bluuebunny/crossref_metadata_2025 huggingface dataset:
How to measure oxidative stress in an ecological context: methodological and statistical issues
Authors: Hõrak Peeter , Cohen Alan
Published: September 2010

1. Reactive oxygen and nitrogen species can damage biomolecules if these lack sufficient antioxidant protection. Maintaining and up‐regulating antioxidant defenses and repair of the damaged molecules require resources that could potentially be allocated to other functions, including life‐history and signal traits.

2. Identifying the physiological mechanisms causing and counteracting oxidative damage may help to understand evolution of oxidative balance systems from molecular to macroevolutionary levels. This review addresses methodological and statistical problems of measuring and interpreting biomarkers of oxidative stress or damage.

3. A major methodological problem is distinguishing between controlled and uncontrolled processes that can lead either to shifts in dynamic balance of redox potential or cause pathological damage. An ultimate solution to this problem requires establishing links between biomarkers of antioxidant defenses and oxidative damage and components of fitness.

4. Biomarkers of redox balance must correspond to strict technical criteria, most importantly to validated measurement technology. Validation criteria include intrinsic qualities such as specificity, sensitivity, assessment of measurement precision, and knowledge of confounding and modifying factors.

5. The complexity of oxidative balance systems requires that assay choice be informed by statistical analyses incorporating context at biochemical, ecological and evolutionary levels. We review proper application of statistical methods, such as principal components analysis and structural equation modelling, that should help to account for these contexts and isolate the variation of interest across multiple biomarkers simultaneously.
Estimating the adaptive potential of critical thermal limits: methodological problems and evolutionary implications
Authors: Rezende Enrico L. , Tejedo Miguel , Santos Mauro
Published: September 2010

1. Current studies indicate that estimates of thermal tolerance limits in ectotherms depend on the experimental protocol used, with slower and presumably more ecologically relevant rates of warming negatively affecting the upper thermal limits (CTmax). Recent empirical evidence also gives credence to earlier speculations suggesting that estimates of heritability could drop with slower heating rates.

2. Using published data from the fruit fly Drosophila melanogaster, we show that empirical patterns can be explained if flies’ physical condition decreases with experimental time in thermal tolerance assays. This problem could even overshadow potential benefits of thermal acclimation, also suggesting that a drop in CTmax with slower heating rates does not necessarily rule out beneficial acclimatory responses.

3. Numerical results from a simple illustrative model show that no clear conclusions can be obtained on how the phenotypic variance in CTmax will be affected with different rates of thermal change. Conversely, the genetic variance and estimated heritabilities are expected to drop with slower heating rates, hence ramping rates in experiments aiming to study the evolutionary potential of thermal tolerance to respond to global warming should be as fast as possible (within the range in which measurement accuracy and physical condition are not affected).

4. Measurements under ecologically realistic warming rates should also consider the impact of other physiological and behavioural strategies that might partly compensate the negative effects of slow heating rates. However, there are situations in which slow heating rates closely mimic natural conditions, as those encountered by some aquatic ectotherms. These heating rates may be an issue of major concern in these species, given its negative impact on CTmax and its adaptive potential.
Haemorrhoidectomy: prevalence and risk factors of urine retention among post recipients
Authors: Lin Yu‐Hua , Liu Kuang‐Wen , Chen Hsin‐Pao
Published: September 2010

Aims and objectives.  The purpose of this study was to explore the prevalence and risk factors of urine retention among posthaemorrhoidectomy recipients.

Background.  Haemorrhoids are one of the most common functional disorders of the anus. The Haemorrhoidectomy surgical procedure is one of the primary treatments for more severe haemorrhoidal occurrences, such as for third‐ and/or fourth‐degree haemorrhoid conditions. Urine retention is a common acute complication after operation, but rare study conducted by nurses in Taiwan to explore the prevalence and risk factors.

Design.  A retrospective chart review was conducted.

Methods.  Data from a prospectively maintained database on patients who had undergone haemorrhoidectomy between April 2004 – August 2008 were retrospectively analysed. A total of 469 charts were used in this analysis. The following outcomes were studied: patient profiles, haemorrhoid type and severity, anaesthesia methods, length of operating room stay, urine retention and management, intravenous fluid given during operation and length of stay.

Results.  The overall urinary retention rate was 32·8% (n = 153). Significant risk factors associated with postoperative urinary retention included severity of haemorrhoid and anaesthesia methods. Logistic regression analysis revealed that epidural anaesthesia (p = 0·008), spinal anaesthesia (p = 0·016) and haemorrhoids with a severity of three degrees or higher (p = 0·017) were predictors of urinary retention post haemorrhoidectomy.

