bluuebunny/crossref_metadata_2025 huggingface dataset:
The economics of routine antenatal anti‐D prophylaxis for pregnant women who are rhesus negative
Authors: Chilcott Jim , Tappenden Paul , Lloyd Jones Myfanwy , Wight Jeremy , Forman Katie , Wray Julie , Beverley Catherine
Published: August 2004

Objective  To investigate the economics of routine antenatal anti‐D prophylaxis in the prevention of haemolytic disease of the newborn, in support of the NICE appraisals process.

Design  Cost effectiveness analysis.

Setting  UK NHS.

Population/Sample  Pregnant women who are RhD‐negative.

Methods  A model was constructed to estimate the incremental cost effectiveness and cost utility of: (1) offering routine antenatal anti‐D prophylaxis to all pregnant women who are RhD‐negative; (2) offering routine antenatal anti‐D prophylaxis to RhD‐negative primigravidae, compared with conventional management alone. Effectiveness estimates were derived from a meta‐analysis of two UK community‐based studies. Costs were derived from published sources and NHS product lists. Threshold analysis was conducted to reflect the social value of routine antenatal anti‐D prophylaxis through incorporating valuations of parental grief and fetal/neonatal loss.

Main outcome measures  Cost per life year gained and cost per quality adjusted life year (QALY) gained.

Results  The cost per life year gained is in the range £5,000–£15,000. The inclusion of long term neurodevelopmental problems results in a cost utility ranging between £11,000 and £52,000 per QALY gained. Threshold analysis suggests that if fetal loss, parental grief and subsequent high intervention pregnancy are valued at greater than 9 QALYs, the comprehensive policy would be more attractive than the primigravidae policy, assuming a maximum acceptable threshold of £30,000 per QALY.

Conclusion  Routine antenatal anti‐D prophylaxis provides a cost effective intervention for preventing haemolytic disease of the newborn in the pregnancies of women who are RhD‐negative.
Randomised treatment trial of bacterial vaginosis to prevent post‐abortion complication
Authors: Miller Leslie , Thomas Katherine , Hughes James P. , Holmes King K. , Stout Suzannah , Eschenbach David A.
Published: August 2004

Objective  To evaluate the efficacy of metronidazole to reduce post‐abortion complications among women with bacterial vaginosis.

Design  A randomised, double‐blind placebo‐controlled trial.

Setting  An American outpatient abortion facility between April 1999 and June 2000.

Sample  Women presenting for surgical abortion were screened for bacterial vaginosis using a pH and amines card test.

Methods  Women positive for elevated pH and amines on a self‐collected vaginal discharge sample were randomised to 1000 mg oral metronidazole before abortion followed by 500 mg twice daily or placebo. All randomised women were also dispensed 100 mg doxycycline to take twice daily for seven days.

Main outcome measures  Data were collected by phone, daily diary or visit and scored from 0 to 7 for post‐abortion complications. Intention‐to‐treat analyses were completed prior to unblinding.

Results  Of 1764 women screened by card test, 638 (36%) were positive. Of these, 393 were randomised. Follow up data were available for 253 (64%) of these women. A complication score of 3 or more occurred in 21% of women assigned to metronidazole, compared with 19% in those assigned placebo (RR 1.1, 95% CI 0.7–1.9). Among 153 women with Gram stain confirmation for bacterial vaginosis, there was a similar lack of benefit with treatment (RR 1.6, 95% CI 0.9–3.0). No individual symptom or sign was statistically different between groups even for second trimester procedures.

Conclusion  Among women undergoing abortion and diagnosed with bacterial vaginosis, oral metronidazole, in conjunction with doxycycline, did not reduce post‐abortion complications.
Video monitoring of smear‐taking at colposcopy: relationship to cytology
Authors: Al‐Awadhi Rana M. , Mansell Elizabeth , Chong Swee , Chow Carl , Singer Albert , Coleman Dulcie V.
Published: August 2004

Objective  To investigate the reasons why cervical smears occasionally fail to reflect the underlying pathology in the cervix even when the smear is taken at colposcopy.

Design  A randomised study of three different smear‐taking devices.

Setting  A colposcopy clinic.

Population  Women attending the colposcopy clinic.

Methods  A smear was taken from 172 nulliparous and 100 multiparous women at colposcopy and the procedure was monitored on a video‐imaging system. The cytological findings were compared with the biopsy report in 147 nulliparous and 85 multiparous women.

Main outcome measures  Accuracy of cytology and the effect of a range of variables on the accuracy of cytology.

Results  Sampling of the transformation zone was incomplete in 15% of nulliparous women and 8% of multiparous women. Univariate analysis of a range of variables including parity, type of sampling devices, completeness of sampling of the transformation zone, size of the transformation zone, size of the lesion (aceto‐white area) and location of the squamo‐columnar junction showed that the accuracy of cytology was influenced by all these factors except for parity and smear‐taking devices. Multivariate analysis showed that the location of the squamo‐columnar junction, the size of the transformation zone area, the size of the aceto‐white area and the ratio of the aceto‐white area to the area of the transformation zone influenced the accuracy of cytology.

