bluuebunny/crossref_metadata_2025 huggingface dataset:
Is there life after Buckley's formocresol? Part II – Development of a protocol for the management of extensive caries in the primary molar
Authors: PATCHETT C. L. , SRINIVASAN V. , WATERHOUSE P. J.
Published: April 2006

Summary.  Objective.  To produce a working clinical protocol for pulp therapy techniques in the extensively carious primary molar.

Introduction.  The International Agency for Research on Cancer has recently classified formaldehyde as carcinogenic to human beings. As such, a medicament that can be used to replace formocresol in clinical practice should be identified.

Methods.  Part I of this paper explored the currently available alternative interventions and materials to formocresol in the form of a narrative review following an extensive literature search. Part II now presents the formation of a specialist group to establish an evidence‐based protocol, for the management of the extensively carious primary molar.

Conclusion.  A protocol and key points document have been developed to assist clinicians in their treatment planning. Areas for further postgraduate training are identified.
Apert syndrome with glucose‐6‐phosphate dehydrogenase deficiency: a case report
Authors: TOSUN G. , SENER Y.
Published: April 2006

Summary.  Apert syndrome is characterized by midface hypoplasia, syndactyly of the hands and feet, proptosis of eyes, steep and flat frontal bones, and premature union of cranial sutures. Maxillary hypoplasia, deep palatal vault, anterior open bite, crowding of the dental arch, severely delayed tooth eruption, and dental malocclusion are the main oral manifestations of this syndrome.

In this report, a case of Apert syndrome with glucose‐6‐phosphate dehydrogenase (G6PD) deficiency is presented. The patient, a 4‐year‐old male and the fourth child of healthy parents, was admitted to our department because of delayed tooth eruption. He had all the cardinal symptoms of the Apert syndrome.

Clinical examination revealed that primary centrals, canines and first molars erupted; however, primary second molars and laterals had not erupted. The patient had no dental caries. Preventive treatments were applied, and subsequently, the patient was taken to long‐term follow up.
A case of Coffin–Lowry syndrome with premature exfoliation of primary teeth
Authors: IGARI K. , HOZUMI Y. , MONMA Y. , MAYANAGI H.
Published: April 2006

Summary.  We present a case of a 5‐year‐old boy with premature exfoliation of primary teeth. All eight primary incisors had exfoliated by the age of 3 years, and three canines and one primary first molar were subsequently lost when he was 4 years old. None of the exfoliated teeth exhibited caries. The boy also showed characteristic facial changes, tapering of the fingers, and mental and motor retardation. Based on these findings, he was diagnosed as having Coffin–Lowry syndrome. Premature exfoliation of primary teeth in Coffin–Lowry syndrome has been described in a few reports. This manifestation of the disease would be helpful for diagnosis at an early stage as those previous reports suggested.
Kabuki syndrome: oral and general features seen in a 2‐year‐old Chinese boy
Authors: ATAR M. , LEE W. , O'DONNELL D.
Published: April 2006

Summary.  This report describes the case of a young Chinese boy with Kabuki syndrome (KS). KS is a congenital condition characterized by multiple anomalies, especially of the face, and is usually associated with mild to moderate mental retardation. The patient presented with the characteristic facial features of KS and some skeletal and neurological anomalies including a butterfly vertebrae with scoliosis, cerebral atrophy, and irregular dentition. Dental examination revealed screwdriver‐shaped incisors and a high arched maxilla, features typical of patients with KS, as well as very poor oral hygiene and early childhood caries. This report includes discussion of the aetiology of KS as well as discussion of the long‐term prognosis for this particular patient, and patients with KS in general, with consideration of associated dental and medical issues.
Periodontal treatment need of the 6th‐grade Jordanian pupils
Authors: HAMASHA A. A. , ALBASHAIREH Z.
Published: April 2006

Summary.  Aim.  The purpose of this study was to assess the periodontal treatment needs of 6th‐grade Jordanian pupils aged 12 years old.

Methods.  Forty‐eight classes teaching 6th‐grade pupils were randomly selected from the six education zones in Irbid region, Jordan. The data were collected during interviews and clinical examinations using the Community Periodontal Index of Treatment Needs (CPITN) criteria.

Results.  The findings revealed that 27·5% of the examined pupils had healthy periodontium, 22·9% showed gingival bleeding on probing but no calculus, and 31·4% had calculus deposits. Pockets in the 4–5 mm range were found in 17·6% and those in the > 6 mm range in 0·6% of the pupils. Healthy periodontium was found in 2·9 sextants, whereas 2·7 sextants showed gingival bleeding and calculus. Periodontal pockets were demonstrated in less than 0·4 sextants. Periodontal therapy was not required for 27·5% of the pupils. The rest of the pupils (72·5%), however, needed oral hygiene improvement, and of these 50% required professional calculus removal.

Conclusion.  This study indicated that about 73% of the sample needed oral hygiene instructions and motivation, 50% needed professional scaling, and 0·6% needed periodontal therapy. The data of this study establish a baseline data, which may help in planning dental services and initiating further research.
Erosive effect of an antihistamine‐containing syrup on primary enamel and its reduction by fluoride dentifrice
Authors: COSTA C. C. , ALMEIDA I. C. S. , COSTA FILHO L. C.
Published: April 2006

Summary.  Aim.  This study evaluated the action of an antihistamine‐containing syrup (Claritin D) on enamel that was subsequently submitted or not to applications of fluoride dentifrice.