Conclusions.  Acute urinary retention can have an adverse effect on a patient’s quality of care. Careful follow‐up of patients with these risk factors can help nurses spot posthaemorrhoidectomy urinary retention early.

Relevance to clinical practice.  The prevalence of acute urinary retention post haemorrhoidectomy is common. Surgical ward nurses should therefore take the responsibility regarding the impact of urinary retention and seeking appropriate nursing interventions of induced urination.
Patients’ perceptions of information and support received from the nurse specialist during HCV treatment
Authors: Grogan Anne , Timmins Fiona
Published: September 2010

Aim. To identify patients’ perceptions of support received from the nurse specialist during Hepatitis C virus (HCV) treatment.

Background. HCV is a worldwide health problem. However, it is a treatable disease and treatment success rates are high. Unfortunately, treatment comes with a multitude of adverse side effects and patients require informational and psychological support from specialist nurses while on treatment. To date, there is little nursing research on support received from this specialist nursing care.

Design. This study used a quantitative descriptive design.

Method. A 59‐item questionnaire collected data from 106 patients with a diagnosis of HCV attending a HCV outpatient clinic.

Results. Overall, patients were very satisfied with support received. Advice on contraception was well received. However, many patients did not feel supported with regard to advice on sleep management. There were no statistically significant differences between overall satisfaction and gender, age, genotype and risk factor. However, there were significant correlations found between support received and reported genotype. Those patients presenting with genotype 1, who are mostly infected through blood or blood products, indicated that they require more support in relation to information on side effects of treatment, quality of life and support groups. Specific approaches to support and advice for this cohort may need to be incorporated into current services.

Conclusion. Results of this study reinforce the need for the ongoing use of specialist nurse services and development of this service where no such facilities exist. In addition, the service may need to further recognise and support the information and psychological needs of patients with differing modes of HCV infection.

Relevance to clinical practice. Findings provide information to practising nurse specialists about patient’s views of information and support received from nurse specialists in HCV treatment centres and identify where deficits exist.
Frequency and barriers of underreported needlestick injuries amongst Iranian nurses, a questionnaire survey
Authors: Azadi Arman , Anoosheh Monireh , Delpisheh Ali
Published: September 2010

Aims and objectives.  To determine the frequency of needlestick injuries and barriers of reporting such injuries amongst Iranian nurses.

Background.  Exposure to blood‐borne pathogens because of needlestick injuries in particular is a potential risk for healthcare workers, including clinical nurses. The burden of sharp injuries sustained by healthcare workers is still unclear, primarily because of underreporting.

Design.  A cross‐sectional study was undertaken amongst 111 clinical nurses working in five major teaching hospitals in Tehran/Iran during 2007–2008 who were randomly selected.

Methods.  A validated self‐reported questionnaire containing demographic characteristics and history of experiences with contaminated needlesticks as well as probably reason/s for underreporting such injuries was used.

Results.  More than half of the enrolled nurses (54·1%, n = 60) had no experience of contaminated injuries, while the rest of 45·9% (n = 51) had experienced at least one contaminated needlestick injuries during their clinical performance. More than one‐third (34·0%, n = 38) had experienced a mean of 58 contaminated needlestick injuries during the past 12 months (crude incidence: 0·52 NSI/nurse/year). Only 14 nurses (36·8%) with needlestick injuries experiences had officially reported their experiences. The major reasons for not reporting needlestick injuries were dissatisfaction with follow‐up investigations by officials after reporting the events (33·3%) and safe/low risk considering of source patients (29·2%).

Conclusions.  Increased frequency and underreporting of needlestick injuries amongst Iranian nurses is going to be a major concern. As a preventive strategy, further interventions such as constant staff training, life‐long learning and standardising postexposure procedures are recommended.

Relevance to clinical practice.  Determining the prevalence, burden and reasons for underreporting needlestick injuries by clinical nurses are required for establishing a preventive strategy to decrease hospital infections.
Relatives’ information needs and the characteristics of their search for information – in the words of relatives of stroke survivors
Authors: Wallengren Catarina , Segesten Kerstin , Friberg Febe
Published: September 2010

Aim and objectives.  To explore relatives’ information needs and the characteristics of their information‐seeking process shortly after the stroke event and six months later.

Background.  Providing relatives of stroke survivors with information is important, as lack of information increases their uncertainty and risk becoming the ‘second patient in the family’ and early death. Therefore, it is essential to be aware of relatives’ information needs and information‐seeking process the first six months after stroke.

Design.  This qualitative study has a descriptive design.

Method.  Open‐ended interviews were conducted with sixteen relatives after stroke survivor’s admission to stroke unit and six months later with nine of these relatives. Data were analysed by means of content analysis.

