bluuebunny/crossref_metadata_2025 huggingface dataset:
Competition and Concentration in the New European Banking Landscape
Authors: Staikouras Christos K. , Koutsomanoli‐Fillipaki Anastasia
Published: May 2006

This paper measures the degree of concentration and competition in the enlarged European Union (EU) banking environment over the period 1998–2002. In the empirical part we opt for a methodology as proposed by Panzar and Rosse based on a non‐structural estimation of market competition. Our results suggest that European banks were operating under conditions of monopolistic competition and that bank interest revenues in the 10 new EU member states was earned under conditions of higher competition than those that existed in the old EU banking countries. The opposite result was observed for total operating revenues. Smaller banks earn interest income in a less competitive environment than larger banks, while the opposite is observed for total revenues.
The fibrinogen Aα R16C mutation results in fibrinolytic resistance
Authors: Flood Veronica H. , Al‐Mondhiry Hamid A. , Farrell David H.
Published: May 2006

The fibrinogen Aα R16C mutation is a common cause of dysfibrinogenaemia and has been previously associated with both bleeding and thrombosis. However, the mechanism underlying the thrombotic phenotype has not yet been elucidated. This report characterises the defect in fibrinolysis seen as a result of the Aα R16C mutation. A young patient with dysfibrinogenaemia (fibrinogen Hershey III) was found to be heterozygous for the Aα R16C mutation. Functional assays were performed on the purified fibrinogen to characterise clot formation and lysis with plasmin and trypsin. Consistent with previous results, clot formation was diminished. Unexpectedly, fibrinolysis was also delayed. Plasminogen activation was normal, ruling out decreased plasmin generation as the mechanism behind the fibrinolytic resistance. Western blot analysis showed no difference in the amount of bound α2‐antiplasmin or albumin. When clot lysis was assayed with trypsin substituted for plasminogen, a significant delay was also observed, indicating that defective binding to plasminogen could not explain the fibrinolytic resistance. These results suggest that the defective fibrinolysis is due to increased proteolytic resistance, most likely reflecting changes in clot structure.
Attributes of nurses that determine the quality of care for mentally handicapped people in an institution
Authors: Ming Ho Lau Victor , Mackenzie Ann
Published: May 2006

This is an ethnographic study that examines, from the relatives' perspective, the attributes of nurses that are considered important in the caring process of mentally handicapped people in an institutional setting in Hong Kong Twelve interviews were carried out with a family member who had a relative living in a special unit for severely mentally handicapped people Empirical studies, mainly from the west, have shown that decisions to place a mentally handicapped family member in residential care is a complex process Family characteristics, the relatives' characteristics as well as the availability of support, have been found to influence decisions about out‐of‐home placement Once this decision has been made, a new caring relationship between nurse, family and relative needs to be established The final categories that emerged from the data show that families have expectations about the nurses' competence and comittment to the job and about their relationships with the client and the family Consequently quality is judged, not only by the way in which nurses work with the clients, but also by the way in which they work with the family Implications for practice and education of nurses working with mentally handicapped people and for nursing administration in Hong Kong are discussed
Attitudes of nurses in a general hospital towards people with learning disabilities: influences of contact, and graduate‐non‐graduate status, a comparative study
Authors: Slevin Eamonn , Sines David
Published: May 2006

A review of the literature suggests people with learning disabilities are viewed negatively by others in society Such negative views have also been found among many health care professionals, including nurses This study measured the attitudes of a randomly selected sample of nurses in a general hospital (n=31) towards people with learning disabilities The study involved a triangulation approach utilizing a Likert scale attitude measurement questionnaire Two comparisons between subjects in the study were undertaken—a comparison of the attitudes of graduate nurses and those who were non‐graduates, a comparison between nurses who had most contact, and those who had least contact with people who have learning disabilities From the sample of 31 nurses, 10 subjects were selected for more in‐depth interviews which were tape recorded, transcribed and, using the process of ‘content analysis’, quantified

Findings suggest the attitudes held by the total sample towards people with learning disabilities were more negative than would be expected from those in a caring profession The graduate nurses were found to be more positive in their perceived attitudes towards people with learning disabilities than non‐graduate nurses Nurses in the sample who had high contact were found to have more positive attitudes than nurses who had lower amounts of contact with people who had learning disabilities
Using individual and group reflection in and on assessment as a tool for effective learning
Authors: Mountford Brenda , Rogers Lynda
Published: May 2006

This paper outlines the background to the current United Kingdom educational scene for post‐registration nurse education, highlighting the influence of the English National Board (ENB) framework and higher award The study reported was undertaken with the help of two student cohorts who were registered consecutively on a 6 month ENB course at diploma level Formal reflection using both individual written and group discussion was introduced focusing on the two summative course assessments This kind of formal reflection was seen as a learning strategy to influence positively students' educational outcomes and professional practice via six key factors (a) academic self‐concept, (b)task awareness, (c)views of knowledge, (d)the influence of knowledge on behaviour, (e)writing as a learning activity, and (f)generating knowledge by reflecting in and on assessment with discussion The findings, reported under the six factor‐headings, fully support the use of reflection in this way for these purposes
Visualizing and realizing caring in practice through guided reflection
Authors: Johns Christopher
Published: May 2006