Methods.  Two hundred sixty‐four slices (n = 44 per subgroup) prepared from exfoliated primary molars were evaluated in hardness tests. Six subgroups were submitted to different treatments for 10 days. The controls underwent pH cycling with (positive control) or without (negative control) three daily immersions in fluoride dentifrice/distilled water slurry. The test subgroups related to daytime use of the antihistamine syrup underwent pH cycling and two 5‐min applications of Claritin D, coupled or not to the three daily immersions in the fluoride slurry. The subgroups related to nocturnal use of the syrup were submitted to the same procedures of daytime subgroups, respectively, but with one of the applications of Claritin D lasting for 8 h.

Results.  The median hardness values obtained after use of the syrup were significantly lower than the initial ones. Equivalent values for subgroups submitted to fluoride applications in addition to treatment with the syrup were significantly higher.

Conclusion.  It was concluded that the antihistamine‐containing syrup reduced the hardness of primary enamel and that, in this experiment, the use of fluoride dentifrice was able to diminish this erosive effect.
Pattern of fluid consumption in a sample of Saudi Arabian adolescents aged 12–13 years
Authors: BELLO L. L. , AL‐HAMMAD N.
Published: April 2006

Summary.  Objective.  To study the pattern of fluid consumption in a group of Saudi adolescent boys and girls aged 12–13 years.

Design.  Prospective study.

Methods.  Three hundred forty‐four boys and girls attending school in Riyadh recorded their fluid intake for three consecutive days, including one weekend day, in April and May 2002. Types of drink/beverage and total amount consumed were analysed and ranked in order of amount/quantity of consumption. Independent samples t‐test was used to compare between genders.

Results.  Mean daily fluid intake was 1917 mL (SD 287). Drinking water provided 37%, whereas carbonated soft drinks and fruit juice/drink accounted for 26% and 25%, respectively. Seven percent of total fluid intake amounting to 134 mL came from milk and 5% (103 mL) was from tea/coffee. Fluid intake was higher in boys (2006 mL) than in girls (1821 mL) (P = 0·049). This was also true for carbonated soft drinks (P = 0·050) and tea/coffee (P = 0·000). Girls consumed more milk (P = 0·001) and fruit juice/drink (P = 0·001) than boys.

Conclusion.  Both carbonated soft drink and fruit juice/drink accounted for the largest proportion of total fluid intake by the sampled Saudi adolescents to the detriment of nutritious milk.
Clinical randomized controlled trial of chemomechanical caries removal (Carisolv™)
Authors: LOZANO‐CHOURIO M. A. , ZAMBRANO O. , GONZÁLEZ H. , QUERO M.
Published: April 2006

Summary.  Objectives.  The purpose of this study was to compare the chemomechanical caries‐removal system (Carisolv™) with high‐speed excavation in cavitated occlusal caries of primary molars.

Design and setting.  The study was a randomized controlled, clinical trial in which the two techniques were compared in each subject. Participants were chosen from public schools, in Maracaibo County, Zulia State, Venezuela.

Sample and methods. The sample consisted of 80 primary molars selected from 40 children (mean age 7·7 ± 0·7 years). Each patient had at least two contralateral primary molars with cavitated occlusal caries and approximately equal‐size access to lesions. The outcome variables were: clinically complete caries removal, size of the opening of the cavity, volume of carious tissue removed, pain during caries removal, anaesthesia requested by the patient, caries‐removal time, and behaviour and preference of patients.

Results.  All treated molars were clinically caries free whichever caries‐removal procedure was used. When Carisolv‘ was used the final cavity entrance sizes were smaller (P < 0·001) and the estimated volume of tissue removed was less (P < 0·001). The time taken for caries removal was three times longer (7·51 ± 1·83 min, P < 0·001). Some pain was reported by seven (17·5%) participants when Carisolv was used, compared with 16 (40%) when high‐speed excavation was used (P < 0·05). Using the Carisolv method there was a higher proportion of patients with positive behaviour (P < 0·01), and 71·0% (P < 0·05) preferred this treatment.

Conclusion.  Carisolv is an effective clinical alternative treatment for the removal of occlusal dentinal caries in cavitated primary molars; it is more conservative of dental tissue and appeared to be more comfortable for most patients, although the clinical time spent is longer than when using high‐speed excavation.
The relationship between caries in the primary dentition at 5 years of age and permanent dentition at 10 years of age – a longitudinal study
Authors: SKEIE M. S. , RAADAL M. , STRAND G. V. , ESPELID I.
Published: April 2006

Summary.  Objectives.  To explore a possible relationship between the caries experience and pattern in the primary dentition at 5 years of age and the permanent dentition at 10 years of age. Further, to examine the possibility of predicting children in a caries‐risk group at 5 years verified at 10 years of age.