Conclusions  Women with large transformation zone areas (>30.03 mm2) and/or small aceto‐white lesions (<7.01 mm2) are more likely to have an inaccurate cytology reports than women with small transformation zone and women with larger aceto‐white areas. A ratio of the aceto‐white area to the area of the transformation zone of 0.22 or less increases the risk of disagreement between the cytological and histological findings.
A prospective study of pregravid oral contraceptive use in relation to fetal growth
Authors: Mucci Lorelei A. , Lagiou Pagona , Hsieh Chung‐Cheng , Tamimi Rulla , Hellerstein Susan , Vatten Lars , Adami Hans‐Olov , Cnattingius Sven , Trichopoulos Dimitrios
Published: August 2004

Objective  Because oral contraceptives are so widely used, any health consequences may have substantial public health implications. Whether pregravid oral contraceptives could affect subsequent pregnancies has not been adequately studied. The study objectives were to examine whether pregravid oral contraceptive use affects fetal growth and pregnancy hormone levels.

Design  A prospective study of pregnant women followed through pregnancy.

Setting  A major teaching hospital in Boston, USA.

Population  Two hundred and sixty Caucasian pregnant women, with a mean age of 31, and a parity of no more than two. Seventy‐nine percent of the women were pregravid oral contraceptive users.

Methods  Exposure and covariate data were collected through structured questionnaires. Blood was drawn for hormonal analysis during the 16th and 27th gestational week. Information on pregravid oral contraceptive use included duration and recency of use, and oral contraceptive formulation. Multivariate regression models were used to examine the effect of pregravid oral contraceptive use on birth outcomes and the studied pregnancy hormones.

Main outcome measures  Birthweight, placental weight, gestational age, pregnancy hormone levels of oestriol and progesterone at 16th and 27th gestational week.

Results  Adjusting for confounders, pregravid oral contraceptive use increased birthweight (mean difference =+207.3 g, 95% CI =+77.6 to +337.1) and placental weight (mean difference =+64.9 g, 95% CI =+13.0 to +116.9) compared with never use. Women with prior oral contraceptive use had higher levels of serum progesterone (P= 0.002) and oestriol (P= 0.12) at the 27th gestational week measurement. The effect on birthweight, placental weight and hormones was stronger among those using oral contraceptives in the previous year and those using a high progestin/high oestrogen potency preparation.

Conclusions  Pregravid oral contraceptive use is positively associated with fetal growth, and this effect may be mediated through oestriol and progesterone.
A double‐blind randomised controlled trial of laparoscopic uterine nerve ablation for women with chronic pelvic pain
Authors: Johnson N.P. , Farquhar C.M. , Crossley S. , Yu Y. , Van Peperstraten A.M. , Sprecher M. , Suckling J.
Published: August 2004

Objective  To determine the effectiveness of laparoscopic uterine nerve ablation (LUNA) for chronic pelvic pain in women with endometriosis and women with no laparoscopic evidence of endometriosis.

Design  A prospective double‐blind randomised controlled trial (RCT).

Setting  Single‐centre, secondary‐level gynaecology outpatient service and tertiary‐level pelvic pain and endometriosis outpatient service in Auckland, New Zealand.

Population  One hundred and twenty‐three women undergoing laparoscopy for investigation and management of chronic pelvic pain, 56 with no laparoscopic evidence of endometriosis and 67 with endometriosis.

Methods  Women were randomised from the two populations, firstly those with no evidence of endometriosis and secondly those undergoing laparoscopic surgical treatment for endometriosis, to receive LUNA or no LUNA. Participant and assessor blinding was employed. Follow up for pain outcomes was undertaken at 24 hours, 3 months and 12 months.

Main outcome measures  Changes in non‐menstrual pelvic pain, dysmenorrhoea, deep dyspareunia and dyschezia were assessed primarily by whether there was a decrease in visual analogue score for these types of pain of 50% or more from baseline and additionally whether there was a significantly different change in median visual analogue score. The numbers requiring further surgery or starting a new medical treatment for pelvic pain and complications were also measured.

Results  There was a significant reduction in dysmenorrhoea at 12 month follow up in women with chronic pelvic pain in the absence of endometriosis who underwent LUNA (median change in visual analogue scale (VAS) from baseline −4.8 versus−0.8 (P= 0.039), 42.1%versus 14.3% experiencing a successful treatment defined as a 50% or greater reduction in visual analogue pain scale for dysmenorrhoea (P= 0.045). There was no significant difference in non‐menstrual pelvic pain, deep dyspareunia or dyschezia in women with no endometriosis undergoing LUNA versus no LUNA. The addition of LUNA to laparoscopic surgical treatment of endometriosis was not associated with a significant difference in any pain outcomes.

Conclusions  LUNA is effective for dysmenorrhoea in the absence of endometriosis, although there is no evidence of effectiveness of LUNA for non‐dysmenorrhoeic chronic pelvic pain or for any type of chronic pelvic pain related to endometriosis.
Analgesia requirements and predictors of analgesia use for women undergoing medical abortion up to 22 weeks of gestation
Authors: Hamoda H. , Ashok P.W. , Flett G.M.M. , Templeton A.
Published: August 2004

Objective  To assess analgesia use and the predictors for requiring analgesia in women undergoing medical abortion at all gestations up to 22 weeks.