Results.  The identified information needs covered the spectrum from stroke survivor’s medical condition because nurses’ actions to relatives’ changed health and life situation. Furthermore, relatives’ information‐seeking process was found to be related to their level of personal involvement, situational circumstances, different forms of knowledge and sources of information.

Conclusions.  Relatives’ search for information emerges when health and lifestyle changes occur in survivors or themselves. It is important that this information affect them personally. Also, they need to develop different forms of knowledge when they cannot trust their own competences. As a result, instead of following established curricula based on their beliefs of relatives’ information needs, nurses need to practice on identifying relatives’ information needs.

Relevance to practice.  Different information needs and characteristics described in the study can serve as guidance in the development and implementation of pedagogical interventions to support relatives of stroke survivors. One pedagogical implication is to explore what a specific relative wants to know by how he/she talks or thinks about it. Thus, it must be taken into consideration that level of personal involvement, situational circumstances, sources of information and factual knowledge, understanding and skills are intertwined.
Preoperative information needs of children undergoing tonsillectomy
Authors: Buckley Aoife , Savage Eileen
Published: September 2010

Aims and objectives.  To identify the information needs of children undergoing tonsillectomy with reference to content of information, method of delivery, information providers and timing of information provision.

Background.  Tonsillectomy can be anxiety provoking for children and preoperative preparation programmes are long recognised to reduce anxiety. However, few have been designed from the perspectives of children and to date little is known about how best to prepare children in terms of what to tell them, how to convey information to them, who can best provide information and what is the best timing for information provision.

Design.  A qualitative descriptive study.

Method.  Data were collected from nine children (aged 6–9) using interviews supported by a write and draw technique. Data were coded and categorised into themes reflecting content, method, providers and timing of information.

Results.  Children openly communicated their information needs especially on what to tell them to expect when facing a tonsillectomy. Their principal concerns were about operation procedures, experiencing ‘soreness’ and discomfort postoperatively and parental presence. Mothers were viewed as best situated to provide them with information. Children were uncertain about what method of information and timing would be most helpful to them.

Conclusion.  Preoperative educational interventions need to take account of children’s information needs so that they are prepared for surgery in ways that are meaningful and relevant to them. Future research is needed in this area.

Relevance to clinical practice.  Practical steps towards informing children about having a tonsillectomy include asking them what they need to know and addressing their queries accordingly. Child‐centred information leaflets using a question and answer format could also be helpful to children.
Gender differences on chest pain perception associated with acute myocardial infarction in Chinese patients: a questionnaire survey
Authors: Khan Jane JB , Albarran John W , Lopez Violet , Chair Sek Y
Published: September 2010

Aims.  To investigate gender differences in chest pain perception among Chinese patients with acute myocardial infarction.

Background.  Thrombolytic therapy is beneficial to outcomes of acute myocardial infarction if administered within 12 hours from the onset of chest pain. However, cardiac symptom interpretation may impact time of presentation to hospital. Differences in cardiac symptom reports by gender partly explain misdiagnoses and delays in treatment, particularly among women. Whether, such trends apply to Chinese patients with myocardial infarction is unknown.

Design.  A descriptive prospective study.

Methods.  Using questionnaires, data on demographic variables, the number of patients reporting chest pain and other chest sensations at the onset of acute myocardial infarction and chest pain intensity, description, location and radiation across the chest were collected.

Results.  A total of 128 participants equally divided by gender were recruited. Chest pain was more prevalent among men than women (84·37% vs. 67·19%, p < 0·05). Although no statistical significance was found, Chinese men had higher mean chest pain intensity scores (7·54 SD 2·35 vs. 7·51 SD 2·25) and reported less atypical chest pain (0·00% vs. 9·3%) compared with women. Men had more upper right sided chest pain (40·74% vs. 20·93%, p = 0·038) whereas women experienced increased neck pain and pain to the upper central chest, middle central chest, upper central back, middle central back and middle right back regions.

Conclusions.  Discreet gender differences in chest pain perceptions exist between Chinese men and women, with the latter group, who may be considered as a high‐risk group for missed and delayed diagnosis from myocardial infarction, reporting more atypical presentations.

Relevance to clinical practice.  Irrespective of culture, women with myocardial infarction tend to present with atypical chest pain symptoms and therefore they should be aggressively investigated.
The role of antenatal pelvic floor muscle exercises in prevention of postpartum stress incontinence: a randomised controlled trial
Authors: Mason Linda , Roe Brenda , Wong Helen , Davies Jane , Bamber Jayne
Published: September 2010

Aim.  This article reports a randomised controlled trial to determine the efficacy of antenatal pelvic floor muscle exercises in the primary prevention of postpartum stress incontinence in primiparous women.

Background.  Pelvic floor muscle exercises are effective in treating stress incontinence, yet prevention studies demonstrate equivocal findings.