Guided reflection provides a challenging and supportive milieu for practitioners to learn through reflection towards achieving desirable work This work inevitably demands confrontation with self and the conditions of practice that limit the achievement of desirable work It also demands an understanding of what is desirable nursing From an ideological position, desirable work is generally defined in terms of humanistic caring The paper discusses how caring can be visualized and realized in practice through the experiences practitioners reflect on and share within guided reflection This work is illustrated using using guided reflection dialogue
Factors affecting the assessment of postoperative pain: a literature review
Authors: Allcock N
Published: May 2006

The report of the Royal college of Surgeons and College of Anaesthetists has stimulated much interest in the relief of pain following surgery Despite the development of new techniques such as patient controlled analgesia, preemptive analgesia and complementary techniques that have helped to improve the situation, the role of pain assessment remains central This literature review discusses the standard of nurses ‘assessment and looks at the factors suggested to influence nurses’ assessment of pain
The patients' experiences of their chronic non‐malignant pain
Authors: Seers Kate , Friedli Karin
Published: May 2006

This paper reports the results of a study which investigated the experiences of 75 people with chronic non‐malignant pain People with chronic non‐malignant pain can find that traditional medical techniques do not help their pain, and they have to learn to live with it However, pain can affect their lives in many ways Within this study, qualitative data were collected to illustrate what it meant to people to experience this chronic pain It was found that pain adversely affected many dimensions of sufferers' lives, and the effects extended to family and friends It seemed that having others believe the pain was crucial to many patients Health care professionals can offer these patients much in helping them come to terms with the way in which pain has affected both themselves and their lives
Patient knowledge and information concerning medication on discharge from hospital
Authors: Holloway Aisha
Published: May 2006

This study aimed to establish whether patients had sufficient knowledge and information concerning their medications on discharge from hospital The purpose was also to identify who educated and provided patients with information and in what form it came The study was carried out in five medical wards of a large teaching hospital, where patients were interviewed on the morning of discharge By using a medication checklist the findings of this study appeared to indicate that the patients interviewed had relatively little knowledge or information regarding their discharge medications However, overall their knowledge and information concerning their discharge medications had improved in relation to that of their admission medications Despite this finding, there remains a definite need for structured medication teaching programmes with appropriate assessment of patients needs on admission to hospital
An analysis of the concept of humour and its application to one aspect of children's nursing
Authors: Sheldon Lesley M
Published: May 2006

This paper explores the concept of humour by exposing it to the analytical framework of Walker and Avant The paper then seeks to examine the benefit humour has in child and parent health education Whilst the author argues that the framework utilized to analyse the concept is positivistic in nature, emphasis is given to the value of humour and the various meanings ascribed to it in the real world Humour was used consciously by seven registered children's nurses and one student nurse completing her final placement of the branch in children's nursing The aim being to reduce parental anxiety and enhance feelings of confidence and competence within the parental groups The findings of this small study indicated that whilst humour is delicate and may be inappropriate in certain settings it appears to have a positive correlation with information giving and reduced anxiety levels amongst parents of hospitalized children when used appropriately The analytical components of the concept were examined carefully and it appeared that the tool used to analyse the concept was successful in that the theoretical framework was directly related to practice, however, the framework also highlighted the delicate nature of the concept and the dangers of inappropriate use The paper argues, however, that humour does play a part in the delivery of skilled, sensitive and competent care and the need for nurse education to address this is paramount
Child‐related services in general accident and emergency departments
Authors: Bentley Jackie
Published: May 2006

A survey undertaken by the British Paediatric Association (BPA) in 1985 highlighted deficits in the services and facilities provided by accident and emergency (A&E) departments for children Following this survey several documents were published by professional and voluntary organizations advising on the care of children in such departments The current study, conducted as part of a larger project, involved the distribution of questionnaires (by post) to the nursing managers of a total of 193 general A&E departments in England, Scotland and Wales The overall response rate of 87% was very encouraging This article explores the nurse managers' perceptions of the personnel required to meet the needs of children in A&E It looks especially at the role of Registered Sick Children's Nurses (RSCNs) The findings suggest that the need for RSCNs is not always accepted RSCNs seem to be employed in some departments as a token presence Factors seen by nurse managers as limiting then‐ recruitment are discussed According to the responses given, the role of the RSCNs currently employed in A&E, varies considerably The findings give some insight into the degree to which current staffing for children in A&E meet the guidelines published by professional and voluntary bodies
Does the Nursing Care Plan help in the management of psychiatric risk?
Authors: Neilson Trish , Peet Malcolm , Poole Jacqui , Ledsham Robert
Published: May 2006