Design  Retrospective observational study.

Setting  Aberdeen Royal Infirmary, Scotland.

Population  Consecutive women undergoing medical abortion under the terms of the 1967 Abortion Act.

Methods  Analgesia requirements and characteristics of women undergoing abortion were analysed using logistic regression.

Main outcome measures  The effect of age, gestation, reproductive history, route and dose of misoprostol administration on analgesia requirements.

Results  Of the total 4343 women included in this review, 3139 women (72%) required analgesia. Of these, 3054 women (97%) used oral analgesia, 75 women (2.4%) used opiates while 10 women (0.3%) had diclofenac sodium given rectally. There was no significant difference in analgesia use whether women used the vaginal or sublingual route of misoprostol administration. Logistic regression showed a significant positive association with gestation at termination (odds ratio [OR] 1.09, 95% confidence interval [CI] 1.05–1.12), number of misoprostol doses used (OR 1.31, 95% CI 1.13–1.51) and induction to abortion interval (OR 1.08, 95% CI 1.03–1.12) and a negative association with the age of women undergoing abortion (OR 0.98, 95% CI 0.97–0.99) and previous live birth (OR 0.43, 95% CI 0.33–0.56).

Conclusions  Analgesia requirement was significantly higher in women of younger age, higher gestation, longer induction to abortion interval and with increased number of misoprostol doses used while women with previous live birth were significantly less likely to use analgesia.
First-, Second-, and Third-Generation Family Firms: A Comparison
Authors: Sonfield Matthew C. , Lussier Robert N.
Published: August 2004

SAGE wishes to inform readers that the article titled “Bahavioral [sic] Characteristics of Entrepreneurs in the Gujrat, Gujranawala and Slalkot Industrial Clusters of Pakistan: A Comparisn [sic] of First, Second and Third Generation Family Firms,” by Shahid Qureshi, Sarfraz A. Mian, and Arif Iqbal Rana, published in Volume 1, Issue 2 (November 2010) of International Journal of Business and Social Science included substantial excerpts from this article, “First-, Second-, and Third-Generation Family Firms: A Comparison,” by Matthew C. Sonfield and Robert N. Lussier, Volume XVII, Number 3 (September 2004) of Family Business Review, without appropriate attribution to Drs. Sonfield and Lussier or authorization of the authors or SAGE. Numerous requests made by SAGE to the editor of International Journal of Business and Social Science to address the inappropriate use of this article have gone unanswered. SAGE has additionally been informed by the lead author of the IJBSS article, Shahid Qureshi, that Sarfraz A. Mian and Arif Iqbal Rana did not participate in the authorship of the IJBSS article, and authorship of the article was completed by Dr. Qureshi alone.

There has been limited prior research into generational differences among family businesses. This study compared first-, second-, and third-generation family firms. Contrary to much of the current literature, only two significant differences were found when testing 11 hypotheses. As hypothesized, first-generation family businesses do less succession planning than second- and third-generation family firms, and there are no differences between first-, second-, and third- generation firms with regard to the influence of the firm's founder. Also, first-generation firms had the highest use of equity versus debt financing. Although not tested as a hypothesis, demographic analysis indicated fewer first-generation firms using the corporation form of ownership. Analysis of covariance indicated no spurious relationships existing in the hypotheses.
A View From Afar: Rethinking the Director's Role in University-Based Family Business Programs
Authors: McCann Greg , Hammond Clark , Keyt Andrew , Schrank Holly , Fujiuchi Kimberly
Published: August 2004

This article is the result of a spark that began at the 2002 USASBE Conference. The idea was to collectively rethink the role of the family business center (FBC). Our goal was twofold: to challenge ourselves and the profession to more effectively lead our centers and serve our stakeholders by more clearly identifying the value propositions generally present in family business centers, and to offer a process through which to explicitly communicate these value propositions to the various stakeholders. This is followed by a brief discussion and outline of typical value propositions related to the stakeholder groups.
Adaptation Under Environmental Turmoil: Organizational Flexibility in Family-Owned Firms
Authors: Hatum Andrés , Pettigrew Andrew
Published: August 2004

This article examines the process of organizational adaptation and competitiveness of family-owned firms in an emerging economy. The study is set in the Argentinean context of the 1990s when a combination of economic and political changes triggered a large-scale transformation in the competitive context of indigenous firms. Two family firms from the edible oil industry, one highly flexible and the other less so, are studied. Longitudinal data are supplied in an effort to explore the determinants of organizational flexibility in these firms.
Labor‐Welfare Linkages and the Imperative of Organizing Low‐Wage Women Workers
Authors: Simmons Louise
Published: August 2004

Many recipients of Temporary Assistance to Needy Families transitioning into the workforce face depressing prospects of low‐wage work, limited opportunities for economic advancement, and huge struggles in balancing demands of work and family. Welfare policy must be overhauled to address these problems, not merely to achieve reductions in caseloads. As welfare recipients are transformed into low‐wage workers, unionization can be a potent method of raising incomes. Other labor movement endeavors such as living‐wage campaigns and policy advocacy are also necessary to address the needs of these as yet unorganized workers.
The Severe Implications of the Economic Downturn on Working Families
Authors: Boushey Heather , Cherry Robert
Published: August 2004

