bluuebunny/crossref_metadata_2025 huggingface dataset:
Ex vivo evaluation of the effectiveness of bleaching agents on the shade alteration of blood‐stained teeth
Authors: Yui K. C. K. , Rodrigues J. R. , Mancini M. N. G. , Balducci I. , Gonçalves S. E. P.
Published: April 2008

Aim  To evaluate ex vivo effectiveness of the three formulations of bleaching materials for intracoronal bleaching of root filled teeth using the walking bleach technique.

Methodology  Extracted premolar teeth were stained artificially with human blood. After biomechanical preparation, the root canals were filled and a 3‐mm thick intermediate base of zinc phosphate cement was placed at the level of the cementoenamel junction. The teeth were divided into four groups (n = 12): C (control, without bleaching material), A1 (sodium perborate + distilled water), A2 (sodium perborate + 10% carbamide peroxide) and A3 (sodium perborate + 35% carbamide peroxide). The bleaching materials were changed at 7 and 14 days. Evaluation of shade was undertaken with aid of the VITA Easyshade™ (ΔE*ab) and was performed after tooth staining and at 7, 14 and 21 days after bleaching, based on the CIELAB system. Data were analysed by anova for repeated measurements, Tukey and Dunnett tests (α = 0.05).

Results  The Tukey test revealed that group A1 (10.58 ± 4.83 ΔE*ab) was statistically different from the others (A2, 19.57 ± 4.72 ΔE*ab and A3, 17.58 ± 3.33 ΔE*ab), which were not different from each other. At 7 days: A1 was significantly different from A2; at 14 and 21 days: A2 and A3 were significantly better than A1; the Dunnett test revealed that the control group was different from A1, A2 and A3 at all periods (P < 0.05).

Conclusion  Sodium perborate associated with both 10% and 35% carbamide peroxide was more effective than when associated with distilled water.
The technical quality of nonsurgical root canal treatment performed by a selected cohort of Australian endodontists
Authors: Bierenkrant D. E. , Parashos P. , Messer H. H.
Published: April 2008

Aim  To investigate the technical quality of nonsurgical root canal treatment performed by endodontists in Melbourne, Australia.

Methodology  Clinical and radiographic records of 100 sequential nonsurgical patients were obtained from each of six endodontists working in private practice. The following variables were analysed: proximity of root filling to radiographic apex; homogeneity and radiodensity of root filling; lateral adaptation of the root filling to the canal walls; taper; extrusion of material; small, appropriate or excessive apical enlargement; presence of lateral canals; transportation; procedural errors. The radiographs were assessed by three independent evaluators. Exploratory data analysis was undertaken using simple frequencies and cross‐tabulations. A generalised linear mixed model (GLMM) was used for the formal statistical modelling.

Results  Of the 1351 canals that were examined, 91.7% were filled within 2 mm of the radiographic apex and 74% were within 1 mm. Homogeneity and adequate density were found along the entire length of the canal in 86.1% and 88.6% of cases respectively. Lateral adaptation was adequate in 95.6% of cases and the taper was ‘smooth and continuous’ in 83.8% of roots. No and/or small extrusion of sealer was noted in 98.3% of cases. Apical enlargement was ‘appropriate’ in 85% of roots. Both transportation (1.1%) and procedural errors (1.3%) were rare occurrences.

Conclusions  The technical quality of root fillings performed by endodontists in Melbourne, Australia complied with current guidelines in 77.4%–91.0% of roots. All variables examined confirmed high levels of technical proficiency. There were very few instances of canal transportation and/or procedural errors.
The varying role of population abundance in structuring indices of biotic homogenization
Authors: Cassey Phillip , Lockwood Julie L , Olden Julian D , Blackburn Tim M
Published: April 2008

Aim An important component of human‐induced global change is the decrease or increase in community distinctiveness (taxonomic homogenization or differentiation, respectively) that follows the loss of native species and gain of non‐native species. We use simulation approaches to assess the extent to which conclusions about the outcome of the homogenization process depend on whether or not abundance data are incorporated.

Location Data were produced through computer simulation.

Methods The frequency with which occurrence‐based similarity indices and abundance‐based similarity indices give different views of changes in community similarity, and the conditions under which such differences occurred were assessed using both deterministic and stochastic modelling approaches to simulate species assemblage states.