The Nursing Care Plan (NCP) is routinely used to direct the nursing care of psychiatric in‐patients, but the impact of NCPs on patient care and clinical outcome is not firmly established NCPs from 246 patients, chosen at random from admissions to acute psychiatric wards, were analysed The NCPs were scored for quality and also specifically for the presence of recorded risk assessment and appropriate level of nursing supervision NCPs were evaluated in relation to psychiatric risk factors present prior to admission, and in relation to risk behaviour during hospitalization Quality of NCP records was generally poor, with scores in all areas assessed being approximately half of the possible maximum Patients with a perceived high risk of suicide prior to admission had significantly better NCP quality than other patients, but about a third of these high risk patients had no recorded risk assessment or supervision level in the nursing notes Patients who had actually self‐harmed within 4 weeks prior to admission were more likely to have a recorded risk assessment but did not score more highly than the rest of the patient population on any other measures of NCP quality Patients who had made suicidal threats prior to admission but who were not deemed to be of high suicide risk before admission had significantly lower quality NCPs and were less likely to have a record of supervision level than the rest of the patients The highest rate of supervision records occurred in patients who had shown dangerous behaviour prior to admission Outcome in terms of two risk behaviours during admission (self‐harm and violence) was not related to whether or not risk assessment and supervision levels had been recorded Patients admitted compulsory to hospital were more likely to have a supervision level recorded but were also more likely to abscond It is concluded that issues of psychiatric risk were not raise serious questions about the usefulness of the NCP in helping to predict and prevent risky behaviour amongst psychiatric in‐patients
Group and single‐subject evaluation of a programme to promote self‐care in elderly nursing home residents
Authors: Blair Charles E , Lewis Robert , Vieweg Victor , Tucker Robin
Published: May 2006

Residents and staff of a nursing home in a metropolitan area were randomly assigned to three conditions to (a) test whether staff's use of operant behavioural management strategies (Condition 1) would cause a greater increase in residents' self‐care behaviour than staff's use of mutual goal setting (Condition 2) or routine nursing care (Condition 3), and (b) examine how useful group scores were, compared to individual scores, in determining change in individual residents' behaviour due to treatment In‐service training was provided to staff in Conditions 1 and 2 but not in Condition 3 Over a period of 22 weeks, nursing staff encouraged subjects to perform targeted self‐care tasks independently Data analysis indicated significantly greater change in self‐care behaviours for subjects in Condition 1 than for subjects in Conditions 2 and 3 However, visual inspection of data for each case revealed that individual scores were more useful than averages and differences between groups for determining the effectiveness of the clinical interventions
Evaluation of health promotion activities in community nursing practice
Authors: Nolan P , Sourtzi P , Andrews R
Published: May 2006

The purpose of this research was to study the extent to which community nurses (CNs) were involved in health promotion activities and to investigate whether these activities were meeting the needs of their clients A cross‐sectional survey by multiple methods was designed and carried out in four district health authorities (DHAs) in one regional health authority in England Two hundred and fifty‐one (83 67%) completed questionnaires were returned by CNs working in primary health care (PHC) Sixty sessions with CNs were observed and 249 interviews were conducted with clients Additionally, as part of the observation 155 clinical records were examined CNs reported involvement in a wide range of opportunistic and organized health promotion activities Lifestyle advice and ill‐health prevention were most frequently used by all groups Health visitors (HVs) were involved significantly more in group and community wide activities District nurses (DNs) were mainly involved in opportunistic health promotion Practice nurses (PNs) were found to be involved significantly more in health promotion activities organized on an individual basis Observation revealed that opportunistic health promotion was carried out in almost half of the consultations observed, of which lifestyle advice was the most frequent Records however showed that this information was rarely recorded The clients of PNs were mostly aware of other health promotion activities available within the general practice, while almost half of the HVs ‘clients knew what other health promotion activities were available to them and few DNs’ clients were aware of any
Incorporating outpatient perceptions into definitions of quality
Authors: Hart Mike
Published: May 2006

This paper reviews the ways in which quality measures have been defined by reference to objective measures and applied by the producers of health care to patients Patient satisfaction surveys may be thought to redress this imbalance and will be addressed as a precursor to the discussion of the SERVQUAL methodology, developed to measure the gap between expectations and performance in service industries An argument will be advanced that quality measurement is still producer‐led and should incorporate the views of patients more directly into the quality measurement process It is suggested that calibration or baseline surveys of patients be conducted which then identify the issues that may be subject to more sustained quantitative analysis Quality monitoring should be conducted in such a way that particular sub‐groups can be subject to routine analysis Models of quality measurement need to incorporate the perspectives of many ‘key players’ in which the views of patients are complemented by relevant professional, clinical and managerial groups The extent to which there is a disjunction between quality as objectively measured (e g by waiting times) and as experienced by patients will receive attention Suggestions will be made that monitoring and clinic operations need to be more mutually reinforcing
An analysis of the concept ‘patient satisfaction’ as it relates to contemporary nursing care
Authors: Mahon Pamela Young
Published: May 2006