Materials and methods.  A sample of 186 children (90 males) were clinically examined as 5‐year‐olds and re‐examined as 10‐year‐olds by calibrated dentists. A five‐graded diagnostic system including enamel caries was used. Bitewing radiographs were taken. A true risk group of children at 10 years were defined as those with at least one dentin or filled lesion on the mesial surface of 6‐year molars, and/or on incisors, and/or total DMFS (decayed, missing, and filled surfaces) more than 1 SD above the mean. The prediction was measured in terms of OR (odds ratio), sensitivity/specificity, and receiver operating characteristic curves.

Results.  Statistically significant correlations (r = 0·5) were found between the caries experience in the two dentitions as well as between the primary second molars at baseline and the permanent teeth at 10 years. ‘Primary second molars’ and ‘all primary molars’ were the most powerful predictors for allocation into the risk group (24% of the sample). The highest achieved sum of sensitivity and specificity, 148%, was attained at a cut‐off point above two carious surfaces in enamel and/or dentin in primary second molars.

Conclusions.  Statistically significant relationship in disease between the dentitions was found. More than two surfaces with caries experience in primary second molars are suggested as a clinically useful predictor at 5 years of age for being at high risk at age 10.
The effect of different milk formulas on dental plaque pH
Authors: DANCHAIVIJITR A. , NAKORNCHAI S. , THAWEEBOON B. , LEELATAWEEWUD P. , PHONGHANYUDH A. , KIATPRAJAK C. , SURARIT R.
Published: April 2006

Summary. Objectives. The purposes of this study were (1) to investigate the effect of different milk formulas on dental plaque pH after rinsing with these three categories, type of protein‐based formulas (milk‐based, soy‐based, protein hydrolysate), type of sugar (only lactose, lactose and other sugars, only non‐milk extrinsic sugars), and casein ratio (high and low casein), and (2) to observe organic acids formed by different milk formulas.

Methods. Baseline plaque pH and plaque pH at 2, 5, 10, 15, 20, 25, 30, and 60 min after rinsing with milk formulas were recorded by a combination electrode in 14 healthy subjects. Deionized water and 10% sucrose were used as a negative and positive control. The plaque sample was also analysed to identify and quantify the organic acids using a high‐performance liquid chromatography. Parameters including minimum pH, maximum pH drop, and area under curve were compared byrmanovaand pairedt‐test.

Results. The minimum pH was not significantly different among different protein‐based formulas, whereas, the maximum plaque pH drop of soy‐based and milk‐based formula was significantly higher than that produced by protein hydrolysate formula (P = 0·022 and 0·03, respectively). Area under curve produced by soy‐based and milk‐based formulas was significantly larger than that created by protein hydrolysate formula (P = 0·025 and < 0·001, respectively). Milk formulas containing only lactose caused significantly less plaque pH change in minimum pH (P < 0·001), maximum pH drop (P = 0·003), and area under curve (P < 0·001) when compared with formulas containing lactose and other sugar but not with special formulas containing only non‐milk extrinsic sugar. Similarly, special formulas containing non‐milk extrinsic sugar produced significantly lower minimum pH and smaller area under curve than formulas containing lactose and other sugar did (P =0·044 and 0·009, respectively). No different results were found between high and low casein follow‐on formulas. Lactic acid was produced more by rinsing with formulas containing lactose and other sugars than that produced by formulas containing only lactose.

Conclusions. This study suggests that milk formulas containing added other sugars tend to cause a decrease in plaque pH.
Biogeographical variation in the population density of wild boar (Sus scrofa) in western Eurasia
Authors: Melis Claudia , Szafrańska Paulina A. , Jędrzejewska Bogumiła , Bartoń Kamil
Published: April 2006

Aim  We reviewed 54 studies reporting population densities of wild boar (Sus scrofa) in western Eurasia in order to investigate the roles of vegetation productivity [fraction of photosynthetically active radiation (FPAR) index], winter harshness (mean January temperature) and presence/absence of wolves (Canis lupus) in shaping the biogeographical variation in population density of wild boar.

Location  We collected published data on the autumn–winter population density of wild boar (number of individuals km−2) in 54 locations in western Eurasia, from 1966 to 2003.

Methods  The mean January temperature, obtained from the World Climate data base (http://www.worldclimate.com), was taken as a measure of winter severity. We used monthly 4 × 4 km MODIS FPAR data sets covering January 2000 to June 2004 to calculate the vegetation productivity index. In addition, we collected literature data about the presence or absence of wolves from the study areas.

Results  In the geographical span of 37–60° N, the population densities of wild boar declined by three orders of magnitude, from 10 to 0.01 individuals km−2. The best multiple regression model (selected with the Akaike information criterion corrected for small samples) showed that mean January temperature and the vegetation productivity index were the most important factors explaining the biogeographical variation in population densities of wild boar. The impact of temperature was stronger than that of productivity. The presence of wolves had a weak limiting effect on population densities of wild boar at the biogeographical scale.

