bluuebunny/crossref_metadata_2025 huggingface dataset:
The value of HR in times of change
Authors: Hennessy Jo , McCartney Claire
Published: October 2008

Purpose

This paper sets out to explore the value of HR in times of change, providing an overview of current organizational change issues and against this backdrop exploring perceptions and requirements of the HR function. It also seeks to look at the important role that HR can play in taking the lead in talent management activities that can help to secure future organizational sustainability.

Design/methodology/approach

Data were collected through Roffey Park's annual The Management Agenda survey, which encompasses a sample of 500 UK managers across a wide range of sectors, organizational sizes and national/international structures. Further organizational data was collected for two case studies; the latter case study on talent management was taken from The Talent Management Journey.

Findings

The paper offers a number of practical recommendations for HR professionals. These include that HR needs to be flexible to both changing business and people requirements; focus attention on customer needs and delivering value; and work in partnership with various stakeholders to ensure successful talent management processes.

Originality/value

The paper is based on original Roffey Park research, both The Management Agenda survey, now in its 11th year, and Roffey Park's The Talent Management Journey research guide. It translates the research findings into practical implications for HR professionals and organizations in times of change.
Surviving change
Authors: Leahy Lynn , Chamberlain Neal
Published: October 2008

Purpose

This paper seeks to investigate change, why and how people react as they do to change, how to manage some of fheir reactions to change – such as stress and individual drivers – and how their career anchors come into play.

Design/methodology/approach

The first author examines the way people react to change and the techniques that can be adopted for better personal management. The second author provides a case study of how the organization worked with Oakridge Training and Consulting when it was facing major internal restructuring and outsourcing and achieved a successful outcome from this major change scenario.

Findings

Unilever outlines the outcomes of a workshop program delivered across 19 countries to 1,600 people. The workshops received consistent positive feedback from across all participating countries and research showed that there was a positive upturn in the perception of how Unilever Europe IT delivers change within the business.

Originality/value

The paper moves away from the process and elements of change to focus on the individual and offers practical tools that HR professionals can apply in a change environment that acknowledge individual needs and differences.
Preparing the organization for change
Authors: Neal Andy
Published: October 2008

Purpose

This paper aims to draw on ChangeMaker's 20 years' experience of helping organizations around the world through a variety of organizational change processes. It aims to identify the role that HR can play to maximize the value of business transformations and motivate and retain key people.

Design/methodology/approach

The paper offers best practice advice based on ChangeMaker's experience in the field and analyzes three major change situations in order to identify the best practice approaches used in each.

Findings

HR needs to be involved on a strategic level from the start of any organizational change in order to influence and promote the development of the necessary people policies to gain full value from the process. This can range from working with the CEO or top team to encourage them to communicate a clear and consistent message with passion and enthusiasm to developing programmes to assist staff through the change process.

Originality/value

HR needs to take a bold approach in terms of encouraging a top‐level focus on people policies and support, asking questions to ascertain the true requirements of the transformation, analyzing capability – including leadership capability – in the light of a changing business environment and being open and honest about any job losses or transfers.
Some support policy options for cotton in China
Authors: Martin William
Published: October 2008

Purpose

The purpose of this paper is to review the economic arguments for and against raising the tariff on imports of cotton into China.

Design/methodology/approach

The paper reviews first the possible arguments for raising the tariff, and particularly the possibility that such an increase in tariffs would have a favorable distributional effect by redistributing from those involved in the production of textiles and clothing to the producers of cotton. The core analysis of the paper examines the policies in place using descriptions of policies and interviews with policymakers. It also assembles statistics designed to assess the export status of cotton, whether in raw or processed form.

Findings

The paper reviews the situation with respect to WTO commitments and confirms that such an increase, up to 40 percent, would be permitted under WTO rules. The paper then examines other constraints on the effective use of such higher tariffs on cotton. Policies that are better than tariff increases in dealing with the serious problems of rural incomes are identified.

Research limitations/implications

The paper is unable to assess the distributional impacts of an increase in the tariff on cotton. It raises a number of cautions about the issues that need to be confronted in making such an assessment.

Originality/value

The issue of raising the tariff on cotton has been a subject of intense debate in China and this paper is intended to provide an input into this debate. The paper agrees that urgent action is clearly needed to mitigate the poverty problems in rural China, but concludes that a number of policy options appear likely to be more effective in dealing with these problems than protection of cotton.
Promotion of dairy farming and poverty reduction in Inner Mongolia, China
Authors: Dagula  , Kiminami Lily
Published: October 2008

Purpose

The purposes of this paper are to examine the actual conditions of the problems of poverty in rural areas in Inner Mongolia, to clarify the problems involved in the measure to fight poverty through promotion of dairy farming and to propose policies for future measures to fight poverty.

Design/methodology/approach

Both quantitative and qualitative analyses are employed, such as the estimation of production functions of agriculture in Inner Mongolia over the period 1998‐2004, the interview analysis and questionnaire survey for case studies. The different roles that three models play in poverty reduction such as the government assistant dairy farming, the enterprise entry dairy farming, and the multiple management dairy farming are discussed.

