routine was to ensure that daily working life works; this routine is practised more on the basis of rational arguments and obvious intentions. The obstructive routine had negative consequences for nursing practice and was described as nursing losing its humanity and violating the patient’s integrity. The meaningful routine involved becoming one with the routine and for the nurses, it felt right and meaningful to adapt to it.

Conclusions. Routines become meaningful when the individual action is in harmony with the cultural pattern on which the nursing work is based. Instead of letting contemporary practice passively become routine, routines can be assessed and developed using research and theoretical underpinnings as a starting point for nursing practice.

Relevance to clinical practice. Leaders have a special responsibility to develop and support meaningful routines. One approach could be to let wards examine their routines from a patient perspective on the basis of the themes of pragmatic, meaningful and obstructive routine.
Influence of four major plant traits on average height, leaf‐area cover, net primary productivity, and biomass density in single‐species forests: a theoretical investigation
Authors: Falster Daniel S. , Brännström Åke , Dieckmann Ulf , Westoby Mark
Published: October 2010

1. Numerous plant traits are known to influence aspects of individual performance, including rates of carbon uptake, tissue turnover, mortality and fecundity. These traits are bound to influence emergent properties of vegetation because quantities such as leaf‐area cover, average height, primary productivity and density of standing biomass result from the collective behaviour of individuals. Yet, little is known about the influence of individual traits on these emergent properties, despite the widespread use in current vegetation models of plant functional types, each of which is defined by a constellation of traits.

2. We examine the influence of four key traits (leaf economic strategy, height at maturation, wood density, and seed size) on four emergent vegetation properties (average height of leaf area, leaf‐area index, net primary productivity and biomass density). We employ a trait‐, size‐ and patch‐structured model of vegetation dynamics that allows scaling up from individual‐level growth processes and probabilistic disturbances to landscape‐level predictions. A physiological growth model incorporating relevant trade‐offs was designed and calibrated based on known empirical patterns. The resulting vegetation model naturally exhibits a range of phenomena commonly observed in vegetation dynamics.

3. We modelled single‐species stands, varying each trait over its known empirical range. Seed size had only a small effect on vegetation properties, primarily because our metapopulations were not seed‐limited. The remaining traits all had larger effects on vegetation properties, especially on biomass density. Leaf economic strategy influenced minimum light requirement, and thus total leaf area and basal area. Wood density and height at maturation influenced vegetation mainly by modifying individual stem mass. These effects of traits were maintained, and sometimes amplified, across stands differing in productivity and mean disturbance interval.

4. Synthesis: Natural trait variation can cause large differences in emergent properties of vegetation, the magnitudes of which approach those arising through changes to site productivity and disturbance frequency. Our results therefore underscore the need for next‐generation vegetation models that incorporate functional traits together with their effects on the patch and size structure of vegetation.
What does minimal important change mean to patients? Associations between individualized goal attainment scores and disability, general health status and global change in condition
Authors: Mullis Ricky , Lewis Martyn , Hay Elaine M.
Published: October 2010

Rationale, aims and objectives In previous work we described a modified version of goal scaling, which enabled patients to identify a meaningful change in their condition within important areas of their lives affected by low back pain. The aim of this study was to explore the associations between goal attainment scores and disability, general health and global change in condition, with particular reference to minimal important change.

Methods This was an observational cohort study. Patients attending a multidisciplinary clinic to manage unresolving acute low back pain were interviewed using the modified goal scaling schedule, completed the Roland‐Morris Disability Questionnaire and rated their general health status. They were reassessed at 3 and 6 months.

Results Thirty‐five patients were recruited. Minimal important change was identified on 67% of the goals. At follow‐up, goal attainment scores were able to distinguish between ‘improvers’ and ‘non‐improvers’, and these categories showed significant agreement with change in disability (Kappa = 0.865). Goal attainment was highly correlated with satisfaction (Spearman's rho = 0.88) and moderately associated with general health status (Spearman's rho = 0.40).

Conclusions The modified version of Goal Attainment Scaling used here may provide useful additional information about both the problems associated with, and the progress of patients who consult with low back pain in Primary Care.
Patient preference for falls prevention in hospitals revealed through willingness‐to‐pay, contingent valuation survey
Authors: Haines Terry P. , McPhail Steven
Published: October 2010

Rationale, aims and objectives  Patient preference for interventions aimed at preventing in‐hospital falls has not previously been investigated. This study aims to contrast the amount patients are willing to pay to prevent falls through six intervention approaches.

Methods  This was a cross‐sectional willingness‐to‐pay (WTP), contingent valuation survey conducted among hospital inpatients (n = 125) during their first week on a geriatric rehabilitation unit in Queensland, Australia. Contingent valuation scenarios were constructed for six falls prevention interventions: a falls consultation, an exercise programme, a face‐to‐face education programme, a booklet and video education programme, hip protectors and a targeted, multifactorial intervention programme. The benefit to participants in terms of reduction in risk of falls was held constant (30% risk reduction) within each scenario.