The Clinton economic boom witnessed a robust expansion of female employment, especially among single heads of households, and of wage increases, especially for low‐wage workers. However, the employment difficulties of African‐American men persisted, official poverty was reduced but not economic deprivation, and the vulnerability of children of single heads increased. Compared to the previous downturn, the current downturn is more severe when measured by employment losses and has hit women harder as a result of September 11.
Treatment Implications of Trigeminal Sensitization in Acute and Chronic Migraine: Expert Commentary on Selected Abstracts
Authors: Becker W. J.
Published: August 2004

Triptan Treatment Provides Better Headache Relief if Taken Early in the Migraine Attack

OBJECTIVE: To evaluate the efficacy and tolerability of sumatriptan, 50‐mg and 100‐mg tablets, compared with the placebo for the treatment of migraine at the first sign of pain.

PATIENTS AND METHODS: Two identical multicenter randomized, double‐blind, placebo‐controlled, single‐attack studies were conducted from May through November 2000 in adults (aged 18–65 years). Patients treated migraine at the first sign of pain, while pain was mild, but not more than 2 hours after onset with oral sumatriptan, 50 or 100 mg, or matching placebo. The primary end point was pain‐free relief at 2 hours after treatment with 50 mg of sumatriptan compared with placebo.

RESULTS: There were 354 patients in study 1 and 337 patients in study 2. Significantly more patients treated with sumatriptan, 50 and 100 mg, were completely free from pain 2 and 4 hours after the treatment versus patients treated with placebo (at 2 hours, 50% and 57% vs. 29%; at 4 hours, 61% and 68% vs. 30%; for both, p < 0.001). Also, significantly more patients treated with sumatriptan, 50 and 100 mg, were migraine‐free (no pain or associated symptoms) versus those treated with placebo at 2 and 4 hours after the treatment (at 2 hours, 43% and 49% vs. 24%; at 4 hours, 54% and 63% vs. 28%; for both, p < 0.001). The incidence of overall adverse events was low with the 50‐ and 100‐mg dose of sumatriptan (placebo, 7%; sumatriptan at 50 mg, 14%; sumatriptan at 100 mg, 16%).

CONCLUSIONS: Treatment of migraine at the first sign of pain with sumatriptan, 50‐mg and 100‐mg tablets, provides superior pain‐free relief at 2 and 4 hours after the treatment compared with the placebo. Results of these studies suggest that sumatriptan at 100 mg may be more efficacious than at 50 mg when used in the early treatment paradigm. Because these studies were not powered to detect statistical differences between active doses, studies to investigate this finding are warranted.
Relevance of Cues for Assessing Hallucinated Voice Experiences
Authors: England Margaret , Rubenstein Linda , Tripp‐Reimer Toni
Published: August 2004

PURPOSE. To assess psychiatric nurses' views of the importance of itemized content represented on an Inventory of Voice Experiences (IVE) for ongoing assessment of atypical auditory sense perception in people who hear voices.

METHODS. Over 6 months, 317 experienced psychiatric nurses rated 58 assessment cues for hallucinated voice experiences. Cronbach's alpha, Cohen's kappa, and Bartko's intraclass correlation coefficients were used to measure concordance of the nurses' judgments against two hypothetical standards derived for purposes of the study.

FINDINGS. There was moderate support for both the internal consistency of the nurses' judgments concerning the importance of itemized content represented on the WE and overall equivalence of the content. There was modest‐to‐moderate concordance of the nurses' original and subsequent judgments but a lack of concordance of the nurses' judgments with equally weighted judgments of the principal investigator even though the judgments of the investigator were based on extant literature and published reports of voice hearers.

CONCLUSIONS. Results may reflect the effects of repeated testing, but it also is possible that some nurses did not have enough knowledge or professional experience to quantify judgments about the importance of hallucinated voice descriptions tied to the items on the WE. The findings are being used to refine the IVE.

PRACTICE IMPLICATIONS. Findings provide nurses with opportunities for discerning specific characteristics, antecedents, and consequences of voice hearing along with their implications for health and well‐being. Discernment of this information will facilitate identification of more specific and meaningful options for helping voice hearers manage their voices.

Search terms: Auditory hallucinations, schizophrenia
Nursing Outcomes Across a Surgical Care Episode
Authors: Porcella Aleta
Published: August 2004

PURPOSE

To test the validity and reliability of the NOC labels.

METHODS

94 NOC labels were assigned to neurologic, orthopedic, and surgical patients. Because of a nursing shortage and nurses' objections to the time‐consuming nature of the study procedures, changes were made in the data‐gathering process. Realizing that busy floor nurses would complete ratings on labels that had already been started but were reluctant to search through 94 different labels to find the ones most critical to their particular patient, the pool of selectable NOCs was shortened by nurse experts from 94 to a handful deemed most critical to the patient population. Outpatient nurses selected NOCs during patients' presurgical work‐up and completed a first rating. Clinic nurses were asked to complete a third rating at the patients' postoperative visit. This left only a second rating and some interrater reliability ratings to be done by inpatient nurses.

