bluuebunny/crossref_metadata_2025 huggingface dataset:
Enhancing the quality of hermeneutic research: decision trail
Authors: Whitehead Lisa
Published: December 2004

Background.  Researchers have ethical and professional obligations to produce research of a high standard. The constituents of quality in research appear to differ between authors, leaving readers unsure about which pathway to follow. This can reflect inadequate consideration of the theoretical framework guiding the study. Many papers fail to consider the theoretical underpinnings of the methodology chosen and the link between these and the methods employed. These need to be accessible to readers in order to assess the trustworthiness of the research.

Aim.  This paper discusses the development of trustworthiness in hermeneutic phenomenological research.

Discussion.  Referring to a study on lived experience of Chronic Fatigue Syndrome/myalgic encephalitis, I describe the decision trail and discuss the strengths and limitations of the choices made throughout the study.

Conclusion.  The methodology focused my approach more fully on the importance of recognizing the influences that I brought to the study and the impact of these in generating the data. It highlighted the fact that the process of setting out my horizon can never be complete, the importance of analysing the data at a macro and micro level, acknowledging the evolution of the data over time, and ensuring that analysis does not move beyond the data and out of the hermeneutic circle. In seeking to make the decision trail clear to others, researchers must distill the philosophical principles of the methodology and set these out in a way that is accessible and open to scrutiny.
Morphine is not the only analgesic in palliative care: literature review
Authors: Wootton Margaret
Published: December 2004

Background.  No comprehensive review has been published to date, which provides information for nurses on pharmaceutical alternatives to morphine in palliative care. As nurses are often the health professional most involved with terminally ill patients, there is a clear need for a review of current practices which is accessible to nurses.

Aim.  The aim of this review is to examine the pharmaceutical alternatives to morphine use in palliative care that are currently available.

Methods.  Searches were made of the CINAHL and MEDLINE databases for articles published between 1990 and 2000, using the keywords ‘pain management’, ‘cancer pain’ and ‘morphine’.

Findings.  Most evidence on the use of pharmaceutical alternatives to morphine is anecdotal, demonstrating a need for more research to be conducted in this field. Evidence presented in this review shows encouraging results following the administration of methadone, fentanyl or ketamine to patients with difficult pain problems.

Conclusion.  Nurses need to be aware of treatment options that may benefit patients with difficult pain problems. Although positive experiences have been documented when using alternatives to morphine, more research must be conducted to allow practitioners to add more pharmaceutical alternatives to their pain management armouries.
Psychological distress: concept analysis
Authors: Ridner Sheila H.
Published: December 2004

Background.  The term ‘distress’ is frequently used in nursing literature to describe patient discomfort related to signs and symptoms of acute or chronic illness, pre‐ or post‐treatment anxiety or compromised status of fetuses or the respiratory system. ‘Psychological distress’ may more accurately describe the patient condition to which nurses respond than does the term ‘distress’. Psychological distress is seldom defined as a distinct concept and is often embedded in the context of strain, stress and distress. This creates confusion for nurses attempting to manage the care of people experiencing psychological distress.

Aims.  This paper is a concept analysis of psychological distress based on Walker and Avant's (1995) criteria that identifies the attributes, antecedents, and consequences of psychological distress based upon the findings of the literature review. In addition, empirical references are identified and constructed cases presented.

Methods.  A literature search was conducted using MEDLINE, CINAHL, Ovid, PsychINFO, and Cancer Lit databases over the last 50 years. The purposes of this concept analysis were: (1) to establish the concept of psychological distress as a clear and distinct concept, separate from strain, stress and distress, and (2) to provide nurses with a base of knowledge from which to plan effective clinical interventions.

Findings.  Content analysis of the literature revealed that, although used frequently in health care literature, the origin of the concept of psychological distress has not been clearly articulated and is ill‐defined.

Conclusions.  Psychological distress is a serious problem faced by many of the people whom nurses encounter on a daily basis. An understanding of the concept of psychological distress will help nurses ameliorate this problem in patients. Nursing research related to the exploration of psychological distress is also needed.
Maternal support during the first year of infancy
Authors: Börjesson Britt , Paperin Christina , Lindell Marianne
Published: December 2004

Background.  Mental health problems among children and adolescents are becoming more visible and some research indicates that they are increasing. Several studies suggest that social support counteracts the increasing risk of ill‐health in families with children. However, there is a lack of studies which focus on the support that expectant mothers and parents might need.

Aim.  The aim of the study was to describe mothers’ experiences of pregnancy, labour and homecoming, support needs, and sources of support in their role as parents.

Methods.  One hundred and twenty‐two mothers participated in the study by answering a questionnaire consisting of 37 questions. Data were analysed using descriptive statistics, chi‐square tests and content analysis.

Findings.  Mothers of infants had a great need to talk about their experiences of labour soon afterwards and over the following months. Most of the mothers had generally received support from their partners. However, in some situations, other people in their networks, and maternity and child health services had been more supportive than partners.