Main conclusion  We propose that winter harshness imposes density‐independent mortality on wild boar populations at higher latitudes. Competition for food in less productive regions may cause stronger density dependence in birth and death rates of wild boar populations. We expect that wild boar will respond to global warming by both an increase in local population densities and an expansion of their geographical range north and north‐eastwards.
Post‐Eocene climate change, niche conservatism, and the latitudinal diversity gradient of New World birds
Authors: Hawkins Bradford A. , Diniz‐Filho José Alexandre Felizola , Jaramillo Carlos A. , Soeller Stephen A.
Published: April 2006

Aim The aim of this study was to test a variant of the evolutionary time hypothesis for the bird latitudinal diversity gradient derived from the effects of niche conservatism in the face of global climate change over evolutionary time.

Location The Western Hemisphere.

Methods We used digitized range maps of breeding birds to estimate the species richness at two grain sizes, 756 and 12,100 km2. We then used molecular phylogenies resolved to family to quantify the root distance (RD) of each species as a measure of its level of evolutionary development. Birds were classified as ‘basal’ or ‘derived’ based on the RD of their family, and richness patterns were contrasted for the most basal and most derived 30% of species. We also generated temperature estimates for the Palaeogene across the Western Hemisphere to examine how spatial covariation between past and present climates might make it difficult to distinguish between ecological and evolutionary hypotheses for the current richness gradient.

Results The warm, wet tropics support many species from basal bird clades, whereas the northern temperate zone and cool or dry tropics are dominated by species from more recent, evolutionarily derived clades. Furthermore, crucial to evaluating how niche conservatism among birds may drive the hemispherical richness gradient, the spatial structure of the richness gradient for basal groups is statistically indistinguishable from the overall gradient, whereas the richness gradient for derived groups is much shallower than the overall gradient. Finally, modern temperatures and the pattern of climate cooling since the Eocene are indistinguishable as predictors of bird species richness.

Main conclusions Differences in the richness gradients of basal vs. derived clades suggest that the hemispherical gradient has been strongly influenced by the differential extirpation of species in older, warm‐adapted clades from parts of the world that have become cooler in the present. We propose that niche conservatism and global‐scale climate change over evolutionary time provide a parsimonious explanation for the contemporary bird latitudinal diversity gradient in the New World, although dispersal limitation of some highly derived clades probably plays a secondary role.
The first biogeographical map
Authors: Ebach Malte C. , Goujet Daniel F.
Published: April 2006

Unbeknownst to many historians of biology, the first biogeographical map was published in the third edition of the Flore française by Lamarck and Candolle in 1805, the same year in which Humboldt's famous Essai sur la Geographie appeared. Lamarck and Candolle's map marks the beginning of a descriptive or classificatory biogeography focusing on the study of biota rather than on the distributional pathways of taxa. The map is relevant because it heralds the beginning of the creation of biogeographical maps popularized by zoogeographers in the mid‐ to late nineteenth century together with the study of biogeographical regions.
An analysis of clinical teacher behaviour in a nursing practicum in Taiwan
Authors: Hsu Li‐Ling
Published: April 2006

Aim and objectives.  The aim of this study was to identify and assess the teaching behaviours (knowledge, attitudes and skills) observed in nurse educators as they taught in the clinical setting.

Background.  Many quantitative studies have defined and evaluated teaching effectiveness in the clinical area. Some of these studies established instruments to evaluate faculty effectiveness in the clinical setting; however, they tended to be so broad that they were of limited use in understanding clinical teaching behaviours in nursing education.

Design.  This study explored clinical teaching behaviours in a nursing practicum. Ten nurse educators taught 10 students in the medical–surgical unit at a hospital in Taiwan for about four weeks. Each teacher was observed by the researcher and one other observer for two days during regularly scheduled clinical teaching time.

Methods.  Data collection and analysis were done by a qualitative approach. Content analysis is a process of identifying, coding and categorizing the themes in the data.

Conclusion.  The themes of clinical teaching that emerged from data analysis included teaching aims (task‐oriented and learner‐centred), teacher competence (teacher knowledge, instructional strategies, planning learning experience, teaching priorities, feedback and caring) and teaching commitment (professional identity and giving of self). These findings offer a holistic blueprint of clinical teaching for nursing faculty members, which will enhance the quality of nursing education.

Relevance to clinical practice.  Complexity in nursing education has increased as it is challenged to meet the needs of diverse populations in rapidly evolving and highly technical health‐care settings. Clinical teachers must be enabled and empowered to provide students with appropriate knowledge and skills to meet the needs of patients. To develop students’ professional nursing identity now and in the future, nurse educators have to commit themselves to both nursing and teaching in clinical settings. More nurses need to be prepared for careers in education at the master's and doctoral levels.
Readmissions: a primary care examination of reasons for readmission of older people and possible readmission risk factors
Authors: Dobrzanska Linda , Newell Robert
Published: April 2006

Aim.  To identify the reasons that may have contributed to the emergency readmission of older people to a medical unit, within 28 days of hospital discharge.

Background.  The current UK Government has initiatives in place to monitor quality and service delivery of NHS organizations. This is achieved by setting, delivering and monitoring standards, one of which is ‘emergency readmission to hospital within 28 days of discharge (all ages), as a percentage of live discharges’.