FINDINGS

Results from the surgical patient population involved 122 subjects with preoperative clinic visit ratings and postoperative inpatient setting ratings. Postoperative clinic visit ratings were obtained on 94 of the 122 subjects as well. Twelve different NOCs were used for this population. Most frequently chosen were Comfort Level (n= 78), Pain Level (n= 26), and Ambulation: Walking (n= 24).

For Comfort Level the average change from first to second rating (mean difference) was 1.12. Change from first to third rating was 1.53. Change from second to third rating was 0.48. These mean differences are all significant at the p<.001 level. Subjects who were rated on Comfort Level in the inpatient setting only (n= 14) demonstrated a change from first to second rating of 0.77, from first to third rating 1.43, and from second to third rating of 0.67. The n on other individual labels of the study subset was too small for meaningful tests of statistical significance. However, grouping all labels together, all mean difference ratings for this population are significant at the p<.001 level.

DISCUSSION

NOC is conceptualized as a neutral patient state that will vary across the life span of the individual as that person's health status changes. It seems axiomatic that ratings spaced widely across the span of a surgical episode of care would demonstrate greater change than those clustered during the inpatient portion of the episode of care. Although very small, this study lends credence to the validity of the language to capture patient state changes.

CONCLUSIONS

The question of when to rate NOCs is of more than passing theoretical interest. It is critical to the appropriate use of outcomes. Although this work needs to be replicated with a larger sample size, different diagnosis‐related groups, and at different institutions, this preliminary work seems to support the ability of NOC to demonstrate significant changes in outcome ratings across an acute surgical episode of care.
Translation, Utilization, and Psychometric Properties of the Functional Health Pattern Assessment Screening Tool With Patients in Brazil
Authors: Leite de Barros Alba Lucia Botura , Marlene Michel Jeanne Liliane , da Nobrega Miriam Lima
Published: August 2004

PURPOSE

To translate the Functional Health Pattern Assessment Screening Tool (FHPAST) into Portuguese and further test and refine its psychometric properties using data obtained from culturally diverse clinical populations with chronic illnesses.

METHOD

A nurse expert in the language translated the FHPAST into Portuguese. The instrument was validated using the back‐translation technique, followed by the judgment of another doctorally prepared nurse before use in the clinical setting. The tool was administered to 99 patients hospitalized in six units of Hospital São Paulo (neurologic surgery, orthopedics, pneumology, cardiac surgery, urology and vascular surgery, and infectious/parasite diseases) and to 28 undergraduate nursing students from Federal University of Paraiba. The 127 questionnaires were computed and data analyzed by the authors jointly with the multicenter study coordinators, according to preestablished analysis techniques.

FINDINGS

The small sample size made it possible to run only frequencies as well as sum scores for the total sample. Reliabilities on usable cases was .94. Nurses who applied the tool observed that these data, added to data collected in specific physical examination for each specialty, allowed them to establish some nursing diagnoses not previously identified with the specialty's own tool. Most patients needed help to understand the questions and fill in the form, given the large percentage of illiterate or low‐scholarship people in this population. Completion time was approximately 25 minutes. Nurses who cared for patients with vascular and urologic conditions believed that using the FHPAST with aged patients was not productive because of the patients' difficulty understanding some questions and decreased hearing acuity. These difficulties were not noted with younger patients, patients from other specialties, or the students.

DISCUSSION

FHPAST was designed to be a reliable and valid instrument allowing nurses to obtain screening assessment data to generate potential clinical judgments, select nursing interventions, and identify patient outcomes. The FHPAST is a 58‐item, self‐completed assessment tool based on Gordon's 11 Functional Health Patterns. It can be used to screen functional health and related behaviors across clinical populations. To date, research conducted to establish the psychometric properties of the instrument has been based on data obtained from well young‐adult populations. There has been limited, if any, use of the tool with culturally diverse populations within an acute care setting.

CONCLUSIONS

There were no problems related to the instrument translation and back‐translation process with respect to semantic equivalence. However, using the tool with different populations (patients and students) showed that changes are needed in the language of specific tool items for use with selected culturally diverse clinical populations.
Comfort Management as a Proposed NIC, and Validation of Three NOCs for End‐of‐Life and Chronically III Patients
Authors: Killeen Mary B.
Published: August 2004

PURPOSE

To describe comfort management interventions and test three outcomes (Pain Level, Comfort Level, and Quality of Life) for their use in data collection and as patient‐initiated clinical tools.

METHODS

Hospice and home care RNs identified eligible patients at weekly team meetings. Three consecutive weekly interviews for each subject were conducted in the home. A study packet, completed by the research interviewer during the patient interviews, consisted of a demographic form, four outcome instruments (Pain Level, Comfort Level, Quality of Life, Patient Satisfaction With Comfort Management [PSCM], Cost of Care), and the criterion tools. The three outcomes were evaluated for criterion‐related validity using gold standard research tools.