Design.  Randomised controlled trial.

Method.  Pregnant women recruited from two hospitals in North‐west England were randomised to an intervention (n = 141) or control group (n = 145). Data were collected from 2005–2006. The intervention comprised four sessions of taught pelvic floor muscle exercise training during pregnancy and 8–12 maximal contractions repeated twice daily at home. A modified Bristol Female Lower Urinary Tract Symptom questionnaire, Leicester Impact Scale and Three Day Diary were administered at 20 and 36 weeks of pregnancy and three months postpartum.

Results.  The intervention group was more likely to exercise their pelvic floor muscles compared to controls at 36 weeks (p = 0·019) and three months (0·022), reporting fewer episodes of incontinence and a lower score on the Leicester Impact Scale. However, these differences were not statistically significant.

Conclusion.  Significant differences were not demonstrated between the groups in relation to incontinence episodes and degree of bother of symptoms postpartum, although trends indicate a positive effect. Further research is necessary to address issues of adherence and the effect of pelvic floor muscle exercise undertaken during pregnancy on postpartum stress urinary incontinence.

Relevance to clinical practice.  A proportion of women did not meet the required attendance at antenatal class, furthermore, few exercised their pelvic floor muscles during pregnancy according to instructions. Health professionals need to find ways to instruct and motivate women to perform pelvic floor muscles exercises regularly during pregnancy and the postpartum.
Mediating roles of social support on poststroke depression and quality of life in patients with ischemic stroke
Authors: Huang Chiung‐Yu , Hsu Mei‐Chi , Hsu Shin‐Pin , Cheng Pei‐Ching , Lin Shu‐Fen , Chuang Chia‐Hui
Published: September 2010

Aims. The purposes of this study were to examine the associations among social support, poststroke depression and quality of life among patients with first‐time ischemic stroke and to further test the impact of the dimensions of social support on poststroke depression and quality of life. The proposed models included mediation hypotheses to examine the mediating roles of social support.

Background. Although considerable attention has recently been devoted to explaining why poststroke depression and poor quality of life are frequent concomitants of stroke, little empirical work has been conducted to test predictions based on these models, especially in Taiwan.

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

Methods. The 102 patients with first‐time ischemic stroke aged 32–90 (mean = 64·5, SD 11·8) were recruited from a large general hospital in Taiwan and through face‐to‐face survey interviews. The participants were assessed using the Social Support Inventory, Centre for Epidemiologic Studies Depression Scale, Barthel Index, the Instrumental Activities of Daily Living and Quality of Life Index‐Stroke Version. The models were tested and confirmed through the application of structural equations with proposed variables.

Results. Nearly half of the Taiwanese patients with stroke felt depressed. Social support fully mediated the prediction of quality of life by age and partially mediated the prediction of quality of life by functional ability. Social support partially mediated the prediction of poststroke depression by functional ability.

Conclusion. This study provides researchers and nurses with increased understanding of the mediating role of social support between functional ability and poststroke depression/quality of life. Social support may be a promising intervening variable in stroke outcome.

Relevance to clinical practice. The results suggest several clinical implications. The inclusion of social support in poststroke depression and quality of life after stroke may help nurses in planning stroke programme development, patient education, effective and efficient use of health care resources and effective rehabilitation, especially in those individuals who lack support or who are involved in stressful situations.
A systematic review of the literature: workplace violence in the emergency department
Authors: Taylor Jessica L , Rew Lynn
Published: September 2010

Aims and objectives. To synthesise the body of literature on workplace violence in the emergency department and to identify characteristics of intervention studies that are the basis for guiding best practice modelling in the clinical setting. The research question addressed was what are the characteristics and findings of studies since 2004 on workplace violence in the emergency department?

Background. Emergency departments are prone to increased incidents of workplace violence. Workplace violence in the health care setting has become a hot topic of policy, political debate and research in recent years. Despite the research that has been carried out in this area, little consensus exists as to what are the best practices for mitigating violence in this setting.

Design. Systematic literature review.

Methods. Search using four online databases, including MEDLINE, CINAHL, PsycINFO and the Dissertations and Theses Full Text Database.

Results. Most research focused on the incidence rates of workplace violence in the emergency department and effects on staff. There was a significant lack of intervention studies to provide a framework for guiding evidence‐based practice. Themes of under‐reporting violence, barriers and attitudes towards reporting, description and characterisation of incidents of violence, predisposing factors and the concept of safety or lack of fear were all major content areas addressed in the literature.

Conclusions. Incidence of workplace violence in the emergency department has been well documented in numerous published studies. Emergency department workers are exposed to significant rates of physical and verbal abuse. Under‐reporting of workplace violence in the emergency department is common and contributes to the difficulty in accurately tracking violence.