Findings

The paper confirms the growth of the corporate‐participating dairy farming contributes significantly to the development of the regions. It also clarifies the problem of the government‐aided dairy farming with its low profitability caused by insufficient input of fodder and the necessity to select management policies according to the natural conditions and resources available in individual regions, such as a shift toward recycling‐oriented beef cattle management in multiple dairy farming.

Originality/value

The paper adds insight into the promotion of dairy farming and poverty reduction in Inner Mongolia.
Thought and practice of sustainable development in Chinese traditional agriculture
Authors: Genpan Li
Published: October 2008

Purpose

The purpose of this paper is to demonstrate that the sustainable development thought is one good reason why Chinese civilization is continuously developing, and it can be used as a reference for the development of Chinese agriculture today.

Design/methodology/approach

The paper employs a historical analysis approach to examine the sustainable thoughts concerning Chinese traditional agriculture, including view of sancai, farming season, fertility, the nature of matters, recycling, and economization.

Findings

The results reveal that the nature of Chinese traditional agriculture is akin to ecological agriculture, which is precious heritage for China and the whole world.

Originality/value

The originality of this paper is that it confirms the fundamental reason of the continuous development of Chinese civilization which, based on organization of sustainable development thought, lies in traditional agriculture.
Clinical training for general managers?
Authors: Royce R.G.
Published: October 2008

The author's contention is that the future demands of managing the Health Service in Britain are not being met by current training programmes. In particular, lay‐managers normally lack any clinical education and suffer accordingly. The preferred solution is to include a sizeable component of especially adapted clinical training into general management education programme to provide managers with a better grasp of health issues and allow them to make fuller use of new managerial tools such as DRGs and QALYs.
An agenda for laboratory managers
Authors: Smith Diane
Published: October 2008

Pathology within the British National Health Service (NHS) is currently undergoing major changes which are causing considerable problems for the laboratory manager. In order to achieve results through other people, it is necessary to develop good leadership skills! Training in these skills is vital to prepare managers for tomorrow's challenges.
Managing primary health care in developing countries
Authors: Schofield David
Published: October 2008

The continuing challenge for health professionals engaged in international health activities is to encourage essential changes in policy and process in order to meet the objectives of ‘Health for All by the Year 2000’, by way of the primary health care (PHC) approach, as laid down by the World Health Organization in 1978. Achievement of the long‐term goals will largely depend on the extent of the immediate commitment to those primary health care management considerations which reflect the expressed health needs of the community and which accommodate and support methods by which those needs can be met appropriately.
Management of a pain relief service
Authors: Collett Beverly‐Jane
Published: October 2008

Chronic pain has important socio‐economic consequences. The reasons for the evolution of a distinct specialty to treat patients with intractable pain are discussed. The users of a pain relief service are defined and their needs explained. A multidisciplinary approach to pain management has many advantages and key personnel are identified. Facilities and funding must be adequate for effective functioning of the service. An important role is education of medical and non‐medical personnel. Careful long‐term planning, both at local and regional level, is needed to ensure that the specialty of pain relief meets current patient needs and can also accommodate new advances in therapy.
The privatisation of National Health Service pathology
Authors: Raby A.H.
Published: October 2008

The current political emphasis directing thinking in the British National Health Service towards an organisational climate in which competition is positively encouraged, is likely, sooner rather than later, to cause general managers to look more closely at their pathology services.
Marketing and the management of change
Authors: Farell Elaine
Published: October 2008

Two more unlikely bedfellows than marketing and the British National Health Service would have been difficult to find five years ago. Increasing demand, making a profit and competing for customers were less than burning issues for the NHS. However, now that discussion of such topics as internal markets, income generation and close co‐operation with the private health care sector is commonplace, marketing would appear to have a great deal more relevance to the public health care sector.
Assessing the quality of residential services for people with mental handicap
Authors: Davies Linda
Published: October 2008

Between 1984 and 1987 the South Western Regional Health Authority funded research to compare the costs and quality of alternative residential services for people with learning difficulties (mental handicap). During this period, 14 residential services were evaluated. The services covered a wide range of models of care and included: small homes run on ‘ordinary life’ principles based in the community, funded and/or managed by health authorities and social services departments; small (health authority) homes in, or adjacent to, mental handicap hospital grounds; traditional mental handicap hospitals; and private or voluntary sector hostels for up to 12 people.
Research in medical economics: A patchwork approach or a systematic plan?
Authors: Schifrin Leonard G.
Published: October 2008

Economists seem to be studying every nook and cranny of the field of medical care, from cost‐benefit analyses of medical technology to economies of scale in hospital size, the utilisation of non‐physician personnel to render care, the effects of pre‐paid financing and care systems, and so on, across an apparently highly divergent range of concerns. Obviously, what these studies have in common is their general subject, ‘medical care financing delivery, and utilisation’, But do they represent only a patchwork approach to understanding the economic features of the ‘real’ system of producing and consuming medical care, or are they somehow systematically, if not always clearly, related to each other? It is argued here that what seems to be a random, unrelated set of studies are indeed closely unified: and together they comprise an integrated analysis of the broad sector of medical care economics.
A dose of Occam's Razor?
Authors: Walker P.
Published: October 2008