FINDINGS

The final convenience sample was 38 chronically ill or end‐of‐life adult patients with chronic or cancer pain from two home care/hospice agencies. The PSCM tool has 22 items on a 4‐point Likert scale from 1 (strongly disagree) to 4 (strongly agree). Content validity was supported with a content validity index of .95 for the total instrument using 10 patient volunteers with pain diagnoses (4 chronically ill, 6 terminally ill) from a medical inpatient unit. All areas of difficulty in 12 items were revised. No omissions were identified. Cronbach's alpha (α) in this study was .96 (n= 19). Two NOC tools, Pain Level (7 items, n= 80, α= .76) and Comfort Level (6 items, n= 81, α= .76) demonstrated good internal consistency reliability for use by chronically and terminally ill patients. Pain Level demonstrated concurrent validity with a 0–10 numeric intensity scale (n= 30, r= .80 p<.01). Criterion validity was minimally established for Comfort Level (r= .38, p= .01) with the visual analogue scale for Total Comfort. Quality of Life did not achieve criterion‐related validity with the Quality of Life Index for chronically ill patients or the Missoula‐VITAS® for hospice patients.

DISCUSSION

The PSCM demonstrated initial reliability and validity and needs to be tested with a larger sample for construct validity. Quality of Life items need to be reevaluated and retested before implementation as a clinical tool with these patient populations. Pain Level and Comfort Level tools had evidence of reliability and validity and usefulness as data collection tools in research studies. The three nursing outcomes demonstrated adaptability for self‐report by patients—a major variation of their intended use as clinical tools used only by RNs.

CONCLUSIONS

Patient satisfaction with comfort management is an important nursing‐sensitive outcome and is needed for outcomes research. These pilot study results will be used as a basis for selecting instruments for a quasiexperimental study on the impact of comfort management on nursing‐sensitive patient outcomes among chronically ill and end‐of‐life patients.
Nursing Records With Standardized Nursing Language in Prehospital Emergency Care: From Utopia to Reality
Authors: Morales Juan Miguel , Rodríguez M.M. , Terol J. , Torres A. , Álvarez J.M.
Published: August 2004

PURPOSE

To design a record containing “traditional” and nursing process–related data, adapted to prehospital emergency care.

METHODS

In the course of conducting a research project about nursing process implementation strategies in prehospital emergency care, a pilot electronic patient record was designed by expert critical care nurses. A prehospital emergency service of a leading city in the Andalusian region in Spain was chosen to test the initial implementation of the record using a qualitative approach that included semistructured interviews and record evaluation, plus a 1‐week education program about clinical use of nursing process. The record included assessment parameters, NANDA, NIC, and NOC standardized nursing terminologies as the main focus of clinical reasoning, care planning, and delineating outcomes and interventions.

FINDINGS

Twelve prehospital emergency care nurses were trained with a specific nursing process program. They all applied the electronic record during their clinical perfomance and related high satisfaction with it in their interviews, although they reported some initial difficulties with terminology. After this pilot phase, the record was extended to the other seven leading cities in the region following a presentation by two expert nurses. The record has been included as a formal component of the hospital information system and the NOC labels will be used as criteria when evaluating the prehospital emergency nurses. A copy of each record is deposited at the admission hospital.

DISCUSSION

The enrichment of an information system with nurse‐sensitive data is crucial for emergency services where the nurse offers complex but often neverdocumented services. The difficulties of combining easily recordable forms and exhaustive data gathering can be overcome with qualitative techniques and education activities that highlight the benefits of standardized nursing language and critical paths prior to implementation.

CONCLUSIONS

The aim of developing a nursing recording system based on standardized nursing language must be balanced against a lack of a nurse‐oriented conceptual framework among emergency nurses and their unfamiliarity with nurse terminology.
Use of Standardized Language in Neuroscience Nursing
Authors: Finesilver Cynthia
Published: August 2004

PURPOSE

To demonstrate the use of standardized nursing language for a client with a severe traumatic brain injury, from the time of admission to the emergency center to the client's admission to the rehabilitation unit.

BACKGROUND

A client with increased intracranial pressure based on pertinent assessment data was followed.

MAIN CONTENT POINTS

Although the client's outcomes remained consistent, the indicators reflected the client's recovery and decreased risk of increased intracranial pressure. The nursing activities were individualized as the client moved from the emergency center, to the intensive care unit, to the acute care unit, and eventually to the rehabilitation unit.

CONCLUSIONS

Challenges to the use of standardized nursing languages include development of software for computer documentation and retrieval. Legend‐code charting rather than text‐based charting must be used. Nurses need to understand the value of taxonomies and standardized nursing languages, and that NOC outcomes and NIC activities are easily individualized for specific client populations.
Development of Consensus‐Based Clinical Guidelines in Critical Care Through Standardized Nursing Language
Authors: Morales Jose Miguel , Torres A. , Muñoz F. , León J. , Miralles L.
Published: August 2004

PURPOSE

To develop regional clinical practice guidelines for nurse decision making in critical care settings.

METHODS

In the health department of the Andalusian region in Spain, a critical care nursing expert panel was created to develop clinical practice guidelines. A total of 14 critical care nurses (scholars, clinical nurses, managers) comprised the panel. The first obstacle was a lack of systematic reviews or clinical trials about these concerns. Therefore, the first version of the guidelines was consensus based. In order to strengthen the guidelines' structure, standardized nursing language systems and nursing process were employed as a conceptual frame. Problem identification using collaborative problems or nursing diagnoses (NANDA), literature review, recommendations presented by NIC labels, peer review of the recommendations, drafting the guidelines, and second peer review by the expert panel members resulted in the final version of each guideline.