Results Occurrence‐based and abundance‐based indices were positively correlated across the set of simulations for both the deterministic and stochastic models. However, in both situations approximately one quarter (25%) of models resulted in contrasting outcomes for the two approaches of calculating changes in compositional similarity; that is, one data type showed a positive value (homogenization), whereas the other showed a negative value (differentiation).

Main conclusions In the majority of cases, species abundances will not change drastically enough after perturbation to produce large differences between homogenization scores measured using occurrence versus abundance information. However, in cases where these changes are large, it is important to recognize that the choice of metric to analyse homogenization trends will influence the qualitative and quantitative conclusions drawn. Studies of real assemblages are therefore necessary to evaluate the role of species abundance in defining the magnitude and direction of changes in community composition across space, and the implications of these changes for native biodiversity.
Nectar‐feeding bird and bat niches in two worlds: pantropical comparisons of vertebrate pollination systems
Authors: Fleming Theodore H. , Muchhala Nathan
Published: April 2008

Aim We review several aspects of the structure of regional and local assemblages of nectar‐feeding birds and bats and their relationships with food plants to determine the extent to which evolutionary convergence has or has not occurred in the New and Old World tropics.

Location Our review is pantropical in extent and also includes the subtropics of South Africa and eastern Australia. Within the tropics, it deals mostly with lowland forest habitats.

Methods An extensive literature review was conducted to compile data bases on the regional and local species richness of nectar‐feeding birds and bats, pollinator sizes, morphology, and diets. Coefficients of variation (CVs) were used to quantify the morphospace occupied by the various families of pollinators. The extent to which plants have become evolutionarily specialized for vertebrate pollination was explored using several criteria: number and diversity of growth forms of plant families providing food for all the considered pollinator families; the most common flower morphologies visited by all the considered pollinator families; and the number of plant families that contain genera with both bird‐ and bat‐specialized species.

Results Vertebrate pollinator assemblages in the New World tropics differ from those in the Old World in terms of their greater species richness, the greater morphological diversity of their most specialized taxa, and the greater degree of taxonomic and ecological diversity and morphological specialization of their food plants. Within the Old World tropics, Africa contains more specialized nectar‐feeding birds than Asia and Australasia; Old World nectar‐feeding bats are everywhere less specialized than their New World counterparts.

Main conclusions We propose that two factors – phylogenetic history and spatio‐temporal predictability (STP) of flower resources – largely account for hemispheric and regional differences in the structure of vertebrate pollinator assemblages. Greater resource diversity and resource STP in the New World have favoured the radiation of small, hovering nectar‐feeding birds and bats into a variety of relatively specialized feeding niches. In contrast, reduced resource diversity and STP in aseasonal parts of Asia as well as in Australasia have favoured the evolution of larger, non‐hovering birds and bats with relatively generalized feeding niches. Tropical Africa more closely resembles the Neotropics than Southeast Asia and Australasia in terms of resource STP and in the niche structure of its nectar‐feeding birds but not its flower‐visiting bats.
Identification of glacial refugia in south‐eastern North America by phylogeographical analyses of a forest understorey plant, Trillium cuneatum
Authors: Gonzales Eva , Hamrick James L. , Chang Shu‐Mei
Published: April 2008

Aim  We examine several hypotheses emerging from biogeographical and fossil records regarding glacial refugia of a southern thermophilic plant species. Specifically, we investigated the glacial history and post‐glacial colonization of a forest understorey species, Trillium cuneatum. We focused on the following questions: (1) Did T. cuneatum survive the Last Glacial Maximum (LGM) in multiple refugia, and (if so) where were they located, and is the modern genetic structure congruent with the fossil record‐based reconstruction of refugia for mesic deciduous forests? (2) What are the post‐glacial colonization patterns in the present geographical range?

Location  South‐eastern North America.

Methods  We sampled 45 populations of T. cuneatum throughout its current range. We conducted phylogeographical analyses based on maternally inherited chloroplast DNA (cpDNA haplotypes) and used TCS software to reconstruct intraspecific phylogeny.

Results  We detected six cpDNA haplotypes, geographically highly structured into non‐overlapping areas. With one exception, none of the populations had mixed haplotype composition. TCS analysis resulted in two intraspecific cpDNA lineages, with one clade subdivided further by shallower diversification.