Discussion.  The study highlights how important it is for expectant mothers and new mothers to be confirmed in their mothering role. Nurses in the maternity and child health services have an important task to support people in becoming and being parents, with regard to their emotional state. There is a need for more resources within these services for establishing parent groups, including groups for fathers. This could improve parents’ physical, psychological and emotional health, and decrease their need for health and social services.
Living with a terminal illness: patients’ priorities
Authors: Carter Helen , MacLeod Rod , Brander Penny , McPherson Kath
Published: December 2004

Background.  Our understanding of terminal illness and its consequences has been predominantly based on models derived from expert definition, rather than the patient's perspective. More recently, quality of life tools have been developed to enable patient choice in responses. However, an even broader approach may be needed to help identify goals for care for patients who are terminally ill.

Aim.  The aim of this paper is to report on an exploratory, qualitative study exploring what people living with terminal illness considered were the areas of priority in their lives.

Methods.  Ten people living with terminal cancer were interviewed. Analysis of the interviews incorporated principles of narrative analysis and grounded theory.

Findings.  Over 30 categories were identified and collated into five inter‐related themes (personal/intrinsic factors, external/extrinsic factors, future issues, perceptions of normality and taking charge) encompassing the issues of importance to all participants. Each theme focused on ‘life and living’ in relation to life as it was or would be without illness. Practical issues of daily living and the opportunity to address philosophical issues around the meaning of life emerged as important areas. The central theme, ‘taking charge’, concerned with people's levels of life engagement, was integrally connected to all other themes.

Conclusions.  The findings suggest that the way in which health professionals manage patients’ involvement in matters such as symptom relief can impact on existential areas of concern. Understanding patients' perspectives in relation to each theme may assist health professionals to develop management strategies appropriate to their needs. The findings challenge some aspects of traditional ‘expert‐defined’ outcome measures. As this was an exploratory study, further work is needed to test and develop the model presented.
Resident‐oriented care in nursing homes: effects on nurses
Authors: Berkhout Afke J.M.B. , Boumans Nicolle P.G. , Van Breukelen Gerard P.J. , Abu‐Saad Huda Huijer , Nijhuis Frans J.N.
Published: December 2004

Background.  In a resident‐oriented care model the assignment of patients to primary nurses takes place. These primary nurses are responsible for the total nursing care of their patients and make use of the nursing process. According to job demand‐control models, these enlarged and enriched jobs can be described in terms of autonomy, job demands and social support, and the presence of these work characteristics has a positive influence on workers’ psychological and behavioural outcomes.

Aims.  This paper reports a study to investigate the extent to which the various features of resident‐oriented care were implemented and its effects nurses’ on work characteristics and on psychological and behavioural outcomes in three Dutch nursing homes.

Methods.  In a quasi‐experimental design, experimental and control groups were followed over 22 months, using a pretest and two post‐tests with questionnaires, interviews and qualitative observations.

Results.  The quantitative data showed significant increases in resident assignment, the two variables measuring the nursing process and, in the psycho‐geriatric experimental group, on resident‐oriented tasks. The qualitative data showed that a partly task‐oriented division of labour was still used and that the planned delegation of coordination tasks to primary nurses was not fully achieved. Effects on work perceptions were limited. After implementation of the new system, the experimental group showed an increase in job autonomy.

Conclusions.  The intervention appeared to be only partly successful. Most of the expected results regarding work characteristics and psychological and behavioural outcomes did not materialize. Theoretical and methodological reflections are presented in the light of these findings.
The urban geography of SARS: paradoxes and dilemmas in Toronto's health care
Authors: Affonso Dyanne D. , Andrews Gavin J. , Jeffs Lianne
Published: December 2004

Background.  Severe acute respiratory syndrome (SARS) has impacted heavily on both Canada's society and its health care system. Quite unexpectedly, hospitals and health care workers became facilitators of disease diffusion. This experience has demonstrated the need for a comprehensive disease control strategy.

Aims.  The aims are threefold. First, to examine the subtle and changing spatial characteristics of SARS during the short but critical period of its rapid spread in the Greater Toronto Area. Second, to make salient three paradoxes, and their associated dilemmas, faced by nurses and other health care professionals challenged with caring for the sick and containing the rapid spread of the disease. Third, to propose some ways of approaching these dilemmas, as well as some broader preventative and mitigating strategies.

Methods.  The crosscutting concepts of ‘clinical uncertainty’ and ‘flow of human contacts’ are used to explain disease transmission characteristics and urban spatial diffusion and to guide the particular strategies developed. Evidence for the paper comes from public health records, governmental and non‐governmental health statements and the initial epidemiological research on SARS. Direct insights are also gained from recent first‐hand experiences of Toronto's health care system during the crisis.

Discussion.  The concepts of clinical uncertainty and the flow of human contacts provide in‐depth insights that complement the findings of large‐scale epidemiological studies, and help operationalize their general calls for enhanced control measures. The comprehensive disease control strategy proposed includes the creation of a hospital infrastructure specific to the containment of biological threats; an advisory coalition of disease control specialists; the development of a biological threat‐and‐containment simulation laboratory and three specific programmes in patient safety, risk assessment and community mobilization.