Design/method.  A year‐long study examined reasons for unplanned readmission of patients (aged 77 and over) within 28 days of hospital discharge. The population was patients, registered with North Bradford PCT General Practitioners, readmitted to one of five care of older people wards in two local acute trust NHS hospitals. Patient records were scrutinized and data related to demography, diagnosis and readmission were collected using a structured extraction tool. Data analysis was undertaken using descriptive statistics and identification of differences and correlations within the data.

Results.  A pilot study indicated patients readmitted from home vs. other sources and patients discharged to home vs. other sources had a significantly shorter stay on readmission. The main study showed other significant findings. Patients who lived in care were readmitted sooner than those who lived at home: those discharged home vs. other sources and agreeing to increased social service provision had longer stays on readmission. Shorter length of stay on index admission (up to 72 hours) was associated with increased likelihood of earlier readmission.

Conclusions.  A framework of factors was identified and could be used to target resources to meet patients’ needs more flexibly.

Relevance to clinical practice.  It is possible that the process of targeting resources to ‘at‐risk’ patients might enable services to be delivered in a more cost‐efficient and cost‐effective way.
Nurse education – the role of the nurse teacher
Authors: Gillespie Mark , McFetridge Brian
Published: April 2006

Aim.  To explore and analyse the role of the nurse teacher.

Background.  This paper examines the issue of clinical credibility among nurse teachers which has been ongoing for over a decade. The move of nurse education from colleges of nursing to the Higher Education Institutes was seen in 1992. Since then, nurse teachers have been faced with the need to juggle the roles of teaching, administration, research and clinical support for students. Nursing students within these Higher Education Institutes require more than the traditional theoretical classroom teaching. Nurse teachers have a role beyond this in encouraging students to link theory with practice, and practice with theory. Therein lies a challenge for nurse teachers to ensure they remain credible within the clinical setting and continue to provide education and support, which is firmly grounded in both practice and theory.

Method.  The authors have critically reviewed the evidence related to the role of the nurse teacher in an attempt to identify key concepts and ideas, assumptions, supporting examples and the implications for their role.

Conclusion.  The role of the nurse teacher, it would appear, is a dynamic one that needs to engage actively the needs of the student. Nurses therefore need to be dynamic in their approach in order to respond to both local and global demands and ensure that students become competent, professional, knowledgeable and caring in their approach.

Relevance to clinical practice.  This paper demonstrates the complex and ever changing role of the nurse teacher. This paper attempts to help nurse teachers understand the complex nature of their role.
An evaluation of nursing practice models in the context of the severe acute respiratory syndrome epidemic in Hong Kong: a preliminary study
Authors: Chan Engle Angela , Chung Joanne WY , Wong Thomas KS , Yang Joseph CS
Published: April 2006

Aim and objective.  Like other health‐care workers, Hong Kong nurses had their professional knowledge and skills seriously challenged during the SARS outbreak. Could current nursing practices support the care of SARS or SARS‐like patients in the future? If not, alternative practices would be needed. Providing a preliminary understanding, this paper compares the conventional with different nursing delivery models in a simulated SARS ward and focuses on nurses’ efficiency, infection control practices and views of the two models.

Design and methods.  This study was conducted in three phases. First, a baseline understanding of nursing practices was achieved through four workflow observations. In an eight‐hour day, four research assistants observed nursing activities in the medical and fever wards. These data were used in the second phase to construct two sets of clinical vignettes, pertaining to SARS patient care in both conventional and alternative practice models. These scripts were discussed with nine nurses of various ranks from the hospital under study for their expert validation and input. In the third phase, nurse participants and patient actors enacted the vignettes in a simulated setting. Video‐taped observations and four nurse participant interviews were employed. Observational data were analysed through descriptive statistics and independent t‐tests. Textual data were coded and categorized for common meanings.

Results.  Conventional practice from the findings consisted of cubicle and named nurse nursing. While the former reflected modified team and functional nursing, it did not confine patient care within a cubicle as suggested by its name. The latter depicted a modified primary nursing approach in a team, with delegation of care. Preliminary findings concerning infection control and nurse satisfaction revealed that the alternative model had an advantage over the conventional.

Relevance to clinical practice.  This study findings lay the foundation for clinical trials, which would evaluate the significance of patient‐care quality, cost‐effectiveness and better human resource management by restructuring current nursing practices.
Model testing on the crisis interventions and actions to prevent medical disputes: a Taiwanese nursing perspective
Authors: Tzeng Huey‐Ming
Published: April 2006

Aims and objectives.  This study investigated the contributions of comprehensiveness and necessity scales on crisis interventions and actions toward nursing practice‐related medical disputes in Taiwanese hospitals and institutions’ demographic characteristics, to overall satisfaction toward nursing‐related crisis management policies and interventions and overall satisfaction toward their institution's crisis management system.

Background.  In a health‐care environment that is focused on cost containment, for overworked nurses and understaffed medical wards, patients still expect nurses to provide high quality, compassionate care. Patients usually regard nurses as the principal link between the technical and interpersonal aspects of their care. However, current hospital systems tend to require patients to be self‐reliant in managing their own care. Patient mistrust of medical care providers might have contributed to the current medical error/dispute crisis.