Main conclusions  Our investigation revealed that T. cuneatum survived the LGM in multiple refugia, belonging to two (western, eastern) genealogical lineages geographically structured across south‐eastern North America. The western clade is confined to the south‐western corner of T. cuneatum’s modern range along the Lower Mississippi Valley, where fossil records document a major refugium of mesic deciduous forest. For the eastern clade, modern patterns of cpDNA haplotype distribution suggest cryptic vicariance, in the form of forest contractions and subsequent expansions associated with Pleistocene glacial cycles, rather than simple southern survival and subsequent northward colonization. The north–south partitioning of cpDNA haplotypes was unexpected, suggesting that populations of this rather southern thermophilic species may have survived in more northern locations than initially expected based on LGM climate reconstruction, and that the Appalachian Mountains functioned as a barrier to the dispersal of propagules originating in more southern refugia. Furthermore, our results reveal south‐west to north‐east directionality in historical migration through the Valley and Ridge region of north‐west Georgia.
The canopy beetle faunas of Gondwanan element trees in Chilean temperate rain forests
Authors: Arias Elizabeth T. , Richardson Barry J. , Elgueta Mario
Published: April 2008

Aim  To describe the coleopteran fauna occurring in canopies of temperate Gondwanan tree species in terms of their diversity and guild and taxonomic structures, and to test the proposition that this structuring reflects the Gondwanan origins of this fauna.

Location  The Andes and the coastal cordillera of temperate Chile.

Methods  Canopy fogging was used to sample beetles from 29 trees. The samples were statistically described using Schao and the Simpson diversity index D. Cluster analyses and multi‐dimensional scaling (MDS) were performed. The taxonomic and guild structures of the Chilean coleopteran fauna were compared quantitatively with those found in other parts of the world using homogeneity chi‐square and t‐tests.

Results  A collection of 25,497 beetle specimens was obtained primarily from Nothofagus dombeyi, Nothofagus obliqua and Araucaria araucana. The specimens collected were distributed between 485 morphospecies and included 107 putative, new generic‐level taxa and 223 apparently undescribed species. Estimates of the size of the canopy beetle fauna showed that 600+ species were likely to be present. The communities found on a tree species differed markedly between years. MDS plots showed less community divergence between tree species for predators than for phytophages and xylophages. The guild structure was similar to that found on Australian ‘Gondwanan’ trees but differed significantly from the community structures found on ‘Laurasian’ tropical and temperate trees in supporting fewer phytophages and saprophages, but more xylophages. The predator guild showed a different pattern, with tropical faunas differing from those of more temperate regions, irrespective of hemisphere, as did the distribution of superfamilies.

Main conclusions  The beetle fauna found in the canopies of N. dombeyi, N. obliqua and A. araucana was large (600+ species), with about half of the species undescribed. Schao was found to vary with sample size and to give lower estimates of S than species attenuation curves, raising the possibility that the two methods are estimating the sizes of different statistical communities. It is possible that the attenuation curve is estimating the number of species to be found on a particular tree species, while Schao is estimating the ‘carrying capacity’ for beetle species of individual trees, and this varies from tree to tree. Care also needs to be taken in experimental design when monitoring temporal changes in forest insect communities given the difference in communities found between years in this study. The proportions of phytophages, saprophages and xylophages resemble those of a ‘Gondwanan’ rain forest from Australia and differ significantly from those of tropical and temperate ‘Laurasian’ forests.
An improved method for the identification of areas of endemism using species co‐occurrences
Authors: Giokas Sinos , Sfenthourakis Spyros
Published: April 2008

Aim  To develop a simple method that (1) combines the notions of biotic elements (groups of taxa with ranges significantly more similar to each other than to the ranges of other taxa) and of areas of endemism (AoE, areas of non‐random distributional congruence among taxa), and (2) overcomes the constraints of a previously suggested null model‐based method that cannot deal with disjunctions and is strictly grid‐dependent.

Location  We used test data sets from southern Africa and Crete.

Methods  First, we used a null‐model approach to detect pairs of species that have a significant degree of co‐occurrence, in order to determine biotic elements. Subsequently, we used a parsimony analysis of endemicity to delineate candidate AoE, and multivariate analysis to define groups of biotic elements on the basis of species interactions (co‐occurrence, mutual exclusion, neutral) using only the species detected in the previous step. We applied this method to the well known data set for Sciobius in southern Africa, as well as to endemic invertebrates of Crete (Greece), in order to evaluate its performance.

Results  Our results are very similar to those of previous analyses, and produce meaningful delineation of AoE and biotic elements in both data sets. The method is flexible regarding null models and significance levels, and eliminates noise in the data.