It is the nature of great bureaucracies — and can there be any greater bureaucracy than the British National Health Service? — for the specific tasks and roles of individuals and departments to be perceived as ends in their own rights rather than as contributions to the pursuit of the objectives of the organisation as a whole. Characteristically, no single person, body or department has an overall view of what the organisation is trying to achieve and where it is going although, since the introduction of general management in 1984, there is evidence that this integrating and visionary function is starting to be fulfilled by at least some general managers. However, when general managers start to do this, and it is entirely appropriate that they should do so, they come face to face with the conundrum that the overall aims and objectives of the National Health Service have never been spelt out except in the broadest possible terms in the original National Health Service Act 1946, in subsequent amending legislation and in the very few central policy statements that have been published, for example the ‘Priorities Document’, the ‘Way Forward’ and ‘Care in Action’.
The elusive junior doctor — A solution
Authors: Marvin Cynthia M.
Published: October 2008

For several years UK health districts have experienced problems in recruiting to junior hospital posts. This led the National Association of Health Authorities (NAHA) to carry out a survey in 1986 which discovered 87 districts with recruitment problems. All specialties were affected but those with the greatest problems were orthopaedics, anaesthesia and accident and emergency (A & E). In the former specialty, at least a third of all districts in the country were affected.
The theory and practice of general management in a community unit
Authors: Piper J.A. , Stewart A.
Published: October 2008

The paper explains the principles and approach taken to introduce the general management philosophy into a community unit; and the way in which it has been implemented is also addressed. The paper also demonstrates how a management educator and practising manager have worked together in an action research mode not only to plan the ‘what’ but also the ‘how’.
Case mix management
Authors: Canning B. , Loeb J.I.
Published: October 2008

The Freeman Hospital in Newcastle upon Tyne is currently introducing case mix management under the auspices of the Department of Health's Resource Management Initiative. Like many other hospitals, particularly teaching institutions and large district general hospitals, Freeman is experiencing a trend towards complex cases arising either from tertiary referrals or technological advance. Successful management has increasingly meant understanding the relationship between the mix of cases treated in a specialty and the implications for resource allocation and expenditure. The biggest obstacle to this cohesive managerial approach has been the inadequacy of existing information systems which have tended to reinforce traditional managerial division between hospital departments and professional disciplines.
Staffing the Service
Authors: Hartley C.V.
Published: October 2008

Ever since Enoch Powell, then Health Minister, secured Cabinet approval for the Hospital Plan in the early 1960s, it has been clear that expensive items like hospitals cannot be placed on every street corner, even if that is what some patients would like. In most parts of the UK old scattered institutions have indeed been replaced by large new district general hospitals (DGHs) in fulfilment of the plan, but recently, understandable resistance to the idea of ‘big is beautiful’ has persuaded some authorities that they can afford to split their acute services between two or more sites. This paper will try to show not only that this is a mistake, but that the time has now come for a major new initiative to encourage a rationalisation of the NHS estate so that acute services are provided wherever possible on only one site in each district — in other words, a new Hospital Plan.
The US health care environment and the prospects for the pharmaceutical industry
Authors: Cooper Theodore , Hoff Lawrence C.
Published: October 2008

The authors contend that health care remains a high priority in the United States, despite a number of policy efforts to restructure the country's health care system. The authors also believe that the research‐based, multinational pharmaceutical companies in the USA will survive a period of industry‐wide compression and emerge stronger than they are now. These companies will benefit partly from an expanding worldwide market, partly from the overall priority given to health by ageing populations in the industrialised world, and partly from the new wave of technological innovation.
Pipeline protection with hot‐applied coatings
Authors: Walker Albert
Published: October 2008

After more than six years of operation carrying the hottest crude oil in the North Sea, the anti‐corrosion system of the Phillips Ekofisk pipeline is free from submarine decay. For the 212‐mile line, which stretches from Norway to Teeside, is protected with 120/5 glass‐reinforced coal tar enamel from Metrotect Ltd., of Cleckheaton, Yorkshire.
Energy Alternatives for Water Pumping in Rural Areas ‐ Using a Case Study Approach
Authors: Omar Ilyas , Makhlomo Selbourne
Published: October 2008

This paper reviews energy alternatives for groundwater pumping in remote, rural areas which are not grid connected or where grid extension costs are prohibitively high. The applicability of photovoltaic (PV) pumping under certain conditions is discussed, using examples of in‐service fieldwork results, and experimental results of a laboratory PV pumping rig with remote monitoring capabilities using telemetry. The outcome of the survey and analysis shows that PV pumping can be competitive with other technologies under specific head and flow conditions, although the socio‐institutional implementation strategies are crucial to the techno‐economic success of actual pumping schemes.
CONSTRUCTION ENTREPRENEURSHIP IN TERENGGANU, MALAYSIA: AN EXPLORATION OF THE INFLUENTIAL FORCES
Authors: Abdul‐Aziz Abdul‐Rashid
Published: October 2008