Methods.  In this cross‐sectional study, the subjects were nursing directors of Taiwanese hospitals (197 valid subjects). The author developed the questionnaire used in this study.

Results.  The ordinal logistic regression analyses demonstrated that being a public hospital managed by the government, being a hospital operated by a corporate body, the more comprehensive the technical/structural aspect and the assessment aspect and the more needed the psychological aspect, contribute to higher general satisfaction levels toward nursing‐related crisis management. The more comprehensive the strategic aspect and having more acute beds, contributes to higher satisfaction levels with their institution's overall crisis management activities.

Conclusions.  These findings inferred a possible change in a hospital's resource allocation or power structure when dealing with issues of patient care quality, including nursing practice‐related crisis management policies, interventions and actions.

Relevant to clinical practice.  A good crisis management system may help to keep a crisis from worsening, which might lead to a serious situation that includes malpractice litigation. It is believed that the questionnaire used in this study may be used as a diagnostic tool for assessing a crisis management system within a hospital's nursing environment.
Evaluation of a model of nursing care for older patients using participatory action research in an acute medical ward
Authors: Glasson Janet , Chang Esther , Chenoweth Lynn , Hancock Karen , Hall Tracy , Hill‐Murray Frances , Collier Lesley
Published: April 2006

Aims and objectives.  The main aim of this study was to improve the quality of nursing care for older acutely ill hospitalized medical patients through developing, implementing and evaluating a new model of care using a participatory action research process.

Background.  One of the challenges of nursing today is to meet the health‐care needs of the growing older population. It is important to consider what quality of nursing care means to older patients if nurses are to address gaps between their own perceptions and those of older patients themselves and to consider conceptual models of care appropriate for older patients care in order to improve the quality of care provided.

Design.  This study is a mixed method triangulated study, involving the use of both quantitative and qualitative methods through participatory action research methodology to establish an evidence‐base for an evolving model of care.

Methods.  The model was tested on 60 acutely ill patients aged at least 65 years. The medical ward nurses selected a key reference group including the researcher to facilitate the participatory action research process to develop, implement and evaluate a new model of care based on Orem's self‐care model incorporating the Nurses Improving Care to Health System Elders Faculty (Am J Nurs 1994; 94:21) medication protocol to improve the nursing care provided for acutely ill older patients.

Results.  The participatory action research process resulted in improved heath‐care outcomes for the patients, such as significant improvements in activities of daily living capabilities between admission to discharge, significant improvements in knowledge levels regarding their medication regimes, as well as increased satisfaction with nursing care activities as perceived by older patients and nursing staff. The implementation of educational sessions during the model of care improved the older patient's functional activities and knowledge levels of their medication regime prior to discharge. In addition, by repeatedly explaining procedures, nurses became more involved with their individual patient's care, developing a patient‐centred care relationship based on Orem's self‐care model.

Conclusions.  This study demonstrates the efficacy of a new model of nursing care in improving the quality of nursing care for older patients in the acute medical ward setting.

Relevance to clinical practice.  This study is significant because of its evidence‐base and demonstrates how the participatory action research process empowered nurses to make sustainable changes to their practice. The nurses in the study wanted to affect change. The planned change was not dictated by management, but was driven by the clinical nursing staff at the ‘grass roots’ level. Therefore, being involved in the decision‐making process provided an incentive to actively implement change.
A legacy for the children – attitudes of older adults in the United Kingdom to genetic testing
Authors: Skirton Heather , Frazier Lorraine Q , Calvin Amy O , Cohen Marlene Z
Published: April 2006

Aim.  The aim of this study was to assess understanding of genetics and attitudes towards genetic testing for clinical and research purposes in a group of older adults in the UK.

Background.  Increasingly, genomics will have an impact on the diagnosis, prevention and treatment of common diseases and the prescription of drugs. The chance of being affected by a medical condition increases with age and therefore the use of genetic testing as part of general health‐care practice has an impact on the older population.

Methods.  Older adults were recruited to two focus groups (n = 7 and n = 10 respectively). Focus group discussions were guided by a series of questions and were audiotaped. The transcribed data were coded for significant statements, which were organized under thematic headings.

Results.  The mean age of participants was 76 years. The main themes to emerge were: understanding, approach to genetic testing and conditions for testing. In this cohort, the older adults were largely unsure about the underlying scientific basis of genetics but were keen to learn more. While enhanced medical knowledge could enable preventive measures to be taken and so reduce suffering, it was acknowledged that for some people knowing the future could potentially cause anxiety and harm. Participants were wary about research being used to benefit private companies and voiced ethical concerns about potential coercion to be tested and the misuse of science. However, all participants had an altruistic approach that influenced their willingness to be tested to benefit others in their family or the wider community. Conditions for testing included provision of information about the purpose of testing and feedback on the results.

Conclusions.  Older adults are positive about the opportunities presented by genetic testing for clinical reasons and research, but need accurate information about the reasons for and implications of such testing.