Conclusion.  It is argued that containment alone, while a necessary and urgent priority, cannot be seen as an end in itself and might better be understood as one possible trajectory within a comprehensive problem‐solving strategy. The experiences in Toronto may offer insights to other cities and countries that currently lack such strategies and hence may be vulnerable to similar outbreaks of dangerous infectious diseases.
Stimulatory effect of octopamine on β3‐adrenoceptors to lower the uptake of [14C]‐deoxy‐D‐glucose into rat adipocytes in vitro
Authors: Yen S. T. , Li M. H. , Hsu C. T. , Lee T. L. , Cheng J. T.
Published: December 2004

The effect of octopamine on β3‐adrenoceptors has been studied in isolated adipocytes of Wistar rats using uptake of [14C]‐deoxy‐D‐glucose as the indicator.

Octopamine (0.1–1 nmol 1−1) induced a concentration‐dependent decrease of [14C]‐deoxy‐D‐glucose uptake into the adipocytes and this inhibition was not influenced by halperidol at concentrations sufficient to block dopaminergic receptors.

Pindolol and propranolol reversed this inhibition of octopamine in a concentration‐dependent manner. The effect of octopamine was reduced in the presence of Rp‐cyclic AMPS triethylamine, the membrane‐permeable antagonist of cyclic AMP (cAMP), indicating the mediation of cAMP in this inhibition.

A direct effect of octopamine on β3‐adrenoceptors was proved using the application of antibodies. In the presence of an antibody for β3‐adrenoceptors, the actions of octopamine were concentration‐dependantly reduced in a manner similar to the decrease of BRL37344‐induced inhibitions.

The same degree of diminished activities for octopamine as that of BRL37344, the well‐known specific agonist of β3‐adrenoceptors, was also obtained in isoprenline‐desensitized adipocytes. Insulin‐stimulated uptake of [14C]‐deoxy‐D‐glucose into adipocytes was not modified by isoprenaline induced desensitization.

These results suggest that octopamine can activate β3‐adrenoceptors to lower the glucose uptake through an increase of cAMP in rat white adipocytes.
Differential regulation of mesenteric and femoral blood flow in the rat as revealed by computerized data acquisition and evaluation
Authors: Heinemann A. , Wachter C. H. , Holzer P.
Published: December 2004

A set‐up for computerized acquisition and evaluation of haemodynamic data was constructed. Blood flow (BF) in the superior mesenteric and femoral artery of urethane‐anaesthetized rats was measured with the ultrasonic transit time shift technique. The signals for arteial blood pressure and BF were fed into a personal computer via an analogue‐digital converter. Mean arterial blood pressure, heart rate and vascular conductance (CV) were calculated on‐line. For subsequent analysis of the data, algorithms were programmed to filter the data, and to determine average and peak values for each parameter.

Systemic hypertension induced by phenylephrine (3–300 nmol kg−1), angiotensin II (0.1–3.0 nmol kg−1) and arginine vasopressin (0.03–1.0 nmol kg−1) was accompanied by constriction of the mesenteric artery. In contrast, the femoral artery responded to phenylephrine with constriction, to angiotensin II with dilatation and to arginine vasopressin with dilation followed by constriction. The haemodynamic effects of endothelin‐1 (0.03–3.0 nmol kg−1) were generally biphasic, the initial hypotension being associated with dilatation, and the delayed hypertension being accompanied by constriction of both the mesenteric and femoral arterial bed.

Terbutaline (3–1.0 nmol kg−1) and calcitonin gene‐related peptide (0.03–1 nmol kg−1) caused systemic hypotension along with mesenteric and femoral vasodilatation.

Telmisartan (1 mg kg−1), an angiotensin AT1 receptor antagonist, dilated the mesenteric artery, but had no effect on femoral VC. In contrast, the α1‐adrenoceptor antagonist prazosin (0.1 mg kg−1), dilated the femoral artery without altering mesenteric VC. Similarly, the β‐adrenoceptor antagonist propranolol (1 mg kg−1) had no effect on mesenteric VC, but constricted the femoral arterial bed.

These data demonstrate that the haemodynamic effects of exogenously administered drugs can widely differ between the mesenteric and femoral arterial beds of urethane‐anaesthetized rats. Furthermore, vascular tone of these two arterial beds in maintained by different vasoconstrictor systems. While the femoral artery is mainly under adrenergic control, the renin‐angiotensin axis is predominant in the mesenteric arterial bed. In addition, this study also demonstrates that computerized analysis enables quick and accurate estimation of haemodynamic drug effects, and is superior to ‘by hand’ evaluation of peak changes in the functional diameter of the vascular bed under study.
Dopamine D2‐like receptors in the kidney of spontaneously hypertensive rats: a radioligand binding assay and light microscope autoradiography study
Authors: Barili P. , Fringuelli Ch. , Baldoni E. , Mignini F. , Zaccheo D. , Amenta F.
Published: December 2004

Dopamine D2‐like receptors were investigated in sections of kidney from male spontaneously hypertensive rats (SHRs) at 6 and 14 weeks of age using radioligand binding assay and autoradiographic techniques with [3H]‐spiperone as a ligand.