FINDINGS

A consensus‐based clinical practice guideline manual prepared for critical care nursing in the health system in the southern region of Spain covered prehospital emergency care, health department services, and ICUs. These guidelines contain nurse‐sensitive situations and are nurse oriented, using standardized nursing languages for clinical decision making.

CONCLUSIONS

Evidence‐based clinical practice guidelines are needed in nursing decision making, but there is a lack of solid research‐based results for developing recommendations. The use of standardized nursing language for guidelines development decreases the variability of clinical practice, fosters homogeneity in nurses' problem‐solving schemes, and opens new research areas in clinical effectiveness. In future guidelines reviews, NOC and available systematic review‐based recommendations will be included. More quality research is needed in critically ill patient human responses.
Linking Nursing Outcomes To Long‐Term Care Quality Indicators
Authors: Nielsen Theresa , Schutte Sheryl
Published: August 2004

BACKGROUND

The Alverno is a 135‐bed long‐term care facility. All long‐term care facilities are required by the Center for Medicare and Medicaid Services to perform a common assessment using the Minimum Data Set format. This assessment can trigger up to 24 quality indicators that directly affect resident care and quality of life. Each facility average is compared with the state average for that quality improvement. A facility percentile is derived from this comparison. High percentiles are indicative of problems.

MAIN CONTENT POINTS

The 24 quality indicators triggered as part of the assessment provided a focal point for state surveys as well as individual facility quality committees. Nursing outcomes using NOC labels can be linked to these quality indicators, but the number is large.

CONCLUSIONS

A large number of NOC labels, although appropriate in acute care, cannot be implemented in long‐term care settings without some modification.
A Proposed Framework of Reference for the Evaluation of Nursing Information Systems
Authors: Mathieu Luc
Published: August 2004

PURPOSE

To develop, implement, and evaluate a clinical knowledgeñbased nursing information system (NIS) to assist nurses working in the field of geriatrics.

METHODS

Using a model familiar to information systems analysis, the author proposes a model in six dimensions (the quality of the system, the quality of the information, uses for the information, user satisfaction, individual impact, and organizational impact) to measure information system success. A Delphi survey was used to identify indicators to evaluate the success of a NIS. Sixty indicators were submitted to 24 nurses working in different clinical settings from various areas of the province of Quebec. The participants were asked to give their opinion on the pertinence and the clarity of definition of the submitted indicators. To be considered, an indicator had to obtain the group's consensus (85%) regarding its pertinence and the clarity of its wording.

FINDINGS

The Delphi Group reached consensus on 50 indicators divided amongst the six dimensions. The choice of various indicators to evaluate an NIS will depend on its very nature and on the concerns for assessment. The results of this work led us to propose a framework of reference for the evaluation of nursing information systems. The chosen indicators constitute a set that can be used to evaluate the success of other NISs.

CONCLUSIONS

Future research is needed to identify the best methods to assess the chosen indicators and clarify the definition of those indicators that have been judged pertinent but are not clearly stated.
Women Putting Out the Fire: Using Research to Work With Women for a Healthier Tomorrow
Authors: Farren Arlene
Published: August 2004

BACKGROUND

Tobacco use by college students is high. In the 1990s, smoking rates among teenage girls rose sharply. The teenage girl smokers of the 1990s are the college‐age women smokers of today and tomorrow. Targeting women is important because their health risks due to smoking include not only the widely known risks, but also reproductive health risks. Healthy People 2010 recommendations include a 30% increase in cessation attempts and a 15%–30% reduction in smoking. AWHONN supports guidance and interventions from a healthcare professional to address prevention, cessation, and follow‐up for women of all ages.

MAIN CONTENT POINTS

Implementing an evidence based program to prevent smoking, assist with cessation, and provide relapse prevention in college‐aged women can enhance existing college programs in smoking cessation. NANDA, NIC, and NOC classification linkages and gold standard guidelines are used in the clinical, clientcentered strategies.

CONCLUSIONS

The college setting is uniquely placed to provide health‐promoting behaviors to young adult women. Nursing professionals, using discipline‐guided classifications, can make a contribution to women's health by using research‐based interventions and outcomes to prevent smoking, assist with cessation, and provide follow‐up to prevent relapse. Nursing students, advanced practice nurses, and nursing faculty can partner with colleagues in the college health and wellness center programs using the best evidence to help women quit smoking.
Translating Nursing Language Into Lay Language
Authors: Thorarinsdottir Kristín
Published: August 2004

PURPOSE

To explore the meaning that patients undergoing total hip replacement ascribe to the lived experience of retaining and reading their nursing care plan in lay language before and after the surgery.

METHOD

A standardized nursing care plan for patients undergoing total hip replacement was written in lay language and used as a perioperative teaching material. Qualitative data were collected with in‐depth interviews and analysed. The sample consisted of 6 patients undergoing total hip replacement.