Relevance to clinical practice. Future research must move beyond descriptive studies to include more advanced research methods. Few practice‐guiding implications can be gained from this body of research because of the lack of intervention studies.
Psychometric properties of the Chinese version of the Bipolar Spectrum Diagnostic Scale
Authors: Chu Hsin , Lin Chuan‐Ju , Chiang Kai‐Jo , Chen Chiung‐Hua , Lu Ru‐Band , Chou Kuei‐Ru
Published: September 2010

Aim and objectives.  The aim of this study was to test the psychometric properties of the Chinese version of the Bipolar Spectrum Diagnostic Scale (C‐BSDS) in a Chinese population to serve as an aid to clinical diagnosis of bipolar disorders.

Background.  Bipolar spectrum disorders are often misdiagnosed because of the wide range of symptoms seen in patients. The consequences of delayed diagnoses or misdiagnoses can be devastating.

Design.  A cross‐sectional research design.

Method.  Two hundred patients with affective disorders from a psychiatric outpatient clinic in Taiwan were enrolled. Internal consistency reliability and two‐week test–retest reliability were performed to evaluate the reliability of the C‐BSDS. Expert content validity and factor analysis were used for testing construct validity. To evaluate sensitivity and specificity, the Chinese version of the Mini International Neuropsychiatric Interview (MINI) was used as the gold standard for diagnosis.

Results.  The internal consistency coefficient measured by intra‐class correlation (ICC) was 0·81, the test–retest reliability coefficient was 0·85 and the expert validity was 0·85. For construct validity, ‘irritable and hyper‐energetic factors’ and ‘depressed and lack of energy factors’ were extracted by factor analysis. These two factors reflected the structure of the original scale and accounted for 33·27% of the variance. The optimal cut‐off was 12, which yielded a sensitivity of 74 and a specificity of 0·97 for detecting bipolar disorder and for bipolar II disorder these were 0·79 and 0·68, respectively.

Conclusions.  The C‐BSDS showed good reliability and validity, and the results were consistent with the English version of the BSDS. Therefore, the C‐BSDS is an effective tool for evaluation of a Chinese population.

Relevance to clinical practice.  The BSDS can further increase the detection rate of bipolar disorders, especially bipolar II disorder, with satisfactory sensitivity and specificity. It can effectively assist with clinical screening of patients for bipolar spectrum disorders.
Debunking the ‘digital native’: beyond digital apartheid, towards digital democracy
Authors: Brown C. , Czerniewicz L.
Published: September 2010

This paper interrogates the currently pervasive discourse of the ‘net generation’ finding the concept of the ‘digital native’ especially problematic, both empirically and conceptually. We draw on a research project of South African higher education students' access to and use of Information and Communication Technologies (ICTs) to show that age is not a determining factor in students' digital lives; rather, their familiarity and experience using ICTs is more relevant. We also demonstrate that the notion of a generation of ‘digital natives’ is inaccurate: those with such attributes are effectively a digital elite. Instead of a new net generation growing up to replace an older analogue generation, there is a deepening digital divide in South Africa characterized not by age but by access and opportunity; indeed, digital apartheid is alive and well. We suggest that the possibility for digital democracy does exist in the form of a mobile society which is not age specific, and which is ubiquitous. Finally, we propose redefining the concepts ‘digital’, ‘net’, ‘native’, and ‘generation’ in favour of reclaiming the term ‘digitizen’.
Net generation students: agency and choice and the new technologies
Authors: Jones C. , Healing G.
Published: September 2010

Based on research investigating English first‐year university students, this paper examined the case made for a new generation of young learners often described as the Net Generation or Digital Natives in terms of agency and choice. Generational arguments set out a case that links young people's attitudes and orientations to their lifelong exposure to networked and digital technologies. This paper drew on interview data from mixed methods research to suggest that the picture is more complex than the equation of exposure to new technologies and a generational change of attitudes and capacities. Starting from the position that interaction with technology is mediated by activity and an intentional stance, we examined the choices students make with regard to the technologies they engage with. We explored the perceived constraints students face and the way they either comply or resist such constraints. We concluded that agency actively shapes student engagement with technology but that an adequate conception of agency must expand beyond the person and the self to include notions of collective agency identifying the meso level as an activity system that mediates between the students and their technological setting.
Beyond natives and immigrants: exploring types of net generation students
Authors: Kennedy G. , Judd T. , Dalgarno B. , Waycott J.
Published: September 2010