Patient satisfaction has become an established indicator of the quality of health care yet, despite the abundance of measurement surveys reported in the literature, there are few theoretical underpinnings for this important concept An analysis of the concept of patient satisfaction, specifically as it relates to contemporary nursing care, provides an excellent vantage point to more closely examine this key measure of health care quality A review of pertinent literature is presented, followed by examination of the uses of the concept in professional literature as well as more general sources Denning attributes cited throughout the literature are identified along with the concept's antecedents and consequences Empirical referents, definitions, and measurements are also presented The analysis concludes with re‐examination of some of the assumptions underlying patient satisfaction literature in general, and thoughts regarding the significance of patient satisfaction with nursing care in particular Suggestions for future inquiry are offered
The influence of bilateral orchiectomy on self‐concept: a pilot study
Authors: Montgomery Phyllis , Santi Gina
Published: May 2006

This pilot study was designed to explore self‐concept alterations in a group of patients undergoing bilateral orchiectomy for treatment of advanced prostate cancer The Tennessee Self‐Concept Scale was used to measure pre‐ and postoperative self‐concept group scores Also, the group of orchiectomy patients was compared to a group of patients undergoing a transurethral resection of the prostate (TURP) for cancer and another group undergoing a TURP for benign prostatic hypertrophy (BPH) The results provide no evidence to suggest that surgical removal of both testicles in a group of males has a significant effect on self‐concept or its indices when compared to a group of men who underwent a TURP, where both groups also were diagnosed with cancer For the group of males who underwent bilateral orchiectomy, no significant differences were detected between the pre‐ and postoperative total self‐concept scores However, statistically significant differences did exist between the group's pre‐ and postoperative physical self scores and identity scores
The clinical role of the nurse teacher: an exploratory study of the nurse teacher's present and ideal role in the clinical area
Authors: Forrest Susanne , Brown Norman , Pollock Linda
Published: May 2006

This paper describes a study which aimed to explore the present and ideal role of the nurse teacher in the clinical area from the perspective of nurse teachers, ward sisters/charge nurses, staff nurses and students nurses undertaking the ‘traditional’ and Project 2000 programmes of training The study adopted a qualitative design Findings from this study demonstrate that the clinical role of the nurse teacher lacks clarity, however, clear criteria emerged as to how trained nurses and student nurses perceived the ideal role Nurse teachers ‘role in assuring the quality of the clinical learning environment emerged as a major area of criticism It was suggested that, if nurse teachers adopted a clinical role that was primarily concerned with supporting clinically based nurses in their teaching role, this served to assure the quality of students’ clinical learning experience In conclusion, it is suggested that for nurse teachers to meet the needs of trained nurses and student nurses in the clinical area, the role must be diverse and flexible Attempts to prescribe a unimodel approach to deliver the service should be avoided Rather, the role must be negotiated between teachers, clinical nurses and students, and constructed in a way that best meets the needs of all parties concerned
Nursing lecturer/practitioners: can lecturer/practitioners be music to our ears?
Authors: Rhead Mark , Strange Frank
Published: May 2006

The value of the recently emerging role of the lecturer/practitioner (LP) in nursing is examined by reflecting on the experience of the authors Within the evolutionary development of nursing education there appears to be separate branchings into theory and practice Much effort has been spent on trying to lessen this so called theory‐practice gap Examination and reflection with reference to the LP led to the conclusion that there is a paradoxical nature to nursing The whole which is nursing comprises of seemingly incongruent aspects, theory and practice which can be integrated This paper argues that nursing knowledge is complementary in nature It consists of ‘knowing how’ and ‘knowing that’ These two aspects cannot exist independently but are integrated through practice It is experience and reflection that integrate these through the embodiment of the LP It is within this context that the evolution of the role of the LP is reviewed from a theoretical and historical perspective
The value to nursing research of Gadamer's hermeneutic philosophy
Authors: Pascoe Elizabeth
Published: May 2006

In recent years there has been an increasing awareness in nursing research of the importance of accumulation of knowledge related particularly to the art of nursing Because of this, nurses are endeavouring to understand more comprehensively the meanings given to central phenomena such as caring, comfort and reassurance, and also to research them with methodologies in such a way that these meanings are not destroyed, distorted or decontextualized Gadamer's hermeneutic philosophy may prove to be a valuable approach in enabling nurses to gain a deeper and fuller understanding of these phenomena which are central to nursing practice
Constitutive expression of cyclooxygenase‐2 in the neuromuscular compartment of normal human colon
Authors: Bernardini N. , Colucci R. , Mattii L. , Segnani C. , Fornai M. , De Giorgio R. , Barbara G. , Castagna M. , Nardini V. , Dolfi A. , Del Tacca M. , Blandizzi C.
Published: May 2006