Ever since hydrocarbon resources were exploited off the coast of Terengganu in 1978, a state in Peninsular Malaysia, its built environment underwent dramatic physical transformation arising from huge investments in first‐grade infrastructure and industrial facilities, largely hydrocarbon‐related in nature. Yet, more than two decades later, the stock and technical competencies of the local contractors have not been to the level one might expect, despite prolonged robust demand that should have acted as an alluring incentive for entrepreneurship. There were, of course, enabling factors such as favorable client and government interventions. However, the inhibitors ‐ economic model, socio‐cultural traits, institution, mix of construction demand and even the recent change in political landscape ‐ were found to exert an even greater influence. The findings of this study underscore the necessity of identifying the influential forces exerting on the construction community's operating environment before any construction entrepreneurial development programme is instituted so that realistic targets can be set. Furthermore, as different regions may possess different types and intensities of such forces, implementing standard policy prescription is likely to yield sub‐national diversity
INTEGRATED FOUNDATION DESIGN OF BUILDINGS: CASE DEMONSTRATION OF A PROTOTYPE EXPERT SYSTEM
Authors: van den Adel J.F. , Al‐Jibouri S.H. , Karim U.F.A. , Mawdesley M.
Published: October 2008

This paper reports on an integrated prototype expert system, which has been developed to support geotechnical engineers during the initial foundation design phase. Foundation design based on Dutch practice and geotechnical codes as well as construction and project management aspects is programmed. The paper discusses an integrated approach to foundation design of buildings using a case‐demonstration to show the proposed system and its basis. The modelling techniques used offer a sound basis for including these aspects in routine geotechnical design. The example has indicated that the system is capable of integrating geotechnical design aspects with construction related aspects in order to produce better foundation design solutions.
Modelling Labour Demand at Project Level — An Empirical Study in Hong Kong
Authors: Chan Albert P.C. , Wong James M.W. , Chiang Y.H.
Published: October 2008

The construction industry plays a significant role to the economy of Hong Kong not only in terms of output but also the employment. The sector, however, has been severely hit by the economic downturn in recent years resulting in serious unemployment. Employment planning becomes one of the critical aspects for the recovery of the economy. The main objective of this paper is to establish a labour demand model for the Hong Kong construction industry. The unique characteristics and the current conditions of the construction labour market are reviewed. Regression analysis based on 123 construction projects was used to compute the relationship between expenditure and site workers employed. The best predictor of average labour demand of construction projects in Hong Kong is found to be DL = 463 C 0.934, where DL is the actual labour demand in man‐days, C is the final cost of contract in millions. The labour demand‐cost relationship can be applied as a manpower forecasting model to estimate the total labour required for a given type of project. The developed model enables a more reliable and accurate planning of manpower requirements in the construction industry.
The Use of Computer Visualisation in Communicating Constructability Information in UK
Authors: Ganah A.A.
Published: October 2008

Design details are not always simple and easy to understand. Builders may spend considerable time on interpreting difficult or complex details in a drawing; this could result in constructability problems. Advanced computer visualisation tools offer good visualisation capabilities that cannot be achieved using traditional tools, such as 2‐D drawings. They provide considerable potential to improve this process in construction and can effectively be used for communication between design and construction teams that are geographically dispersed. However their use is still at present limited and not fully understood. This paper presents an industry survey on the use of computer visualisation to communicate design information as part of a research study, which aims to demonstrate how computer visualisation can be used in clarifying design details and in dealing with constructability problems. The analysis of the results shows that the most common methods used by designers and site teams for clarifying information on constructability problems were traditional tools and methods, which have serious limitations in supporting virtual construction project teams. It also shows that traditional tools are not adequate to communicate design information related to constructability between designers and builders.
Predicting Construction Plant Breakdown Time Using Time Series Modelling
Authors: Oloke David A. , Edwards David J. , Thorpe Tony A.
Published: October 2008

Construction plant breakdown affects projects by prolonging duration and increasing costs. Therefore, prediction of plant breakdown, as a precursor to conducting timely maintenance works, cannot be underestimated. This paper thus sought to develop a model for predicting plant breakdown time from a sequence of discrete plant breakdown measurements that follow non‐random orders. An ARIMA (1,1,0) model was constructed following experimentation with exponential smoothening. The model utilised breakdown observations obtained from six wheeled loaders that had operated a total of 14,467 hours spread over a 300‐week period. The performance statistics revealed MAD and RMSE of 5.03 and 5.33 percent respectively illustrating that the derived time series model is accurate in modelling the dependent variable. Also, the F‐statistics from the ANOVA showed that the type and frequency of fault occurrence as a predictor variable is significant on the model's performance at the five percent level. Future work seeks to consider a more in depth multivariate time series analyses and compare/contrast the results of such against other deterministic modelling techniques.
Study On Awareness Of Records Management
Authors: Hirota Den‐ichiro
Published: October 2008

These days the Japanese have been increasingly demanding freedom of information, or a system to open official information to the nation, or community residents, when requested. To make such information available for the public, records management is a prerequisite. Needless to say, most of the information handled by administrative offices, national or local, is represented by records in the form of papers. Therefore, records management is inevitable.
Records Management as the Basis of Open Information
Authors: Hiroyuki Hata
Published: October 2008