Previously assumed to be a homogenous and highly skilled group with respect to information and communications technology, the so‐called Net Generation has instead been shown to possess a diverse range of technology skills and preferences. To better understand this diversity, we subjected data from 2096 students aged between 17 and 26 from three Australian universities to a cluster analysis. Through this analysis, we identified four distinct types of technology users: power users (14% of sample), ordinary users (27%), irregular users (14%) and basic users (45%). A series of exploratory chi‐square analyses revealed significant associations between the different types of technology users and the university that students attended, their gender and age and whether the student was local or international. No associations were found for analyses related discipline area, socio‐economic status or rurality of residence. The findings are discussed in light of the rhetoric associated with commentaries about the Net Generation, and suggestions about their implications for teaching and learning in universities are offered.
Creating a multidisciplinary low back pain guideline: anatomy of a guideline adaptation process
Authors: Harstall Christa , Taenzer Paul , Angus Donna K. , Moga Carmen , Schuller Tara , Scott N. Ann
Published: September 2010

Rationale, aims and objectives  A collaborative, multidisciplinary guideline adaptation process was developed to construct a single overarching, evidence‐based clinical practice guideline (CPG) for all primary care practitioners responsible for the management of low back pain (LBP) to curb the use of ineffective treatments and improve patient outcomes.

Methods  The adaptation strategy, which involved multiple committees and partnerships, leveraged existing knowledge transfer connections to recruit guideline development group (GDG) members and ensure that all stakeholders had a voice in the guideline development process. Videoconferencing was used to coordinate the large, geographically dispersed GDG. Information services and health technology assessment experts were used throughout the process to lighten the GDG's workload.

Results  The GDG reviewed seven seed guidelines and drafted an Alberta‐specific guideline during 10 half‐day meetings over a 12‐month period. The use of ad hoc subcommittees to resolve uncertainties or disagreements regarding evidence interpretation expedited the process. Challenges were encountered in dealing with subjectivity, guideline appraisal tools, evidence source limitations and inconsistencies, and the lack of sophisticated evidence analysis inherent in guideline adaptation. Strategies for overcoming these difficulties are discussed.

Conclusion  Guideline adaptation is useful when resources are limited and good‐quality seed CPGs exist. The Ambassador Program successfully utilized existing stakeholder interest to create an overarching guideline that aligned guidance for LBP management across multiple primary care disciplines. Unforeseen challenges in guideline adaptation can be overcome with credible seed guidelines, a consistently applied and transparent methodology, and clear documentation of the subjective contextualization process. Multidisciplinary stakeholder input and an open, trusting relationship among all contributors will ensure that the end product is clinically meaningful.
Interhospital variation in appropriateness of cataract surgery
Authors: Llorente César , Blasco Juan A. , Quintana José M. , Bilbao Amaia , Alberdi Txomin , Lacalle Juan R. , Begiristain José M. , Baré Marisa ,   the IRYSS‐Cataract Group
Published: September 2010

Objective  The aim of this study was to analyse the inter‐hospital variation in the appropriateness of cataract phacoemulsification in Spain.

Methods  This observational, multicentre, prospective study involved patients aged 18–90 years. Each phacoemulsification intervention was classified as ‘necessary’, ‘appropriate’, ‘uncertain’ or ‘inappropriate’ according to explicit appropriateness criteria previously established using the RAND/UCLA methodology. A descriptive statistical analysis was performed, followed by univariate and multivariate logistic regression analysis, in order to examine the differences between hospitals.

Results  In total, 5063 patients from 15 hospitals were enrolled. The percentage of patients in each hospital who inappropriately underwent phacoemulsification varied from 1.2% to 24.0% (P < 0.0001). The most common inappropriate scenario was that of patients with a simple, unilateral cataract with no limitation of their visual function, with a pre‐surgery visual acuity of ≥0.5 in both eyes, and for whom surgical correction would involve low technical complexity.

Conclusions  The variation in appropriateness of phacoemulsification cannot be attributed solely to the clinical differences between the hospitals' patients. There is room for improvement in the appropriate indication of phacoemulsification. Measures based on the dissemination of appropriateness criteria might improve quality of care.
Shared care for hearing complaints: guideline effects on patient flow
Authors: Duijvestijn Jan A. , Grutters Janneke P. C. , Chenault Michelene N. , Joore Manuela A. , Manni Johannes J. , Anteunis Lucien J. C.
Published: September 2010

Rationale, aims and objectives  A national guideline was proposed to enable shared care in hearing complaints and therefore to change patient flows. In this study the effect of this guideline is evaluated.

Methods  From a total of 3500 patients with hearing complaints, consulting the Ear Nose and Throat Department of a large non‐university hospital in the Netherlands in 2002, a random sample of 1000 patients was selected. Patient flow was simulated according to guideline criteria with as main outcome measures: the effect of the guideline on patient flow.

Results  Simulation of the consensus guideline did not really alter patient flow, with 89% to 97% of the patients still being referred to the Ear Nose and Throat specialist or Audiological Centre. Age, ear operations in the past and asymmetric hearing loss are the most important factors determining whether a person is labelled as a patient in need of medical care.