Main conclusions  We offer a simple method that provides reasonable identification of both biotic elements and AoE, produces good‐fit statistics, reduces uninformative or junk output, and reduces computational time.
Parsimony analysis of endemicity describes but does not explain: an illustrated critique
Authors: Garzón‐Orduña Ivonne J. , Miranda‐Esquivel Daniel Rafael , Donato Mariano
Published: April 2008

Aim To demonstrate that parsimony analysis of endemicity (PAE) is not analogous to a cladistic biogeographical analysis.

Location We used six data sets from previously published studies from around the world.

Methods In order to test the efficiency of PAE in recovering historical relationships among areas, we performed an empirical comparison of nodes recovered with PAE, primary Brooks parsimony analysis (BPA), and an event‐based method using three models (maximum codivergence, reconciled trees, and the default model of thetreefitterprogram) for six data sets. We measured the performance of PAE in recovering historical area relationships by counting the number and examining the content of nodes recovered by PAE and by historical methods. The dispersal/vicariance ratio was calculated to assess the prevalence of dispersal or vicariance in each reconstruction and its relationship to the performance of PAE.

Results Our results show that PAE recovers an average of 17.25% of historical nodes. PAE and BPA tend to provide similar results; however, in relation to the event‐based models, PAE performance was poor under all the tested scenarios. Although in some cases PAE reconstructions are more resolved than historical reconstructions, this does not necessarily mean that PAE produces more informative answers. These additional nodes correspond to unsupported statements that are based solely on the distributional data of taxa and not on their phylogenetic history. In other words, these nodes were not found by the historical methods, which take phylogenetics into account. The number of historical nodes recovered using PAE was in general negatively correlated with the dispersal/vicariance ratio.

Main conclusions Our results show that PAE is unable to recover historical patterns and therefore does not fit into the current paradigm of historical biogeography. These findings raise doubts regarding conclusions derived from biogeographical studies that interpret PAE trees as area cladograms. We acknowledge that PAE aims to describe but does not explain the current distribution of organisms. It is therefore a useful tool in other biogeographical or ecological analyses for exploring the distribution of taxa or for establishing hypotheses of primary homology between areas.
Differences in health‐related quality of life between older nursing home residents without cognitive impairment and the general population of Norway
Authors: Drageset Jorunn , Natvig Gerd Karin , Eide Geir Egil , Clipp Elizabeth C , Bondevik Margareth , Nortvedt Monica W , Nygaard Harald A
Published: April 2008

Aim.  To advance the understanding of health‐related quality of life among older nursing home residents by assessing their health‐related quality of life and comparing this with norms from the general population.

Methods.  The study used a two‐group cross‐sectional comparative design. The samples comprised 227 nursing home residents aged 65–102 years with at least six months’ residence and a representative population sample of 1137 Norwegian citizens aged 65–102 years. All nursing home residents had a Clinical Dementia Rating Scale score ≥0·5 and were capable of conversing. The respondents provided demographic information and were surveyed using the SF‐36 Health Survey. We used univariate and multivariate linear models to identify possible differences in health‐related quality of life between the nursing home residents and the general population, controlled for age, sex, marital status and education.

Results.  After adjustment for age, group, sex, marital status and education, the nursing home residents scored significantly higher on bodily pain and on physical and emotional role limitation and significantly lower on the other SF‐36 subscales, except social functioning, with the largest differences for physical functioning (mean nursing home 23·2 and mean general population 62·9). The general population scores on all subscales generally increased with increasing education but not among the nursing home residents.

Conclusions.  The mean SF‐36 scale scores differed markedly between the nursing home residents and the general population, with the nursing home residents generally scoring lower. The association with background variables known to be related to health‐related quality of life differed between the groups. Healthcare professionals should increase attention to health‐related quality of life among nursing home residents, periodically assess health‐related quality of life and consider interventions that may improve health‐related quality of life in older institutionalised populations.

Relevance to clinical practice.  This study highlights the role of nurses and other health professionals in ensuring that nursing home residents have opportunities to improve their health‐related quality of life.
Acupressure and meridian massage: combined effects on increasing body weight in premature infants
Authors: Chen Li‐Li , Su Yi‐Chang , Su Chia‐Hsien , Lin Hung‐Chih , Kuo Hsien‐Wen
Published: April 2008

Aims and objectives.  The purpose of this study was to assess the body weight gain of combined acupressure and meridian massage in premature infants.