With the complication, intensification and specialization of administration, the information drawn up and acquired by administrative organs for the performance of their duties is steadily increasing and has reached immense proportions, and the continued diversification and increase of administrative information is inevitable in the future. In administrative affairs in our country, systematization by means of computerization of activities based around large‐scale, repetitive work is fairly advanced, but fundamentally, that work is still carried out with paper documents at its heart. It is an old survey, but in 1976, the quantity of documents held by internal subdivisions of all provincial governments was such that, converted to B5 size and piled up, the documents would reach 380,000 metres, which is equivalent to 100 times the height of Mt Fuji. Each employee would have as much as about 10 metres of documents.
Disaster Prevention in Records Management in Japan
Authors: Yūjiro Ogawa
Published: October 2008

Because Japan is on the western extremity of the Pacific Ocean and on a typhoon route, every year several typhoons strike and much flood damage is suffered. Japan is also a country where earthquakes frequently occur. On a map of the epicentres of earthquakes occurring in the world, so many occur in Japan that its whereabouts can not be seen. The area of plains in Japan comes to not much more than 10% of the total area, and since cities grow on the estuaries of swift rivers, topographically too there is proneness to flood damage, and also to damage from tidal waves. Since Japanese cities are densely populated and wooden house building has been common since ancient times, as regards city structure also there is typically a great danger of damage from fire. If the storage of information in Japan, prone as it is to disasters in terms of meteorology, geography and urban structures, does not take account of flood, fire and earthquake damage, then storage policy can hardly be called adequate.
The Records Management Society and An Archivist: A Japanese story of Unrequited Love
Authors: Ogawa Chiyoko
Published: October 2008

No Japanese records management colleagues can forget the name of Mr. William Benedon. He, the former President of IRMC, took the key role to push the establishment of the Japanese Records Management Society by presenting the first comprehensive records management textbook Records Management System in Japanese in 1988.
Sustained modulation of intestinal bacteria by exclusive enteral nutrition used to treat children with Crohn’s disease
Authors: LEACH S. T. , MITCHELL H. M. , ENG W. R. , ZHANG L. , DAY A. S.
Published: October 2008

Background  The use of exclusive enteral nutrition to treat paediatric Crohn’s disease (CD) is widely accepted, although the precise mechanism(s) of action remains speculative.

Aim  To investigate the changes to key intestinal bacterial groups of Eubacteria, Bacteroides, Clostridium coccoides, Clostridium leptum and Bifidobacteria, during and after exclusive enteral nutrition treatment for CD in paediatric patients and correlate these changes to disease activity and intestinal inflammation.

Methods  Stool was collected from six children at diagnosis of CD, during exclusive enteral nutrition and 4 months post‐therapy, and from seven healthy control children. The diversity of bacteria was assessed by polymerase chain reaction‐denaturing gradient gel electrophoresis with changes to bacterial diversity measured by Bray–Curtis similarity, intestinal inflammation assessed by faecal S100A12 and the disease activity assessed by PCDAI.

Results  A significantly greater change in intestinal bacterial composition was seen with exclusive enteral nutrition treatment compared with controls. Further, the intestinal bacteria remained altered 4 months following exclusive enteral nutrition completion. Changes in the composition of Bacteroides were associated with reduced disease activity and inflammation.

Conclusions  Exclusive enteral nutrition reduces bacterial diversity and initiates a sustained modulation of all predominant intestinal bacterial groups. Exclusive enteral nutrition may reduce inflammation through modulating intestinal Bacteroides species. The implications of these results for exclusive enteral nutrition therapy and CD pathogenesis should now be the subject of further investigation.
Combination testing for antibodies in the diagnosis of coeliac disease: comparison of multiplex immunoassay and ELISA methods
Authors: RASHTAK S. , ETTORE M. W. , HOMBURGER H. A. , MURRAY J. A.
Published: October 2008

Background  Tissue transglutaminase (TTG) antibodies and newly developed deamidated gliadin peptide (DGP) antibodies have better accuracy than native gliadin antibodies. Multiplex immunoassay (MIA) measures multiple antibodies simultaneously providing a complete antibody phenotype with reduced turnaround time and cost.

Aim  To evaluate the agreement between MIA and enzyme‐linked immunosorbent assay (ELISA) test results for coeliac antibodies in biopsy‐proven coeliac patients and controls and to model the diagnostic utility of combination testing.

Methods  We compared the sensitivity, specificity and accuracy of MIA and ELISA methods for TTG and DGP antibodies in mainly adult untreated coeliac patients (n = 92) and controls (n = 124).

Results  There was excellent agreement and a significant correlation between the results of MIA and ELISA methods (κ > 0.8, r > 0.7) for all tests, except TTG IgG. Diagnostic indices of individual and combination tests measured by the MIA method did not differ significantly from those measured by ELISA. The combination tests slightly increased sensitivity (if any test was positive) and specificity (if all tests were positive) compared to the individual tests.