Systolic blood pressure values were slightly higher in 6‐week‐old SHRs in comparison with agematched normotensive Wistar‐Kyoto (WKY) rats and considerably higher in 14‐week‐old SHRs in comparison with the other groups investigated. Renal dopamine levels were higher in SHRs aged 6 and 14 weeks in comparison with age‐matched WKY rats. Noradrenaline concentrations were similar in 6‐week‐old SHRs and normotensive WKY rats, and increased slightly in SHRs aged 14 weeks.

The density of [3H]‐spiperone binding sites was similar in SHRs and WKY rats at 6 weeks of age, and decreased in SHRs at 14 weeks in comparison with age‐matched normotensive animals. Light microscope autoradiography revealed the accumulation of silver grains in the tunica adventitia, in the adventitia‐media border of intrarenal arteries and within cortical tubules. A few specific silver grains were also developed in the glomerular tuft. No changes in the density and pattern of silver grains were noticeable between SHRs and WKY rats at 6 weeks of age, whereas a reduction in silver grains largely affecting vascular binding sites was observed at 14 weeks of age.

Renal denervation considerably decreased the density of [3H]‐spiperone binding sites in sections of rat kidney, with an almost complete loss of vascular binding sites.

The above findings indicate the occurrence of a decrease of dopamine D2‐like receptors in the kidney of SHRs with the progress of hypertension. Dopamine D2‐like receptors which are mainly prejunctional are involved in the modulation of sympathetic neurotransmission in the kidney. The loss of these receptors in SHRs may contribute to the pathophysiology of hypertension.
In vitro excitatory actions of corticotropin‐releasing factor on rat colonic motility
Authors: Mancinelli R. , Azzena G. B. , Diana M. , Forgione A. , Fratta W.
Published: December 2004

Corticotropin‐releasing factor (CRF) has been shown to affect gastrointestinal functions, however, a direct effect of CRF on the intestine has not been demonstrated.

To determine the direct effect of CRF and its antagonist α‐helical‐CRF9–41 (α‐h‐CRF) on the enteric nervous system, we studied the action of these substances on electrical and mechanical parameters of peristaltic activity on isolated distal colon of the rat.

The effects of CRF were evaluated in vitro on rat isolated colonic segments in which intraluminal pressure, longitudinal displacement, ejected fluid volume and extracellular electrical activity were simultaneously recorded during colonic peristaltic reflex.

The addition of CRF (10−10–10−8 M) to the bath fluid provoked a concentration‐dependent increase of both mechanical and electrical peristaltic activity. The CRF‐receptor antagonist α‐h‐CRF dose‐dependently (10−10–10−7 M) induced a decrease of the colonic mechanical and electrical activity and prevented (10−8–10−6 M) CRF (10−8 M) maximal effects.

These results indicate: (a) CRF can exert its effects on colon functions by a direct action, (b) a specific CRF‐receptor is present in the rat colon. Indeed, CRF effects are antagonized by the specific CRF antagonist α‐h‐CRF, (c) the fact the αs‐h‐CRF displays an activity on its own reveals that colonic functions are controlled by an endogenous CRF tonic activity.
Transmitter release and uptake evoked by the amphibian skin alkaloid, pumiliotoxin‐B (PTX‐B), in the electrically stimulated mouse vas deferens preparation (MVD)
Authors: Severini C. , Erspamer G. Falconieri , Erspamer V.
Published: December 2004

Upon electrical stimulation three transmitters are known to be released from the adrenergic nerve terminals of the isolated MVD preparation: two motor transmitters (noradrenaline (NA) and ATP) acting synergistically to provoke twitch contraction, and an inhibitory transmitter, the peptide NPY.

The frog alkaloid pumiliotoxin‐B (PTX‐B) displayed two opposite effects on the electrically stimulated MVD: at low concentrations (0.1–0.3 μM) it caused twitch depression, at higher concentrations (0.5–2 μM) there was a potent twitch stimulation. Transmitters and/or receptors involved in the depressive effect could not be clearly identified, although interference with NPY is possible. On the other hand, the potent twitch stimulation caused by PTX‐B may be due to exaggerated release of the same transmitters (NA and ATP) involved in twitch stimulation produced by electrical stimulation.

Opening by PTX‐B of the Na+ channels on the membrane of the adrenergic nerve terminals causes activation of the amine pump facilitating re‐uptake of not only endogenous NA but also of exogenous catecholamines.
From plains to inselbergs: species in special habitats as indicators for climate change?
Authors: Burke Antje
Published: December 2004

Aim  This study proposes a process to select plant species that would provide suitable candidates for monitoring climate change impacts in areas where complete biological inventories are lacking.