Results  Participants valued the targeted, multifactorial intervention programme the highest [mean WTP (95% CI): $(AUD)268 ($240, $296)], followed by the falls consultation [$215 ($196, $234)], exercise [$174 ($156, $191)], face‐to‐face education [$164 ($146, $182)], hip protector [$74 ($62, $87)] and booklet and video education interventions [$68 ($57, $80)]. A ‘cost of provision’ bias was identified, which adversely affected the valuation of the booklet and video education intervention.

Conclusion  There may be considerable indirect and intangible costs associated with interventions to prevent falls in hospitals that can substantially affect patient preferences. These costs could substantially influence the ability of these interventions to generate a net benefit in a cost–benefit analysis.
Pharmacokinetic–pharmacodynamic integration of orbifloxacin in Japanese quail (Coturnix japonica) following oral and intravenous administration
Authors: HAWKINS M. G. , TAYLOR I. T. , BYRNE B. A. , ARMSTRONG R. D. , TELL L. A.
Published: October 2010

Hawkins, M. G., Taylor, I. T., Byrne, B. A., Armstrong, R. D., Tell, L. A. Pharmacokinetic–pharmacodynamic integration of orbifloxacin in Japanese quail (Coturnix japonica) following oral and intravenous administration.J. vet. Pharmacol. Therap.34, 350–358.

The pharmacokinetics of single‐dose administration of orbifloxacin were determined in Japanese quail (Coturnix japonica) at dosages of 5 mg/kg intravenous (i.v.n = 12) and 7.5 mg/kg oral (p.o.;n = 5), 10 mg/kg p.o. (n = 5), 15 mg/kg p.o. (n = 12) and 20 mg/kg p.o. (n = 5) via HPLC. Orbifloxacin minimal inhibitory concentrations (MICs) against 22 microbial isolates from various bird species were performed to calculate pharmacodynamic surrogate markers. The concentration–time data were analyzed using a naïve pooled data (NPD) approach and compartmental and noncompartmental methods. Steady‐state volume of distribution (Vdss) and total body clearance (Cl) after i.v. administration were estimated to be 1.27 L/kg and 0.60 L/h·kg, respectively. Following 15 and 20 mg/kg p.o. dose, bioavailability was 102% and 117%, respectively. The harmonic mean of the corresponding terminal half‐lives (T1/2λz) across all the dose groups was 1.71 h. The Cmax/MIC90and AUC0∞24/MIC90for the 15 and 20 mg/kg p.o. doses were ≥5.22 and ≥8.98, and ≥25.80 and ≥39.37 h, respectively. The results of this study suggest that 20 mg/kg orbifloxacin p.o. would be a rational daily dose to treat susceptible infections in Japanese quail not intended for food consumption. For more sensitive bacterial organisms, 15 mg/kg p.o. may also be effective.
Involvement of breast cancer resistance protein (BCRP/ABCG2) in the secretion of danofloxacin into milk: interaction with ivermectin
Authors: REAL R. , EGIDO E. , PÉREZ M. , GONZÁLEZ‐LOBATO L. , BARRERA B. , PRIETO J. G. , ÁLVAREZ A. I. , MERINO G.
Published: October 2010

Real, R., Egido, E., Pérez, M., González‐Lobato, L., Barrera, B., Prieto, J. G., Álvarez, A.I., Merino, G. Involvement of breast cancer resistance protein (BCRP/ABCG2) in the secretion of danofloxacin into milk: interaction with ivermectin. J. vet. Pharmacol. Therap.34, 313–321.

Danofloxacin, a veterinary fluoroquinolone antimicrobial drug, is actively secreted into milk by an as yet unknown mechanism. One of the main determinants of active drug secretion into milk is the transporter (BCRP/ABCG2). The main purpose was to determine whether danofloxacin is an in vitro substrate for Bcrp1/BCRP and to assess its involvement in danofloxacin secretion into milk. In addition, the role of potential drug–drug interactions in this process was assessed using ivermectin. Danofloxacin was transported in vitro by Bcrp1/BCRP, and ivermectin efficiently blocked this transport. Experiments with Bcrp1−/− mice showed no evidence of the involvement of Bcrp1 in plasma pharmacokinetics of danofloxacin. However, the milk concentration and milk‐to‐plasma ratio of danofloxacin were almost twofold higher in wild‐type compared with Bcrp1−/− mice. The in vivo interaction with ivermectin was studied in sheep after co‐administration of danofloxacin (1.25 mg/kg, i.m.) and ivermectin (0.2 mg/kg, s.c.). Ivermectin had no significant effect on the plasma levels of danofloxacin but significantly decreased danofloxacin concentrations in milk by almost 40%. Concomitant administration of multiple drugs, often used in veterinary therapy, may not only affect their pharmacological activity but also their secretion into milk, because of potential drug–drug interactions mediated by BCRP.