Conclusions  Multiplex immunoassay testing for antibodies is as accurate as ELISA for coeliac disease diagnosis and has practical advantages over ELISA method. Rational combination testing can help identify patients who need intestinal biopsy and may reduce unnecessary biopsies.
Insulin resistance is a major determinant of sustained virological response in genotype 1 chronic hepatitis C patients receiving peginterferon α‐2b plus ribavirin
Authors: CHU C.‐J. , LEE S.‐D. , HUNG T.‐H. , LIN H.‐C. , HWANG S.‐J. , LEE F.‐Y. , LU R.‐H. , YU M.‐I. , CHANG C.‐Y. , YANG P.‐L. , LEE C.‐Y. , CHANG F.‐Y.
Published: October 2008

Background  Cross‐sectional studies suggest insulin resistance is strongly associated with hepatic steatosis and fibrosis in patients with chronic hepatitis C (CHC), which might affect the efficacy of antiviral therapy.

Aim  To investigate retrospectively the impact of insulin resistance on treatment response in Chinese genotype 1 CHC patients receiving a 24‐week course therapy with peginterferon α‐2b/ribavirin.

Methods  A total of 133 biopsy‐proven CHC patients were enrolled for analyses. Insulin resistance was evaluated by homeostasis model assessment of insulin resistance (HOMA‐IR). Hepatic fibrosis was graded by the METAVIR scoring system.

Results  Mean HOMA‐IR progressively elevated along with the severity of hepatic fibrosis (F1–F2 fibrosis: 2.55 ± 0.16 vs. F3–F4 fibrosis: 3.61 ± 0.20, P < 0.001). Compared with patients with sustained virological response (SVR), patients without SVR had significantly higher percentages of F3–F4 fibrosis (62.2% vs. 21.6%, P < 0.001) and baseline high viral load (≥600 000 IU/mL; 64.4% vs. 35.6%, P = 0.038). In addition, patients without SVR had significantly higher plasma levels of insulin (15.03 ± 0.89 vs. 10.19 ± 0.55 μU/mL, P < 0.001) and HOMA‐IR values (3.76 ± 0.23 vs. 2.50 ± 0.15, P < 0.001). Multivariate analyses showed that F1–F2 fibrosis (odds ratio: 4.49, P = 0.001), HOMA‐IR < 2 (odds ratio: 7.15, P = 0.005) and pre‐treatment hepatitis C virus RNA < 600 000 IU/mL (odds ratio: 3.26, P = 0.012) were the independent factors associated with SVR.

Conclusions  Insulin resistance is a major determinant of SVR in genotype 1 CHC patients receiving peginterferon α‐2b/ribavirin. Strategies to modify insulin resistance may be effective in enhancing SVR before or during anti‐viral therapy.
Assessment of asymptomatic liver fibrosis in alcoholic patients using fibroscan: prospective comparison with seven non‐invasive laboratory tests
Authors: NGUYEN‐KHAC E. , CHATELAIN D. , TRAMIER B. , DECROMBECQUE C. , ROBERT B. , JOLY J.‐P. , BREVET M. , GRIGNON P. , LION S. , LE PAGE L. , DUPAS J.‐L.
Published: October 2008

Background  Systematic screening for liver fibrosis in heavy‐drinking patients is a challenge.

Aims  To assess Fibroscan for non‐invasive diagnosis of asymptomatic liver fibrosis in alcohol abuse patients, to determine diagnostic liver stiffness cut‐off values and to compare performance of Fibroscan with seven non‐invasive laboratory tests.

Methods  One hundred and three alcoholic patients were studied. Liver fibrosis was staged by METAVIR system. Fibroscan, Fibrotest, Fibrometer, Hepascore, APRI, PGA, PGAA and hyaluronic acid tests were performed. Liver stiffness cut‐offs were determined using receiver‐operating characteristic (ROC) curves.

Results  Liver stiffness was correlated with fibrosis (r = 0.72, P < 0.014), with median at 5.7, 6.3, 8.4, 15 and 47.3 kPa for F0 (n = 8), F1 (n = 18), F2 (n = 24), F3 (n = 20) and F4 (n = 33) stage fibrosis respectively. For Fibroscan, areas under ROC curves (AUROCs) were 0.84 (95% CI: 0.73–0.95) (F ≥ 1), 0.91 (0.85–0.98) (F ≥ 2), 0.90 (0.82–0.97) (F ≥ 3) and 0.92 (0.87–0.98) (F = 4), yielding diagnostic stiffness cut‐offs of 5.9 (F ≥ 1), 7.8 (F ≥ 2), 11 (F ≥ 3) and 19.5 (F4) kPa. Sensitivity, specificity, PPV and NPV were 80%, 90.5%, 93% and 70% for F ≥ 2, and 85.7%, 84.2%, 68.6% and 87.9% for F = 4. Performance of Fibroscan was higher than seven laboratory tests, for which AUROCs ranged from 0.66 to 0.77 (F ≥ 1), from 0.54 to 0.82 (F ≥ 2), from 0.43 to 0.88 (F ≥ 3) and from 0.56 to 0.89 (F = 4), with significant difference only vs. APRI (P < 0.001) and Hepascore (P = 0.04). Combining Fibroscan with each tests did not improve performance.