Location  Inselberg floras of nine inselberg landscapes (i.e. isolated mountains) in the arid Desert and Nama Karoo biome in Namibia were analysed to develop a selection process.

Methods  Data from detailed field surveys were summarized to determine species only occurring on inselberg habitats (i.e. inselberg specialists). Detrended correspondence analysis and a step‐by‐step selection process based on species distribution patterns were used to determine species occurring on inselbergs beyond their zonal distribution ranges.

Results  The systematic selection process initially identified 88 plant species. Based on field observations and published sources eliminating species (1) with a wide distribution elsewhere, (2) distribution influenced by local effects and (3) for which their status of knowledge of distribution was clearly inadequate, this list was further reduced to 25 species. This included southern species occurring on inselbergs likely beyond their zonal distribution, such as Adenolobus garipensis, Aloe dichotoma and Euphorbia gummifera, as well as savanna and escarpment species at their western zonal distribution edge (e.g. Cordia sinensis, Commiphora glaucescens and Moringa ovalifolia).

Main conclusions  The step‐by‐step selection process proposed in this study to assist with the selection of indicators for climate change provides an objective tool in areas where biodiversity coverage is not adequate and little is known about physiology, growth and reproductive patterns of individual species. As such it introduces a method for preliminary screening of species, but will require further input based on field observations and expert knowledge.
Spatial congruence of ecological transition at the regional scale in South Africa
Authors: Van Rensburg Berndt J. , Koleff Patricia , Gaston Kevin J. , Chown Steven L.
Published: December 2004

Aim To determine whether patterns of avian species turnover reflect either biome or climate transitions at a regional scale, and whether anthropogenic landscape transformation affects those patterns.

LocationSouth Africa and Lesotho.

Methods Biome and land transformation data were used to identify sets of transition areas, and avian species occurrence data were used to measure species turnover rates (β‐diversity). Spatial congruence between areas of biome transition, areas of high vegetation heterogeneity, high climatic heterogeneity, and highβ‐diversity was assessed using random draw techniques. Spatial overlap in anthropogenically transformed areas, areas of high climatic heterogeneity and highβ‐diversity areas was also assessed.

Results Biome transition areas had greater vegetation heterogeneity, climatic heterogeneity, andβ‐diversity than expected by chance. For the land transformation transition areas, this was only true for land transformation heterogeneity values and for one of theβ‐diversity measures. Avian presence/absence data clearly separated the biome types but not the land transformation types.

Main conclusions Biome edges have elevated climatic and vegetation heterogeneity. More importantly, elevatedβ‐diversity in the avifauna is clearly reflected in the heterogeneous biome transition areas. Thus, there is spatial congruence in biome transition areas (identified on vegetation and climatic grounds) and avian turnover patterns. However, there is no congruence between avian turnover and land transformation transition areas. This suggests that biogeographical patterns can be recovered using modern data despite landscape transformation.
‘Rage against the machine?’: nurses’ and midwives’ experiences of using Computerized Patient Information Systems for clinical information
Authors: Darbyshire Philip
Published: December 2004

Background.  Computerized Patient Information Systems (CPIS) are used increasingly in health care, yet few studies have asked clinicians to describe their experiences of using these systems and what they mean to their practice and patient care.

Aims and objectives.  The aim of this study was to explore clinical nurses’ and midwives’ perceptions and understandings of computerized information systems in everyday practice. The objective was to provide a detailed and faithful account of clinicians’ experiences of using such systems.

Design.  A qualitative design was used, based upon interpretive phenomenology.

Methods.  A total of 13 focus groups involving 53 practitioners was conducted in hospitals across five Australian states with nurses and midwives from a wide range of practice settings. The participants ranged from Level 1 RNs to Clinical Nurse Consultants and nurses with an IT project management role.

Results.  This study focuses specifically on clinicians’ experiences of using CPIS to manage clinical information. Clinicians’ experiences were characterized by digital disappointment rather than electronic efficiencies. Clinicians reported generally that computerization had neither enhanced their clinical practice nor patient care, nor had it improved patient outcomes.

Conclusions.  Participants’ experiences were predominantly negative and mostly critical of CPIS and their: perceived inability to capture ‘real nursing’, difficulty in use, incompatibilities, non‐responsiveness and irrelevance to patient care and meaningful clinical outcomes.

Relevance to clinical practice.  Technological ‘solutions’ to health care problems are endlessly seductive and easily entrance policy and decision makers. Computerization will continue to impact upon clinical practice and cannot be wished away. Today's computerized systems may have been developed with scant regard for clinician end‐users. A crucial issue facing everyone in health informatics is how point‐of‐care systems can be developed in ways that involve clinicians meaningfully and which recognize and respond to the complexity and subtlety of the world of nursing and midwifery practice.
Spirituality: the emperor's new clothes?
Authors: Bash Anthony
Published: December 2004

Background.  This paper explores the concept of ‘spirituality’ with reference to the Patients’ Charter that stipulates that a person's religious, spiritual and cultural needs should be respected at all times.