Abstract Prostaglandins regulate various functions throughout the gastrointestinal system. Their biosynthesis depends on cyclooxygenase isoforms, named COX‐1 and COX‐2. The initial hypothesis that COX‐2 is an inducible enzyme has been challenged and its constitutive expression in the stomach has been established. In this study, an immunohistochemical analysis was performed to evaluate the distribution and cellular localization of COX‐2 in normal human colon. Colonic surgical specimens were processed for COX‐2, protein HuC/HuD, neurofilament, S‐100 protein and CD117/c‐kit immunodetection. COX‐2 protein was found to be constitutively expressed in the colonic wall: detectable amounts were localized in mucosal, submucosal and muscular layers, mainly in the neuromuscular compartment. In particular, COX‐2 was expressed in muscularis mucosae, submucosal ganglia, longitudinal muscle layer and myenteric ganglia, the neurons of which displayed different degrees of immunostaining. Intramuscular interstitial cells of Cajal, regarded as important sites for the regulation of enteric neuromuscular activity, were also partly COX‐2 immunoreactive. This study provides a detailed mapping of COX‐2 expression in human colon, and allows better understanding of the roles played by this isoenzyme in gut physiology.
Intragastric acidification inhibits motilin‐induced phase III activity in humans
Authors: Haans J. J. L. , Masclee A. A. M.
Published: May 2006

Abstract In a randomized, placebo‐controlled crossover design we studied the effect of gastric acidification on motilin‐induced interdigestive antropyloroduodenal motility. Ten healthy volunteers participated in the study consisting of four experiments. Each experiment started after a spontaneous occurring phase III and consisted of intragastric infusion of either saline or acid (0.08 mol L−1HCl) for 90 min and intravenous infusion of either saline or motilin (4 pmol kg−1 min−1) for 30 min. Antropyloroduodenal motility and pH were recorded continuously for 240 min. Reoccurrence of phase III was significantly (P < 0.05) earlier during intragastric saline‐intravenous motilin infusion compared with control (intragastric saline‐intravenous saline), 52 min (range 25–79) and 113 min (84–141) respectively. This effect was completely abolished during intragastric acid‐intravenous motilin infusion, 112 min (82–142). The percentage of phase III of antral origin was significantly (P < 0.05) higher during intragastric saline‐intravenous motilin infusion (90%) compared with control (30%). The mean area under the contraction (AUC) for phase II was significantly (P < 0.05) lower during intragastric saline‐intravenous motilin infusion and intragastric acid‐intravenous saline infusion compared with control. It is concluded that in humans intragastric acidification inhibits the effect of motilin on antroduodenal motility, decreases the AUC of antral phase II contractions and delays the occurrence of phase III of the migrating motor complex.
Factors associated with attitude and hypothetical behaviour regarding brain death and organ transplantation: Comparison between medical and other university students
Authors: Ohwaki Kazuhiro , Yano Eiji , Shirouzu Makiko , Kobayashi Aya , Nakagomi Tadayoshi , Tamura Akira
Published: May 2006

Abstract:  The aim of this study was to investigate the factors, including knowledge, that determine an individual's attitudes and behaviours regarding brain death and organ transplantation using questionnaires among medical and other university students. A total of 522 students (388 medical and 134 other) answered a questionnaire. The survey included the individual's knowledge about brain death, attitudes towards brain death and organ transplantation, and hypothetical behaviours assuming their willingness to donate their own or their family's organs. Medical students were more likely to have knowledge about brain death and to accept brain death and organ transplantation compared with other students, while there was no difference in their willingness to donate their own or their family's organs. Logistic regression analysis was used to assess the effects of various factors on the attitudes and behaviours. In both medical and other students, confidence in brain‐death diagnosis by doctors was independently associated with their willingness to donate their own organs after the adjustment for other factors, including knowledge (odds ratio [OR], 1.85; 95% confidence interval [CI], 1.15 to 2.97 and OR, 4.97; 95% CI, 1.01 to 24.39, respectively). An increase in knowledge may cause positive attitudes towards brain death and organ transplant. Meanwhile, reducing uncertainty about the brain‐death diagnostic process might have a beneficial effect on the willingness to donate organs.
Environmental risk factors of rhinitis in early infancy
Authors: Biagini Jocelyn M. , LeMasters Grace K. , Ryan Patrick H. , Levin Linda , Reponen Tiina , Bernstein David I. , Villareal Manuel , Khurana Hershey Gurjit K. , Burkle Jeffrey , Lockey James
Published: May 2006