Conclusions  Fibroscan is effective to assess liver fibrosis in alcoholic patients. Instant screening of liver fibrosis in heavy drinkers is feasible without liver biopsy.
Clinical trial: gluten microchallenge with wheat‐based starch hydrolysates in coeliac disease patients – a randomized, double‐blind, placebo‐controlled study to evaluate safety
Authors: KAUKINEN K. , SALMI T. , COLLIN P. , HUHTALA H. , KÄRJÄ‐LAHDENSUU T. , MÄKI M.
Published: October 2008

Background  Wheat‐based starch hydrolysates such as glucose syrups, dextrose and maltodextrins are found in more than 50% of European processed food. These products contain low amounts of residual gluten and it has been questioned whether they are safe for coeliac disease patients.

Aim  To investigate whether coeliac disease patients can safely consume wheat‐based starch hydrolysate products.

Methods  This randomized, double‐blind, placebo‐controlled, prospective follow‐up study involved 90 coeliac disease patients in remission randomized to consume glucose syrups, maltodextrins or placebo for 24 weeks. Small bowel mucosal morphology and inflammation, symptoms, coeliac serology and malabsorption laboratory data were evaluated at baseline and at the end of the study.

Results  Daily ingestion of wheat‐based starch hydrolysates, glucose syrups and maltodextrins, had no deleterious effect on small‐bowel mucosal villous architecture or inflammation in coeliac disease patients when compared to the placebo group. Neither were there any significant differences in gastrointestinal symptoms, serology or malabsorption parameters after 24 weeks.

Conclusions  Wheat‐based starch hydrolysates, glucose syrups and maltodextrins did not have harmful effect on coeliac disease patients. Coeliac patients can thus safely continue to consume these products.
Community‐based treatment for chronic hepatitis C in drug users: high rates of compliance with therapy despite ongoing drug use
Authors: WILKINSON M. , CRAWFORD V. , TIPPET A. , JOLLY F. , TURTON J. , SIMS E. , HEKKER M. , DALTON J. , MARLEY R. , FOSTER G. R.
Published: October 2008

Background  Chronic hepatitis C infection is common in drug users. Treatment of injectors is possible under controlled conditions, but many have not yet been included in treatment programmes as there are concerns about their ability to comply with therapy. It is not known which factors influence compliance.

Aim  To examine the hypothesis that active drug users would comply with anti‐viral therapy if treatment was delivered in a convenient manner.

Methods  We established a community‐based treatment programme and offered anti‐viral therapy to all drug users who wanted it. Few pre‐treatment requirements were imposed and, by design, compliance with therapy was reviewed after 50 patients had completed treatment.

Results  Of the 441 patients who were known to be HCV RNA positive and attended the specialist addiction services during the period of this study, eighty three patients considered therapy. Twenty patients did not undergo treatment: 14 declined and 6 had medical conditions that precluded it. In 60 episodes (58 patients) where treatment had been completed, compliance was greater than 80% and homelessness, active illicit drug use and pre‐treatment antidepressant therapy were not associated with noncompliance. In 25 of 49 treatment episodes that were assessed 6 months after treatment cessation, a sustained virological response (51%) was seen.

Conclusion  Active drug users using illicit drugs can be successfully treated in community‐based clinics.
Changing perceptions and practices regarding aspirin, nonsteroidal anti‐inflammatory drugs, and cyclooxygenase‐2 selective nonsteroidal anti‐inflammatory drugs among US primary care providers
Authors: ELNACHEF N. , SCHEIMAN J. M. , FENDRICK A. M. , HOWDEN C. W. , CHEY W. D.
Published: October 2008

Background  Our understanding of the benefits and risks of aspirin non steroidal anti‐inflammatory drugs (NSAIDs), cyclooxygenase‐2 (COX‐2) selective NSAIDs and gastro‐protective agents (GPAs) continues to expand.

Aim  To assess the perceptions and practices of US primary care physicians (PCPs) regarding the use of aspirin, NSAIDs, COX‐2 selective NSAIDs and GPA.

Methods  A 34‐question survey was administered to 1000 US PCPs via the internet. Questions addressed issues involving aspirin, NSAIDs, COX‐2 selective NSAIDs, and GPAs. Around 491 of 1000 PCPs had participated in a similar survey conducted in 2003.

Results  Eighty‐five per cent of PCPs reported that >25% of their patients were taking aspirin for preventive reasons. Nineteen per cent performed a risk calculation when deciding whether to start aspirin for cardioprotection. Fifty‐four per cent recommended a proton pump inhibitor (PPI) for a patient with a recently healed ulcer who required ongoing aspirin. Thirty‐one per cent reported prescribing NSAIDs more often and 52% were more likely to recommend a GPA with an NSAID than in 2003. Although PCPs were less likely to recommend a COX‐2 selective NSAID compared to 2003, only 41% felt that rofecoxib increased cardiovascular risk. One‐third felt that celecoxib and traditional NSAIDs were associated with increased cardiac risk.