Relevance to clinical practice.  The results of this study confirm the need for nurses to be proactive in developing the genetic competencies required to detect potential familial disease, make appropriate referrals to genetic services and ensure informed consent is obtained for genetic testing.
Life satisfaction among older people (65+) with reduced self‐care capacity: the relationship to social, health and financial aspects
Authors: Borg Christel , Hallberg Ingalill R , Blomqvist Kerstin
Published: April 2006

Aims and objectives.  This study aimed at investigating life satisfaction and its relation to living conditions, overall health, self‐care capacity, feeling lonely, physical activities and financial resources among people (65+) with reduced self‐care capacity.

Background.  Knowledge about factors related to low life satisfaction among older people with reduced self‐care capacity is sparse, although this is important in health care and nursing so that the care is adapted to their needs and perspective. Previous research has mainly focused on isolated aspects such as pain in relation to life satisfaction among older people in general and less among so those with reduced self‐care capacity in general.

Design and method.  A subsample of 522 persons was selected from a randomly selected cross‐sectional survey using a modified form of the Older Americans’ Resources Schedule and Life Satisfaction Index Z.

Results.  The mean age in the total sample was 77·9; women (79·5) were significantly older than men (77·0). Low life satisfaction was found among women, as well as those living in special accommodations. Life Satisfaction Index Z was 15·3 (SD 5·6) in the total sample. Gender and living conditions did not explain life satisfaction whilst poor overall self‐reported health and poor financial resources in relation to needs had the strongest explanatory value. Also of significant importance were loneliness, the degree of reduced self‐care capacity and feeling worried.

Conclusion.  Life satisfaction in older people with reduced self‐care capacity is determined by several factors, with social, physical, mental and financial aspects probably interacting with each other; especially feeling lonely, degree of self‐care capacity, poor overall health, feeling worried and poor financial resources in relation to needs. These factors need to be considered in the care of these people to preserve or improve their life satisfaction.

Relevance to clinical practice.  Nursing interventions in terms of preventive home visits, rehabilitation, health education directed towards physical, psychological, social and economic aspects of importance may help to preserve or improve life satisfaction for those with reduced self‐care capacity.
Nursing documentation audit – the effect of a VIPS implementation programme in Denmark
Authors: Darmer Mette Rosendal , Ankersen Lena , Nielsen Bettina Geissler , Landberger Gitte , Lippert Elisabeth , Egerod Ingrid
Published: April 2006

Aim and objectives.  The aim of this paper is to present a study describing nurses’ adherence to the VIPS model by evaluating the quality of nursing assessment, and the quantity of completed nursing care plans.

Background.  Numerous efforts have been made over the years to improve nursing documentation in Denmark. Hospitals have traditionally based nurses’ charting on a rudimentary version of the nursing process and on Virginia Henderson's theory of human needs. In 2002–2004 the Copenhagen University Hospital, Rigshospitalet, introduced the Swedish VIPS model for nursing documentation. VIPS is an acronym for well being, integrity, prevention and safety, all of which are seen as major goals for nursing care. The model organizes nursing data according to a system of keywords, which facilitates storage and retrieval of data.

Design and methods.  The design in this part of the study was retrospective, wherein 50 journals from each of the departments of cardiology, neurology, oncology and urology were audited annually for three years using the Cat‐ch‐Ing instrument (n = 600). All nursing journals were randomly selected by including the first 50 journals at each site given a specific date.

Results.  The nursing documentation significantly improved during the course of the study. After the second year the participants used the keywords appropriately and correctly according to the VIPS model. Application of primary nursing increased during the study. Initial, ongoing and discharge patient status improved. The nurses’ familiarity with nursing diagnoses, goals and interventions increased.

Conclusions.  The structured implementation programme significantly improved nursing documentation, and the simultaneous training of the entire nursing staff shows promise. The VIPS model has prepared the nurses for more complex computerized taxonomies and classification systems in the future by improving the nurses’ analytical skills.

Relevance to clinical practice.  New strategies for improving nursing documentation have been demonstrated.
Do Corticosteroids Damage the Brain?
Authors: Herbert J. , Goodyer I. M. , Grossman A. B. , Hastings M. H. , De Kloet E. R. , Lightman S. L. , Lupien S. J. , Roozendaal B. , Seckl J. R.
Published: April 2006

Corticosteroids are an essential component of the body's homeostatic system. In common with other such systems, this implies that corticosteroid levels in blood and, more importantly, in the tissues remain within an optimal range. It also implies that this range may vary according to circumstance. Lack of corticosteroids, such as untreated Addison's disease, can be fatal in humans. In this review, we are principally concerned with excess or disturbed patterns of circulating corticosteroids in the longer or shorter term, and the effects they have on the brain.
Regulation of Salmon Gonadotrophin‐Releasing Hormone Gene Expression by Sex Steroids in Rainbow Trout Brain
Authors: Vetillard A. , Ferriere F. , Jego P. , Bailhache T.
Published: April 2006