Previous studies of allergic rhinitis in children have not documented the environmental risk factors for infants at age one. We examined the relationship of environmental tobacco smoke (ETS) and visible mold exposures on the development of allergic rhinitis, rhinitis and upper respiratory infection (URI) in a birth cohort where at least one parent was skin prick test (SPT) positive. ETS exposure and upper respiratory symptoms were obtained by questionnaires. Visible mold was classified as none, low or high during home visit. Infants had a SPT at age one. After adjustment for potential confounders, exposure to >20 cigarettes per day was associated with an increased risk of developing allergic rhinitis at age one [odds ratio (OR) = 2.7; 95% CI 1.04–6.8] and rhinitis symptoms during the first year (OR = 1.9; 95% CI 1.1–3.2). Infants with low (OR = 1.5; 95% CI 1.1–2.3) or high (OR = 5.1; 95% CI 2.2–12.1) levels of visible mold in their homes were more likely to have more frequent URI during the first year. Older siblings were protective for development of both rhinitis symptoms and allergic rhinitis. This study suggests that ETS exposure, rather than visible mold, is associated with rhinitis and allergic rhinitis in infants. The analysis also suggests that mold may be a stronger risk factor for URI that ETS.
Five years’ experience with thymoglobulin induction in a pediatric renal transplant population
Authors: Colleen Hastings M. , Wyatt Robert J. , Lau Keith K. , Jones Deborah P. , Powell Sandra L. , Hays Dena W. , Gaber Lillian W. , Osama Gaber A. , Ault Bettina H.
Published: May 2006

Abstract:  Antibody induction therapy is used in the majority of pediatric patients undergoing renal transplantation. Our center has previously reported short‐term outcomes with TMG as induction therapy. We now present our experience over the last five yr. Patients received TMG intra‐ and post‐operatively at a dose of 1.5 mg/kg/day. The dose was decreased to 0.75 mg/kg/day or held dependent on the patient's WBC and platelet counts. Post‐transplant immunosuppression also included corticosteroids, MMF, and either TAC or CSA. Patient and graft survival, number of acute rejection episodes, creatinine clearance, incidence and type of infections, and trough levels of calcineurin inhibitor drugs were monitored during the follow‐up period. Thirty‐four renal transplants were performed in 33 pediatric patients ranging in age from 1.7 to 17.8 yr. Seventeen rejection episodes occurred during the time of follow‐up with three patients having more than one episode, but only three episodes occurred within the first year after transplantation. Three patients had graft loss in the first week after transplantation from primary non‐function (1) or technical failure/thrombosis (2). Graft losses occurred in seven additional patients during the time of follow‐up with the first loss occurring at 17.7 months. Among patients with functional grafts at one wk after transplant, graft survival at one and three yr was 100% and 73% respectively. There were no patient deaths. There were no cases of post‐transplant lymphoproliferative disease or other malignancy. One patient had symptomatic CMV disease. TMG is safe and effective as induction therapy in pediatric renal transplant patients. Late graft loss remains a challenge in the pediatric patient population, particularly in adolescents.
Conversion from calcineurin inhibitor to sirolimus in pediatric chronic allograft nephropathy
Authors: Falger Jutta C. , Mueller Thomas , Arbeiter Klaus , Boehm Michael , Regele Heinz , Balzar Egon , Aufricht Christoph
Published: May 2006

Abstract:  CAN is a major cause for allograft loss in renal transplantation. Sirolimus was recently introduced as a potent non‐nephrotoxic alternative to CNIs. In the present study, effects of a conversion protocol were investigated in pediatric CAN with declining GFR, defined by a Schwartz formula clearance below 60 mL/1.73 m2/min, steadily increasing SCr and allograft biopsy. In eight children with a median age of 12.8 yr, sirolimus was started at median 32 months after transplantation with a loading dose of 0.24 mg/kgBW, followed by 0.2 mg/kgBW/day, aimed at trough levels of 15–20 ng/mL. CNIs were reduced to 50% at start of sirolimus and discontinued at median seven days when target levels of sirolimus were reached. Following conversion, changes of GFR significantly stabilized (−2.9 vs. +0.4 mL/min/1.73 m2/month, p = 0.025). Individual GFR increased in five of eight patients (p = 0.026), only one child exhibited unaltered progression of graft failure. In the responders, mean SCr improved by 0.3 mg/dL (p = 0.043). Effects were not dependent on GFR at conversion, nor time post‐transplantation. Blood pressure, hematological parameters and proteinuria remained stable during the observation period, serum lipids transiently increased. About half of the children suffered from infectious complications. No child had to be taken off sirolimus; there was no graft loss during the observation period. In conclusion, conversion from CNIs to sirolimus is an effective protocol with tolerable side effects to stabilize renal graft function for at least one yr in the majority of children with biopsy proven CAN.
Hepatitis C viral recurrence in a pediatric patient following liver transplantation
Authors: Udell Ian W. , Barshes Neal R. , Finegold Milton J. , Lee Timothy C. , Scott Jaymee D. , Carter Beth , Karpen Saul , Goss John A.
Published: May 2006

Abstract: Hepatitis C virus (HCV) infections are known to have a more benign course in children than in adults. Although the natural history of HCV recurrence after liver transplantation has been well studied in adult patients, much less is known about HCV recurrence after liver transplantation in pediatric patients. Herein, we report a case of a pediatric patient with HCV presumably acquired through vertical transmission. She underwent liver transplantation at 14 yr of age. The first three yr after liver transplantation were uneventful. However, in the past 12 months she has been hospitalized twice after developing ascites, hematemesis and esophagogastroduodenoscopy (EGD)‐documented esophageal varices. Post‐transplant biopsy has demonstrated chronic inflammation complicated with active hepatitis C and stage 2–3 scarring. This case report demonstrates the need for further epidemiologic studies to study the natural history of the rate of HCV recurrence after liver transplantation in the pediatric population.
Should children ever be living kidney donors?
Authors: Webb Nicholas J. A. , Fortune Peter‐Marc
Published: May 2006