Conclusion  The present study emphasizes the importance of designing evidence‐based guidelines for shared care.
Patients Assessment of Chronic Illness Care (PACIC) in two Australian studies: structure and utility
Authors: Taggart Jane , Chan Bibiana , Jayasinghe Upali W. , Christl Bettina , Proudfoot Judy , Crookes Patrick , Beilby Justin , Black Deborah , Harris Mark F.
Published: September 2010

Aims  To validate the Patients Assessment of Chronic Illness Care (PACIC) among patients with chronic disease in the Australian context and to examine the relationship between patient‐assessed quality of care and patient and practice characteristics.

Methods  Cross‐sectional analysis of baseline data in two independent health service intervention studies that involved patients with type 2 diabetes, ischaemic heart disease and/or hypertension in general practice. The first study involved 2552 patients from 60 urban and rural general practices. The second involved 989 patients from 26 practices in Sydney. Patients were mailed a questionnaire, which included the PACIC and Short Form Health Survey. Factor analysis was performed and the factor scores and total PACIC were analysed using multi‐level regression models against practice and patient characteristics.

Results  Factor analysis revealed a two‐factor solution with similar loading of PACIC items in both studies: one for shared decision making and self‐management and the other for planned care. Practice characteristics were not related to PACIC scores. Scores were related to patient characteristics – education, retirement, type and number and duration of conditions.

Conclusions  The two‐factor structure of the PACIC found in these Australian studies is different from the five‐factor structure found in the US and the European studies. This may be related to differences in the way patients interact with the health system especially the use of Team Care plans. The association of total scores with patient characteristics was consistent with those found in other studies including a lack of association with gender, age and ethnicity. These findings should be taken into consideration when comparing patient‐assessed quality of care between countries using this tool.
Decisions on pharmacogenomic tests in the USA and Germany
Authors: Wegwarth Odette , Day Robert W. , Gigerenzer Gerd
Published: September 2010

Background  With the increase in molecular genetic understanding of disease, diagnostic test development and availability are growing rapidly. This study investigated oncologists’ decision making on using pharmacogenomic tests for cancer treatment and examined cross‐cultural differences between the USA and Germany.

Methods  Pilot studies revealed that the following cues play a role in decisions on pharmacogemonic tests: stage of cancer, availability of treatment options, cost of the treatment options, severity of side effects of the treatments, therapeutic consequence of the test, cost of the test and guideline recommendation specifying use of the test. All cues were used for designing the main study comprising nine scenarios, for each of which oncologists were asked to decide whether they would order a pharmacogenomic test.

Results  On average, US oncologists opted for the test in 6.5 out of the nine scenarios (SE = 0.2), and German oncologists in 5.4 scenarios (SE = 0.2). The majority of oncologists’ decisions in both the USA (76.1%) and Germany (64%) were best explained by a simple sequential model (heuristical strategy). In the USA, the information about cost of the test was most influential on the decisions; in Germany it was the guideline recommendation of the test. When the side effects of therapy B were described as being more severe within the scenarios, choices in favour of a non‐recommended test increased by about 20% within both samples.

Conclusion  Both US and German oncologists were highly inclined to use pharmacogenomic tests, but differed in what information influenced their decisions – a difference possibly explained by the differences in the health insurance systems. Although many oncologists’ heuristical decisions were based on the valid cue of a test's guideline recommendation, an alarming number abandoned it when a therapy had potentially severe side effects.
The Postoperative Recovery Profile (PRP) – a multidimensional questionnaire for evaluation of recovery profiles
Authors: Allvin Renée , Svensson Elisabeth , Rawal Narinder , Ehnfors Margareta , Kling Anna‐Maria , Idvall Ewa
Published: September 2010

Aims and objectives  The previously developed Postoperative Recovery Profile (PRP) questionnaire is intended for self‐assessment of general recovery after surgery. The aim of this study was to further evaluate the questionnaire regarding the construct validity and ability to discriminate recovery profiles between groups. Furthermore, the item variables of greatest importance during the progress of recovery were investigated.

Methods  Post‐operative recovery was assessed during the period from discharge to 12 months after lower abdominal and orthopaedic surgery. Construct validity was evaluated by comparing the assessments from the PRP questionnaire and a global recovery scale. Recovery profiles of the diagnose groups were displayed by the cumulative proportion recovered participants over time. The importance of item variables was investigated by ranking ordering.

Results  A total of 158 patients were included. Support was given for good construct validity. The result showed that 7.6% of all possible pairs were disordered when comparing the assessments from the PRP questionnaire and the global recovery scale. Twelve months after discharge the PRP assessments discriminated significantly the recovery profiles of the abdominal and orthopaedic groups. The variable pain was one of the top five most important issues at each follow‐up occasion in both study groups. The importance of the item variables was thereby emphasized.