Salmon gonadotrophin‐releasing hormone (sGnRH) is the major form of gonadotrophin‐releasing hormone in the brain of Salmonids and is encoded by two different genes: sGnRH1 and sGnRH2. In the present study, we examined the expression patterns of these two genes during development and throughout the reproductive cycle of the female rainbow trout (Oncorhynchus mykiss), and also investigated the feedback action of sex steroids on brain mRNA levels. Both genes are expressed as early as 14 days postfertilisation and show a similar expression pattern during early life stages. In the adult female, sGnRH1 and sGnRH2 mRNAs are both present in neurones located in the ventral forebrain. This gene expression in the brain appears to be low during early vitellogenesis, and increases during oocyte maturation to reach a maximum after ovulation. The expression of sGnRH1 was not modified by in vivo steroid treatments in any experiment; however, testosterone and 5α‐dihydrotestosterone down‐regulate brain sGnRH2 gene in immature and adult ovariectomised females. Oestradiol treatment decreases sGnRH2 mRNA levels in the brain of adult ovariectomised females only. In the triploid fish brain, none of the steroids affect brain sGnRH mRNA levels. Our results suggest that, unlike sGnRH1, the sGnRH2 gene is under a strongly androgenic inhibitory control in the immature and adult female rainbow trout.
Brain‐Derived Neurotrophic Factor in the Brain of Xenopus laevis May Act as a Pituitary Neurohormone Together with Mesotocin
Authors: Calle M. , Wang L. , Kuijpers F. J. , Cruijsen P. M. J. M. , Arckens L. , Roubos E. W.
Published: April 2006

Brain‐derived neurotrophic factor (BDNF), a member of the neurotrophin family, occurs abundantly in the brain, where it exerts a variety of neural functions. We previously demonstrated that BDNF also exists in the endocrine melanotroph cells in the intermediate lobe of the pituitary gland of the amphibian Xenopus laevis, suggesting that BDNF, in addition to its neural actions within the brain, can act as a hormone. In the present study, we tested whether BDNF, in addition to its neural and hormonal roles, can be released as a neurohormone from the neural pituitary lobe of X. laevis. By light immunocytochemistry, we show that BDNF is present in perikarya, in ventrolaterally projecting axons of the hypothalamic magnocellular nucleus and in the neural lobe of the pituitary gland, and that it coexists in these structures with the amphibian neurohormone, mesotocin. The neural lobe was studied in detail at the ultrastructural level. Two types of neurohaemal axon terminals were observed, occurring intermingled and in similar numbers. Type A is filled with round, moderately electron‐dense secretory granules with a mean diameter of approximately 145 nm. Type B terminals contain electron‐dense and smaller, ellipsoid granules (long and short diameter approximately 140 and 100 nm, respectively). BDNF is exclusively present in secretory granules of type A axon terminals. Double gold‐immunolabelling revealed that BDNF coexists in these granules with mesotocin. Furthermore, we demonstrate in an superfusion study performed in vitro that mesotocin stimulates peptide release from the endocrine melanotroph cells. On the basis of these data, we propose that BDNF can act on these cells as a neurohormone.
Pituitary Cocaine‐ and Amphetamine‐Regulated Transcript Expression Depends on the Strain, Sex and Oestrous Cycle in the Rat
Authors: Kappeler L. , Gautron L. , Layé S. , Dantzer R. , Zizzari P. , Epelbaum J. , Bluet‐Pajot M. T.
Published: April 2006

Cocaine‐ and amphetamine‐regulated transcript (CART) mRNA and peptides are abundant in the adenohypophysis, but their role in pituitary function has not yet been elucidated. CART peptides were recently shown to colocalise with luteinising hormone (LH) or prolactin in rat anterior pituitary, and contradictory results concerning the peptide effects on pituitary hormonal secretions were obtained in vitro from pituitary cell cultures. Thus, we reinvestigated the expression of CART mRNA within the pituitary. Immunohistochemistry for pituitary hormones was performed on sections from adult male Wistar rats followed by in situ hybridisation using CART mRNA antisense 35S‐labelled probes. The most represented CART‐expressing cells were lactotrophs (42 ± 1% of CART cells) and gonadotrophs (32 ± 3%), followed by thyrotrophs (10 ± 2%), corticotrophs (7 ± 2%) and somatotrophs (6 ± 1%). In the pars tuberalis, CART mRNA was easily detectable in gonadotrophs and lactotrophs and, to a lesser extent, in corticotrophs and thyrotrophs. CART peptide was quickly and potently released from perifused pituitary by depolarisation (K+ 30 mM for 15 min; 465 ± 37% over basal release, n = 5). Gonadotrophin‐releasing hormone and thyrotrophin‐releasing hormone (0.1 µM) were also active to a lesser extent (138 ± 11% and 71 ± 17, n = 7, respectively). CART (0.1 µM) did not modify basal LH or prolactin release but selectively inhibited K+‐induced LH release without affecting K+‐induced prolactin secretion. Pituitary CART mRNA and content were sex dependent and varied during the oestrous cycle, being lower in dioestrous 2. Pituitary CART content also varied widely amongst rat strains being five to six‐fold higher in Wistar and Fischer rats compared to Brown Norway and Lou C rats. Ageing differentially affected pituitary CART mRNA and content, resulting in a marked decrease in Lou C and an increase in Wistar and Sprague‐Dawley rats. Taken together, these results suggest that pituitary CART expression is dependent of the sex steroid environment and may be physiologically involved in LH secretion.