Aims and objectives.  The aim is to offer a critical analysis of what the word ‘spirituality’ may mean when used in the Patients’ Charter and to explore the implications of this for clinical practice.

Design.  A critical discussion based on a literature review, examining in particular methodological presuppositions.

Methods.  The meaning of ‘spirituality’ in the Judaeo–Christian biblical traditions is explored. Some of the heuristic assumptions in contemporary research on ‘spirituality’ are examined. Philosophical (i.e. non‐scientific) and scientific questions to do with ‘spirituality’ are disentangled.

Results and conclusions.  The paper concludes that: (i) ‘Spirituality’ is an elastic term not capable of universal definition as each person's spirituality is an individual matter for them and (ii) tools that are being developed for identifying a person's spirituality run the risk of making wrong presuppositions about what comprises spirituality.

Relevance to clinical practice.  It is unlikely that tools can be developed that are widely applicable for identifying and assessing spirituality.
Violence in the care of adult persons with intellectual disabilities
Authors: Strand MarieLouise , Benzein Eva , Saveman Britt‐Inger
Published: December 2004

Background. Violence, for example physical, psychological, financial and sexual abuse and neglect, exists and is an under‐reported problem in caring situations involving adult persons with intellectual disabilities and their caregivers, where both parties can be seen as victims and perpetrators.

Aims and objectives. To investigate violent situations involving Swedish adult persons with intellectual disabilities and their caregivers in group‐dwellings.

Design. A total population‐based survey.

Methods. A questionnaire, including violence towards adults with intellectual disabilities and violence towards staff members during 1 year, was sent to all staff members (n = 164) from 17 care settings for adults with intellectual disabilities with a response rate of 74%.

Results. Thirty‐five per cent of 122 respondents admitted they had been implicated in or witnessed a violent incident towards an adult person with intellectual disabilities and 14% of the staff members admitted they themselves had been the perpetrators. Sixty‐one per cent of the staff members described various situations when they were exposed to violence from an adult person with intellectual disabilities. Physical violence was most frequently reported. Most of the aggression occurred in helping situations when persons with intellectual disabilities did not co‐operate or when both actors reacted with violence. The violent situations led the staff members to feel powerless and inadequate. In order to cope they discussed with each other or with the manager.

Conclusions. Violence seems to be accepted as a natural part of the daily care for adult persons with intellectual disabilities. Most of the violence is physical and psychological and occurs in close helping situations.

Relevance to clinical practice. Supportive interventions, i.e. supervision for the staff members and training of communication skills individually or in group for the adults with intellectual disabilities.
Chronic renal failure: assessing the Fatigue Severity Scale for use among caregivers
Authors: Schneider Robert A.
Published: December 2004

Background.  Quality of life for caregivers of end‐stage renal disease patients has not been well addressed yet the physical and psychological status of this overlooked group can be important in the recovery or adaptation of patients with chronic renal failure, not to mention the caregivers themselves. One particular feature of the overall quality of life of such caregivers is that of fatigue.

Aims and objectives.  The purpose of the study was to test the Fatigue Severity Scale for potential usefulness in assessing fatigue among a non‐medical population, caregivers of end‐stage renal disease patients.

Methods.  Subjects completed a short battery of measures at either a dialysis centre or at home.

Results.  The Short Form‐12 of the Short Form‐36 and the Center for Epidemiologic Studies Depression Scale accounted for 56% of the variance on the Fatigue Severity Scale. The results suggest that physical fatigue may be more prominent than mental fatigue as a feature of caregiver quality of life.

Conclusions.  The Fatigue Severity Scale which has been used for multiple sclerosis patients may prove to be useful as a short assessment of fatigue among the non‐medical population of end‐stage renal disease caregivers. This may result in improved interventions for the population of caregivers.

Relevance to clinical practice.  Physicians, nurses and allied health professionals will be called on more frequently to assess and intervene with fatigued and overburdened caregivers in addition to patients themselves. A more thorough understanding of the nature of caregiver fatigue may drive changes or innovations with caregivers who are too often overlooked in the current era of scarce resources. Accordingly results of the study suggest that the direction in intervention may focus more on rest and respite as opposed to a need for psychosocial support or counselling. While there are various modes for assessing end‐stage renal disease caregivers’ fatigue, a simple measure like the Fatigue Severity Scale is brief enough to be administered without undue demand on practitioners or caregivers.
Advanced home care: patients’ opinions on quality compared with those of family members
Authors: Larsson Bodil Wilde , Larsson Gerry , Carlson Solveig Rizell
Published: December 2004

Background.  Advanced medical care in the patient's home setting is becoming more common. Many of the patients who receive this kind of care have severe illnesses and are unable to respond to questions about the quality of care. The research question was: are the patients’ opinions congruent with those of family members?

Aim.  To explore and compare the relationship between patients’ perception of the quality of care and close family members’ perception of this care as well as their perception of the patients’ perception.

Methods.  Sixty‐seven patients receiving advanced home care, 82 family members (54 matched patient + family member pairs) participated. Data were collected using a short version of the quality from the patient's perspective questionnaire modified to advanced home care.