Conclusion  This survey identified several areas of ongoing confusion regarding aspirin, NSAIDs, COX‐2 selective NSAIDs and GPAs, which should help direct future educational efforts regarding the benefits, risks and appropriate use of these agents.
Systematic review: adverse event reports for oral sodium phosphate and polyethylene glycol
Authors: BELSEY J. , EPSTEIN O. , HERESBACH D.
Published: October 2008

Background  Screening colonoscopy exposes healthy patients to the risk of serious adverse events associated with bowel preparation. Randomized controlled trials are not an effective method for evaluating this risk.

Aim  To search published literature in order to characterize the risk of adverse events associated with oral polyethylene glycol (PEG) or sodium phosphate (NaP).

Methods  A systematic review identified case reports of any serious events associated with PEG or NaP. Reports to the Food and Drug Administration (FDA) were also examined.

Results  Fifty‐eight publications of significant events in 109 patients using NaP and 22 patients using PEG were identified. As the total number of prescriptions issued is unknown, rates for the two agents cannot be directly compared. Most commonly reported were electrolyte disturbances, renal failure and colonic ulceration for NaP and Mallory–Weiss tear, electrolyte disturbances and allergic reactions for PEG between January 2006 and December 2007; there were 171 cases of renal failure reported to the FDA following use of NaP and 10 following PEG.

Conclusions  Adverse events following bowel preparation are uncommon, but potentially serious. Given that many of these patients are healthy individuals undergoing screening, the benefit/risk ratio must be carefully considered when deciding which preparation to prescribe in individual patients.
Evaluating the process of care in nonvariceal upper gastrointestinal haemorrhage: a survey of expert vs. non‐expert gastroenterologists
Authors: ESRAILIAN E. , GRALNEK I. M. , JENSEN D. , LAINE L. , DULAI G. S. , EISEN G. , SPIEGEL B. M. R.
Published: October 2008

Background  When faced with the same facts, physicians often make different decisions.

Aim  To perform a survey to measure the process of care and variations in decision‐making in nonvariceal upper gastrointestinal tract haemorrhage (NVUGIH) and compare results between experts and non‐experts.

Methods  We administered a vignette survey to elicit knowledge and beliefs about NVUGIH, including 13 ‘best practice’ guidelines. We compared guideline compliance between experts and non‐experts.

Results  One hundred and eighty‐eight gastroenterologists responded (46%). Experts endorsed more ‘best practices’ than non‐experts (93% vs. 85%; P = 0.002). Non‐experts were more likely to endorse incorrectly bolus dosing vs. continuous infusion of intravenous proton pump inhibitors (PPIs; 92% vs. 64%; P = 0.005) and to select standard‐channel vs. large‐channel endoscopes in high‐risk bleeding (100% vs. 85%; P = 0.04). There were wide variations within groups regarding the timing of nasogastric lavage, use of promotility agents, use of hemoclips and appropriateness of snaring clots overlying ulcers.

Conclusions  Experts are more likely to comply with NVUGIH guidelines. Non‐experts diverge from experts in the dosing of PPIs and choice of endoscope in high‐risk bleeding. Moreover, there are wide variations in key practices even within groups. This suggests that best practices have been generally well disseminated, but that persistent disconnects exist that should be further investigated.
Mannose-binding lectingene polymorphic variants predispose to the development of bronchopulmonary complications but have no influence on other clinical and laboratory symptoms or signs of common variable immunodeficiency
Authors: Litzman J , Freiberger T , Grimbacher B , Gathmann B , Salzer U , Pavlík T , Vlček J , Postránecká V , Trávníčková Z , Thon V
Published: October 2008

Mannose-binding lectin (MBL), activating protein of the lectin pathway of the complement system, is an important component of the non-specific immune response. MBL2 gene polymorphisms, both in the coding and promoter regions, lead to low or deficient serum MBL levels. Low serum MBL levels were shown to be associated with serious infectious complications, mainly in patients in whom other non-specific immune system barriers were disturbed (granulocytopenia, cystic fibrosis). We have analysed two promoter (−550 and −221) and three exon (codons 52, 54 and 57) MBL2 polymorphisms in a total of 94 patients with common variable immunodeficiency (CVID) from two immunodeficiency centres. Low-producing genotypes were associated with the presence of bronchiectasis (P = 0·009), lung fibrosis (P = 0·037) and also with respiratory insufficiency (P = 0·029). We could not demonstrate any association of MBL deficiency with age at onset of clinical symptoms, age at diagnosis, the number of pneumonias before diagnosis or serum immunoglobulin (Ig)G, IgA and IgM levels before initiation of Ig treatment. No association with emphysema development was observed, such as with lung function test abnormalities. No effect of MBL2 genotypes on the presence of diarrhoea, granuloma formation, lymphadenopathy, splenomegaly, frequency of respiratory tract infection or the number of antibiotic courses of the patients was observed. Our study suggests that low MBL-producing genotypes predispose to bronchiectasis formation, and also fibrosis and respiratory insufficiency development, but have no effect on other complications in CVID patients.