FINDINGS

The overriding theme, acquired knowledge, was the main meaning that participants ascribed to their experience of the care plan. Other issues or major themes that were of particular importance to participants were that the text of the care plan was understandable and meaningful, the care plan had empowering effects, and revision of the care plan was recommended. In addition, general satisfaction of the healthcare service was a significant part of the participants' experience.

CONCLUSIONS

Patients can acquire empowering knowledge from a patient version of their nursing care plan. Patient versions of care plans for total knee and hip replacements have been implemented in the hospital.
NIC: An Orientation Program for Long‐Term Care
Authors: O'Gara Joanne
Published: August 2004

BACKGROUND

An organized, comprehensive orientation program enables new nurses to adjust to their new work environment and feel a part of the organization. The orientation program at the Alverno Health Care Facility, a 135‐bed long‐term care facility in Clinton, IA, was based on state and federal requirements and job descriptions. The familiarity of having included NANDA, NIC, and NOC in resident care plans for years prompted the integration of standardized nursing language into the existing orientation.

MAIN CONTENT POINTS

Successful implementation of NIC requires organizational commitment. The revamping of the orientation began with meetings of the nursing management team consisting of the chief executive officer, nursing supervisors, infection control nurse, continuous quality improvement nurse, and inservice director.

During the initial phase of development, the NIC interventions most applicable to long‐term care were identified. From this list, each team member selected 25 interventions based on regulations, frequency, and high risk. These interventions were compared to the topics in the existing orientation program. Job descriptions were reviewed for key roles to identify topics that correlated to the interventions. Data were queried from the care plans to determine the frequency of nursing diagnoses, interventions, and outcomes. In addition, federal requirements were itemized with the corresponding intervention identified for each area.

The team collated the data from the existing orientation, job descriptions, care plans, and federal regulations to select 25 care competencies to include in the nursing orientation program. The team agreed to designate seven activities most applicable to long‐term care for each intervention. Staff nurses were included in the selection process. Some activities listed in the third edition of NIC were altered to be more specific to long‐term care. The results were compiled and used as the foundation for the nurses' orientation and performance evaluation.

The orientation program was designed to be completed within 4 weeks, with week 1 addressing federal and OSHA requirements. A preceptor was assigned to each new nurse to enhance the learning opportunities. Various methods of presentation were constructed using the principles of adult learning to foster interest and retention of information. Classes were interspersed with clinical orientation.

CONCLUSIONS

Including NIC interventions in the nursing orientation program provided an opportunity to support standardized nursing language, conveyed a sense of teamwork and commitment to the organization, and defined expectations in the standards of care. The general orientation for all departments was enhanced by incorporating NIC into required topics of safety, infection control, abuse prevention, body mechanics, resident rights, and dementia management. Further, the NIC‐based orientation was used as a basis for the hiring process.
NIC Use by Urologic Nurses in Iceland
Authors: Jonsdottir Anna , Thoroddsen Asta
Published: August 2004

PURPOSE To investigate which NIC interventions are used by nurses in the urologic unit in order to establish a nursing documentation system for an electronic patient record.

METHODS The NIC Use Survey questionnaire, developed by the Iowa Intervention Project Team, had been translated into Icelandic by a group of nurses within the Directorate of Health. Some changes were made to the questionnaire in concordance with the up‐to‐date version of NIC; it included 450 intervention labels and their definitions grouped into 27 classes of interventions according to the NIC class structure. Respondents (a convenience sample of 19 nurses who worked in the urological units) were asked to rate how often they performed each intervention. Six responses are possible: never, rarely, about once a month, about once a week, about once a day, or several times a day.

FINDINGS The respondents were 15 nurses (response rate 79%). Most of the subjects had >5 years of experience in nursing (93%) and most had >5 years of experience in urologic nursing (73%).

On the urologic unit, 299 (66%) of the 450 interventions were used rarely or more often by >50% of the nurses. Of those 299 interventions, 153 (34%) were used monthly or more often by more than 50% of the nurses; 151 interventions (34%) were never used by more than 70% of the nurses, and of these interventions 71 (15%) were never used by 100% of the urologic nurses.

CONCLUSIONS The NIC Use Survey was a useful tool to determine which interventions should be included in the computer software of specialities. However, the interventions that are most frequently used by urologic nurses cannot be called core interventions because they include a lot of common nursing interventions and therefore do not define the nature of the speciality.
Nanoscale measurements and manipulation
Authors: Colton Richard J.
Published: August 2004

This review attempts to recount, from my perspective, some of the science and technology highlights (and pitfalls) that fueled the nanoscience and nanotechnology revolution—an odyssey of sort on nanoscale measurements and manipulation. Seminal papers by several pioneering groups are given special attention as well as the role played by the AVS who hosted many of the earlier conferences and published proceedings that recorded the field’s early progress. This review is organized around the introduction and evolution of the various scanning probe microscopes that have revolutionized the way we study the structure and properties of surfaces. The use of these enabling tools in pursuit of more ambitious goals in nanotechnology, such as creating unique structures by manipulating individual atoms or molecules, and developing concepts in electronics, information storage, sensor technology, nanotribology, and nanomechanics, is also discussed.