Results.  A high degree of perceptual congruence was found between patients and their family members. The similarity was also high between family members’ own opinion and their appraisal of how the patient perceived the care. A subgroup of family members who met the patient once a week or less often deviated from this pattern.

Conclusion.  Patients’ views on the quality of care are congruent with the opinions of family members if they meet every day (live together) and share the same everyday and care‐related experiences. The results can be understood in the light of empathic accuracy theory.

Relevance to clinical practice.  The findings of this study have important implications for clinical nursing practice. Family members’ perception of the quality of care may be a valuable data source for nurses in the case of advanced home care if the patient and family member share the same everyday, care‐related experiences, otherwise family members’ perception tend to be more critical than those of the patients themselves.
Dementia and aggressiveness: stimulated recall interviews with caregivers after video‐recorded interactions
Authors: Skovdahl Kirsti , Kihlgren Annica Larsson , Kihlgren Mona
Published: December 2004

Background.  In a previous study, nine caregivers and two residents with dementia showing aggressive behaviour, were video recorded. Caregivers who reported problems when dealing with such behaviour and caregivers, who did not, were included in this study.

Aim.  The aim of the present study was to obtain insight into the reasoning of the caregivers who had reported problems when dealing with older people with dementia and aggressiveness and those who did not relative to their respective video‐recorded interactions with these residents. A further aim was to gain insight by discussing their reasoning in relation to each other.

Method.  Stimulated recall interviews were carried out with all the caregivers who had been video taped in the previous study. The text was analysed by thematic content analysis.

Findings.  Two main ways of thinking and discussing the care situations emerged. The caregivers, who had reported problems in handling behavioural and psychiatric symptoms in dementia earlier, reasoned that they were more focused on their duties, this included being responsible for the resident receiving her weekly shower. For this group of caregivers, the well being of the resident was in focus, but their attention was concentrated on the resident's well being and comfort after their shower. However, these caregivers seemed therefore unwittingly to prevent a positive interaction with the resident. The other caregivers were able to reflect spontaneously and appeared to be self‐critical. This caregiver group seemed to sustain a positive interaction with the resident both during and after the shower.

Relevance to clinical practice.  In this study a nurturing and supportive climate and competence seemed to be the conditions necessary to facilitate reflections and promote creativity in the caregivers such that they are able to develop possible ways of handling difficult situations like aggressiveness in residents with dementia.
SARS – a perspective from a school of nursing in Hong Kong
Authors: Thompson David R. , Lopez Violeta , Lee Diana , Twinn Sheila
Published: December 2004

Background.  Severe acute respiratory syndrome (SARS) is a new infectious disease with significant morbidity and mortality that has had a major impact on health and health care services worldwide. Hong Kong has had a significant number of cases and deaths. Nurses, at the vanguard of the clinical health care team, have been particularly affected by it. The outbreak prompted the health authorities to implement a series of public health measures and hospital policies, including a guideline for the diagnosis and management of patients with SARS.

Aims and objectives.  This paper aims at providing an overview of what is known about SARS and the impact it has had in Hong Kong and to highlight from the perspective of a school of nursing the major clinical, educational and public health implications.

Conclusions.  The lack of understanding and uncertainty about the disease led to significant variation in the provision of information, contributing to the confusion and anxiety in the community. Therefore, there is a need to revise the nursing curriculum, to provide continuing education to all health care professionals, particularly with regard to infection control measures, and to revisit the range of public health policies to ensure the health of the community is protected by these policies. There also has been a reaffirmation of the importance of health promotion that highlights the importance of the partnership between nurses, health policy makers and public health personnel. It is evident that the organization and delivery of clinical practice, teaching and health promotion have to be flexible and responsive to a changing health scenario.

Relevance to clinical practice.  Nurses must play a crucial role in the prevention, detection and containment of SARS. They will need to implement and ensure strict adherence to infection control measures and, in some circumstances, isolation and quarantine may be warranted. Attention to the psychological state of patients and family members should not be overlooked. Paramount is education of patients, families and members of the public at large.
Barriers to physicians’ decisions to discuss hospice: insights gained from the United States hospice model
Authors: McGorty E. Kiernan , Bornstein Brian H.
Published: December 2004

Due to its comprehensive and cost‐saving design, hospice has become a critical component of health care. Physicians have become the primary gatekeepers to information on hospice and sources of referral to hospice. However, many physicians do not discuss hospice options until late in the disease course, when patients and their families are no longer able to benefit from hospice services. Although physicians, as well as patients and hospice personnel, cite patient and hospice structure factors as barriers, the present article will focus on barriers physicians have more control over, such as their discomfort discussing terminality and fear of losing contact with patients. Focusing on the American hospice model, the present article will review past findings, examine gaps in the research, and propose systematic ways to discern whether the factors physicians claim are barriers actually affect their decision making about hospice referral.
Eyelid trichoblastoma: an unusual localization
Authors: Mencía‐Gutiérrez Enrique , Gutiérrez‐Díaz Esperanza , Ricoy José R. , Rodríguez‐Peralto José L.
Published: December 2004