Abstract:  Living kidney donation by minors is an infrequently performed although highly controversial procedure. This manuscript reports the frequency of this practice in North America, Europe, Australia and New Zealand. The relevant laws and professional guidelines are reviewed and the ethical considerations discussed.
Renal transplantation in patients with Alport syndrome
Authors: Kashtan Clifford E.
Published: May 2006

Abstract:  For pediatric kidney transplant physicians, two aspects of Alport syndrome set the disease apart from other causes of terminal renal failure. First, an understanding of the genetics of Alport syndrome is needed to make appropriate decisions regarding potential related kidney donors to Alport patients requiring renal transplantation. Second, renal transplantation for Alport syndrome may be complicated by post‐transplant anti‐GBM nephritis, a problem that is nearly unique to this disease. This review discusses these aspects of Alport syndrome and attempts to provide rational recommendations for clinicians.
Successful unrelated mismatched cord blood transplantation in a child with malignant infantile osteopetrosis
Authors: Jaing Tang‐Her , Hou Jia‐Woei , Chen Shih‐Hsiang , Huang I‐Anne , Wang Chao‐Jan , Lee Wei‐I
Published: May 2006

Abstract:  Allogeneic hematopoietic stem cell transplantation represents the only curative option for malignant infantile osteopetrosis (MIOP), a rare disease of infants and young children, characterized by excessive accumulation of mineralized bone and abnormal hematopoiesis. We report a case of successful engraftment and stable full‐donor chimerism in a patient with MIOP who underwent unrelated donor cord blood transplantation (CBT). The donor was 2‐loci human leukocyte antigen (HLA)‐mismatch. After a conditioning regimen based on the combination of busulfan, cyclophosphamide, total body irradiation, and antithymocyte globulin, the patient received a dose of 3.85 × 107/kg of nucleated cells. Neutrophil and platelet engraftment had been achieved by day +33 and +82, respectively, and the patient was discharged home on day +89. A successful engraftment of donor hematopoiesis was demonstrated and the child experienced grade II acute graft‐vs.‐host disease (GVHD) involving the skin only. A remarkable but non‐progressive decrease in lumbar spine bone mineral density was observed in the first nine months post‐transplant. This case suggests that unrelated donor CBT may be a feasible option in case of unavailability of a fully HLA‐matched related or unrelated donor.
Organ transplantation, organ donation and mental retardation
Authors: Martens Marilee A. , Jones Linda , Reiss Steven
Published: May 2006

Abstract:  We reviewed the literature on accessibility and outcomes of organ transplantation in individuals with mental retardation (MR) and on the prevalence of organ donation in this population. Six centers have published outcome data on renal transplantation in 34 individuals with MR. The one‐ and three‐yr patient survival rates were 100% and 90%, respectively. The studies reported good compliance with post‐transplant medications due to consistent support from family members or caregivers. The outcome studies for liver and heart transplantation among these individuals are limited. The literature on organ donation in individuals with MR is mostly concerned with legal issues. The courts generally permit organ donations when such is in the best interests of the donor.
Rural pharmacy not delivering on its health promotion potential
Authors: Sunderland Bruce , Burrows Suzanne , Joyce Andrew , McManus Alexandra , Maycock Bruce
Published: May 2006

Objective:  To investigate the level and perceived quality of health promotion advice received from rural pharmacists.

Design:  Self‐administered written survey on access to and quality of pharmacy services in rural Western Australia completed by rural residents.

Setting:  Rural pharmacy.

Participants:  Four hundred and eighty‐three respondents who regularly used a pharmacy.

Outcome measures:  Items in the survey included frequency of receiving prevention advice and satisfaction ratings on health and pharmacy services.

Results:  Eighty‐eight per cent of respondents had never discussed exercise or diet with their pharmacist and 65% had never discussed preventing health problems. Receiving good prevention advice predicted satisfaction with health services in general but not satisfaction with pharmacy services.

Conclusion:  Pharmacies are being underutilised with respect to their capacity to deliver heath prevention advice and ways to capitalise on this potential need to be investigated.
Patterns of drug use and associated harms among rural injecting drug users: Comparisons with metropolitan injecting drug users
Authors: Day Carolyn , Conroy Elizabeth , Lowe Julia , Page Jude , Dolan Kate
Published: May 2006

Objective:  Given the harms associated with injecting drug use to both individuals and community and the paucity of such data from rural areas, the study aimed to compare: patterns of drug use, harms, and service access and utilisation among rural and metropolitan injecting drug users (IDU).

Design:  Cross‐sectional survey, using interviewer‐administered structured questionnaire.