Conclusions  The PRP questionnaire allows for evaluation of the progress of post‐operative recovery, and can be useful to assess patient‐reported recovery after surgical treatment both on individual and group levels. Knowledge about recovery profiles can assist clinicians in determining the critical time points for measuring change.
Designing health innovation networks using complexity science and systems thinking: the CoNEKTR model
Authors: Norman Cameron D. , Charnaw‐Burger Jill , Yip Andrea L. , Saad Sam , Lombardo Charlotte
Published: September 2010

Rationale, aims and objectives Complex problems require strategies to engage diverse perspectives in a focused, flexible manner, yet few options exist that fit with the current health care and public health system constraints. The Complex Network Electronic Knowledge Translation Research model (CoNEKTR) brings together complexity science, design thinking, social learning theories, systems thinking and eHealth technologies together to support a sustained engagement strategy for social innovation support and enhancing knowledge integration.

Methods The CoNEKTR model adapts elements of other face‐to‐face social organizing methods and combines it with social media and electronic networking tools to create a strategy for idea generation, refinement and social action. Drawing on complexity science, a series of networking and dialogue‐enhancing activities are employed to bring diverse groups together, facilitate dialogue and create networks of networks.

Results Ten steps and five core processes informed by complexity science have been developed through this model. Concepts such as emergence, attractors and feedback play an important role in facilitating networking among participants in the model.

Conclusions Using a constrained, focused approach informed by complexity science and using information technology, the CoNEKTR model holds promise as a means to enhance system capacity for knowledge generation, learning and action while working within the limitations faced by busy health professionals.
Unscheduled care following attendance at Minor Illness and Injury Units (MIU): cross‐sectional survey
Authors: Rubin Greg
Published: September 2010

Rationale, aims and objectives  Minor Illness and Injury Units (MIUs) are becoming a key element in the Urgent Care strategies of Primary Care Trusts. They are intended to both improve access to primary care and to reduce the workload of hospital emergency departments. Their efficiency in resolving patients' needs for health care has been questioned. We sought to describe subsequent health care utilisation among people attending two MIUs in Sunderland, UK.

Method  Audit of all patients who attended the MIUs during two separate week‐long blocks with General Practitioner (GP) case note review of those who had been either treated and discharged or referred to their GP.

Results  A total of 1995 patients from 38 practices attended during the study period. 1262 (63.3%) were treated and discharged and 281 (14.1%) referred to the GP. In the subsequent 7 days 336 (21.8%) attended their GP, 37 (2.4%) attended an emergency department and 18 (1.2%) reattended the MIU. Overall, 855 (42.9%) of all attenders required further care, and in 265 (29.9%) this was unscheduled.

Conclusion  Although most people attending Minor Illness and Injury Units are treated and discharged, subsequent use of health care services is common and in a third of cases is unscheduled. This calls into question the effectiveness of MIUs as an alternative to general practice but may reflect a need for better signposting of patients to the service best suited to their needs.
Routine outcome monitoring and feedback on physical or mental health status: evidence and theory
Authors: Carlier Ingrid V.E. , Meuldijk Denise , Van Vliet Irene M. , Van Fenema Esther , Van der Wee Nic J.A. , Zitman Frans G.
Published: September 2010

Objectives  Routine Outcome Monitoring (ROM) is an important quality tool for measuring outcome of treatment in health care. The objective of this article is to summarize the evidence base that supports the provision of feedback on ROM results to (mental) health care professionals and patients. Also, some relevant theoretical aspects are considered.

Methods  Literature study (Pubmed, Medline, PsychINFO, Embase Psychiatry, 1975–2009) concerning randomized controlled trials (RTC's) of ROM and feedback on physical or mental health status of patients of all ages. Main search terms were routine outcome monitoring/measurement, feedback, health status measurement, patient reported outcome measures.

Results  Included were 52 RCT's concerning ROM and feedback with adult or older patients: of these seven RCT's were exclusively focused on physical health and 45 RCT's (also) on the mental health of the patient, although not always in a mental health care setting or as primary outcome measure. There appears to be a positive impact of ROM on diagnosis and monitoring of treatment, and on communication between patient and therapist. Other results were less clear. There were no published RCT's on this topic with children or adolescents.

Conclusions  ROM appears especially effective for the monitoring of patients who are not doing well in therapy. Further research into this topic and the clinical‐and cost‐effectiveness of ROM is recommended, especially in mental health care for both adults and children. Also, more theory‐driven research is needed with relevant conceptualizations such as Feedback Intervention Theory, Therapeutic Assessment.