A 79‐year‐old woman presented with an eyelid mass below the eyebrow. It was first noticed by the patient 7 months before and had slowly increased in size and had become itchy. Physical examination revealed an ulcerated, desquamative, nonumbilicated, nodular mass arising from the inner third of the right upper eyelid (Fig. 1). It was firm, well‐demarcated, and measured 12 mm in diameter and 10 mm in height, without free edge involvement (to 0.9 cm). The remainder of the ocular examination was normal. With a clinical diagnosis of basal cell carcinoma, it was completely excised under local anesthesia, with 3‐mm safety margins of normal appearing tissue. Wound repair by means of a skin flap advanced from the temporal side was performed.

Firm, well‐defined nodular mass (12 mm in diameter) arising from the inner third of the right upper eyelid below the eyebrow; ulcerated, desquamative, and nonumbilicated

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A histopathologic diagnosis of trichoblastoma was made based on the presence of a well‐circumscribed, symmetrical mass occupying dermal and upper areas of subcutaneous tissue and closely related to the overlying epidermis (Fig. 2, top). The tumor consisted of nests and cords of cells with an interlacing pattern included in an abundant, delicate, fibrocytic, fibrillary stroma. A follicular germ‐like structure was also seen (Fig. 2, bottom). Immunohistochemistry showed isolated Merkel cells positive for chromogranin A.

Top: panoramic view with the presence of a well‐circumscribed, symmetrical mass occupying dermal and upper areas of subcutaneous tissue and closely related to the overlying epidermis (hematoxylin and eosin; original magnification, × 5). Bottom: the tumor consists of nests and cords of cells with an interlacing pattern included in an abundant, delicate, fibrocytic, fibrillary stroma. A follicular germ‐like structure at the central part of the neoplastic epithelial cells can also be seen (hematoxylin and eosin; original magnification, × 50)

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Melanocyte–keratinocyte cell transplantation for stable vitiligo
Authors: Mulekar Sanjeev V.
Published: December 2004

Background Vitiligo is a common disorder with a worldwide prevalence of 1–2%. In India the psychological and social impact of the disease is significant and is detrimental to patients.

Objective To evaluate the usefulness of epidermal cell transplantation in the treatment of vitiligo.

Methods A simpler and modified method based on that of Olsson and Juhlin has been used. It utilizes a shave biopsy skin sample of up to one‐tenth the size of the recipient area. The skin sample is incubated, the cells mechanically separated using trypsin EDTA solution, and then centrifuged to prepare a suspension. The cell suspension is then applied to the derm‐abraded depigmented skin area and collagen dressing is applied to keep it in place.

Results One hundred and twenty‐two patients with generalized vitiligo, 43 with segmental and 19 with focal vitiligo were treated and observed for a period of 1 year. In the generalized vitiligo group 65 (53%) showed excellent pigmentation, 10 (8%) showed good pigmentation, 11 (9%) showed fair pigmentation and 28 (23%) patients showed poor pigmentation. Eight (7%) patients did not follow up. Thirty‐six (84%), five (12%) and two (4%) patients showed excellent, good and poor pigmentation, respectively, in the segmental vitiligo group. Thirteen (69%) and five (26%) patients showed excellent and poor results, respectively, in the focal vitiligo group. One (5%) patient did not appear for follow up. Recurrence was observed in 15 patients.

Conclusion This surgical treatment gives its best results in segmental and focal vitiligo, even with large affected areas, and in at least 50% of patients with generalized vitiligo, thus improving their appearance.
Comparison of efficacy criteria across onychomycosis trials: need for standardization
Authors: Gupta Aditya K. , Ryder Jennifer , Summerbell Richard C.
Published: December 2004

Background The last 10 years have seen a substantial increase in the number of studies reporting the efficacy of the various antifungal agents used to treat onychomycosis.

Aim To examine the definitions of efficacy parameters reported in clinical studies on the treatment of onychomycosis and discuss the importance of standardized reporting.

Methods We searched MEDLINE (1966–2001) for studies in which oral treatments, griseofulvin, ketoconazole, terbinafine (continuous and pulse), itraconazole (continuous and pulse), and fluconazole, were used to treat dermatophyte onychomycosis.

Results Mycologic cure was predominantly defined as negative microscopy and culture. Unlike mycologic cure, clinical parameters (e.g. clinical response, clinical cure) were variably defined. Subjective terms, such as “cure” or “markedly improved,” were used; although these terms appear to be explicit, what is considered to be “cured” or “markedly improved” by one evaluator may not be by another. Also, infected nails were clinically evaluated to determine the response to treatment. Studies measured the distance between the proximal nail fold and a notch in the nail plate, at the junction between the diseased and normal‐appearing nail, or in some cases estimated the diseased nail plate involvement.

Conclusions This review of the literature on systemic agents used to treat onychomycosis shows that standard and explicit definitions are required for the accurate comparison of the effectiveness of the various therapies.