Participants:  One hundred and sixty‐four rural and 96 metropolitan IDU from seven different New South Wales Area Health Services, recruited through needle and syringe programs (NSPs), snowballing techniques and advertisement.

Results:  Age, gender, education and employment were similar for rural and metropolitan participants. Both samples reported use of a range of drugs, but rural participants were less likely than metropolitan participants to report daily heroin use (2% vs 10%), but more likely to report having injected morphine (50% vs 21%) in the last six months. Similar proportions reported using a needle/syringe after another person. Rural participants were less likely to report use of NSPs (36% vs 80%) and reported a number of barriers to NSP access and also to drug treatment services. Rural participants reported a significantly longer period of time between blood‐borne virus testing.

Conclusion:  Samples of rural IDU are similar to metropolitan, although report some differences in patterns of drug use. Service provision, including access to new injecting equipment, blood‐borne virus testing and drug treatment was found to cause considerable problems for rural IDU. These issues warrant further consideration.
Far West Area Health Service Mental Health Integration Project: Model for rural Australia?
Authors: Perkins David A. , Roberts Russell , Sanders Tuana , Rosen Alan
Published: May 2006

Objective:  To see if a new model of service delivery ensures that individuals with a mental illness in rural and remote settings could be assessed, treated and cared for in a more appropriate way.

Design:  Community mental health teams (CMHTs), general practitioners (GP) and other agencies were provided with clinical and broader support services by consultant psychiatrists from public and private sectors. The occasions of service were logged, audited and relevant provider groups were interviewed. Ethics approval was provided by Human Research Ethics Community of University of New South Wales.

Setting:  Far West Area Health Service (FWAHS), remote New South Wales.

Participants:  An enhanced service was provided for residents, specialist mental health and other healthcare providers.

Results:

Regular access to psychiatrists for primary and secondary care was achieved in remote communities in FWAHS.

3908 new patients were seen by CMHTs between July 2002 and December 2003 and 380 by visiting psychiatrists between January 2002 and July 2003.

Secondary consultation, mentoring and education opportunities were made available by tele‐conference and face‐to‐face for CMHTs and others in FWAHS.

GPs and CMHTs in remote settings were satisfied with improved access to psychiatrist care.

Conclusions:  This model appears to be sustainable with reasonable levels of funding in FWAHS and may be applicable to other remote contexts.
Maternity emergency care: Short course in maternity emergencies for remote area health staff with no midwifery qualifications
Authors: Kildea Sue , Kruske Sue , Bowell Libby
Published: May 2006

Objective:  To improve the maternity emergency skills and knowledge of health service providers, without midwifery qualifications, in remote Australia.

Design:  A descriptive paper utilising data from a needs assessment and course evaluations used to develop and refine a short course in maternity emergencies.

Subjects:  Remote area health providers.

Interventions:  A multidisciplinary short course, targeting non‐midwives in remote areas, aimed at improving knowledge and skills in detection, management and referral of maternity emergencies.

Results:  Ten courses have been delivered to 175 participants. Evaluations demonstrate a highly valued program, well received and supported by remote health staff.

Conclusions:  The course is an important strategy to improve the maternity services offered to women in remote Australia.
Diversity in occupational therapy: Experiences of consumers who identify themselves as minority group members
Authors: Kirsh Bonnie , Trentham Barry , Cole Sametta
Published: May 2006

Background/Aim:  The occupational therapy profession is in need of self‐examination in view of the extent to which culturally constructed meanings of occupation guide its work within an increasingly diverse practice environment.

Methods:  Semistructured interviews were completed with 14 individuals who defined themselves as minority group members in order to gain an understanding of their experience of the occupational therapy process.

Results:  Five themes emerged: the importance of social location, the need for safety and acceptance, avoiding omissions, understanding differences in occupation, and the face of discrimination.

Conclusions:  Cultural and sexual identities influence occupational choices and interface with the social location of the therapist to influence the therapeutic process. Despite holistic and client‐centred values, the comprehensive nature of occupational therapy is not experienced by clients of minority groups. Practice models are needed that provide directives for the establishment of alliances with minority clients and that highlight the significance of exploring occupational choices, experiences of oppression and the impact of the therapists’ culture on the therapeutic process.
Home programmes in paediatric occupational therapy for children with cerebral palsy: Where to start?
Authors: Novak Iona , Cusick Anne
Published: May 2006

Aim:  Home programmes are used extensively for children with cerebral palsy. Even though there is consensus about the importance of home programme intervention, there is little evidence of efficacy and scant information regarding programme characteristics that might affect family participation. Instead, research to date has focussed on parental compliance with prescribed programmes and parent–child interactions.

Methods:  Based on reviewed literature, this article proposes a model to guide development of home programmes for children with cerebral palsy. It is a starting point for therapists to consider the way in which they focus and structure their home programmes for children who have cerebral palsy.

Results and Conclusions:  The paper identifies an urgent need to develop clinical guidelines for home programmes through rigorous formal processes and to evaluate the impact of occupational therapy home programmes.