Background.  Each year in Taiwan, 8–10% of newborns are delivered prematurely. Effective postnatal care is essential to ensure the healthy development of premature infants. Massage therapy has been administered to facilitate weight gain in the neonatal unit. The evidence‐based findings in previous studies did not include acupressure or meridian massage.

Design.  A double‐blind clinical trial was conducted in a medical centre in central Taiwan.

Methods.  Forty subjects were randomised into two groups. The 20 subjects in the experimental group were given a standard procedure of acupressure at Zhongwan, Zusanli, Yongquan, abdominal rubbing, spleen and stomach meridian massage, and kneading the points along the spine of the bladder meridian. These treatments were administered for 15 minutes per session, one hour before meals, three times daily over 10 days. The control group, also consisting of 20 subjects, underwent routine care and was observed. The infants’ body weights and the volume of milk ingested were measured and recorded daily.

Results.  The daily average weight gain of the infants in the experimental group was 32·7 g (SD = 8·1) compared with 27·3 g (SD = 7·7) in the control group. While in the first week there was no significant difference in weight gain between the two groups; in the second week, the weight gain observed in the experimental group was significantly higher than that observed in the control group.

Conclusions.  An experimental trial established the effects of using acupressure and meridian massage on increasing body weight in premature infants. Acupressure and meridian massage have a significant effect on weight gain in premature infants.

Relevance to clinical practice.  Nurses could be trained in acupressure and meridian massage techniques to provide more effective level of clinical care for premature infants.
Predicting child abuse and neglect: ethical, theoretical and methodological challenges
Authors: Taylor Julie , Baldwin Norma , Spencer Nick
Published: April 2008

Aims. This paper explores the ethical, theoretical and methodological implications of predictive testing in studies of child abuse, neglect and harm.

Background. The use of screening instruments to make predictions about children who may later be abused, neglected or at risk of exclusion is promoted in research and policy. The recent UK Action Plan on Social Exclusion suggests that health visitors and community midwives should be trained to use these tools in practice.

Method. Position paper.

Conclusions. The accuracy of screening instruments to identify children who will be abused or neglected has not been established. Even if the theoretical and methodological challenges of predictive instruments could be overcome, the ethical implications of their use are very difficult for nurses and midwives.

Relevance to clinical practice. Nurses, midwives and health visitors require high levels of awareness of risk factors in working with children and families. We have a responsibility to reach professional judgements about risks of harm for individuals. This is best performed through improving skills in working with parents and carers to identify those factors which may impede their ability to offer safe developmental care to their children.
A systematic review of the use of hydrocolloids in the treatment of pressure ulcers
Authors: Heyneman Alexander , Beele Hilde , Vanderwee Katrien , Defloor Tom
Published: April 2008

Aims and objectives.  The aim of this systematic literature review was to describe the current evidence in the field of pressure ulcer treatment with hydrocolloids and to give recommendations for clinical practice and further research.

Background.  Pressure ulcers are a common problem in clinical practice and generate substantial expense. A wide range of dressings is available but little is known about the effect on pressure ulcer healing.

Methods.  A Cochrane‐based search strategy was used in four databases (PubMed, Embase, the Cochrane Central Register of Controlled Trials and the Cumulative Index to Nursing and Allied Health Literature), manuals and reference lists. Randomised controlled trials on the treatment of pressure ulcers with hydrocolloids, as defined by the British National Formulary, were systematically included and analysed.

Results.  Twenty‐nine publications, dealing with 28 different studies, met the inclusion criteria and were included in the review. Hydrocolloids were most frequently used on pressure ulcers grade 2–3. Concerning the healing of the pressure ulcer, hydrocolloids are more effective than gauze dressings for the reduction of the wound dimensions. The absorption capacity, the time needed for dressing changes, the pain during dressing changes and the side‐effects were significantly in favour of hydrocolloids if compared to gauze dressings. Based on the available cost‐effectiveness data, hydrocolloids seemed to be less expensive compared with collagen‐, saline‐ and povidine‐soaked gauze but more expensive compared to hydrogel, polyurethane foam and collagenase.

Conclusions.  This review demonstrates that hydrocolloids are to be preferred to gauze dressings in the treatment of pressure ulcers. Additional research is needed to confirm these results.

Relevance to clinical practice.  Based on the studies included in this review, hydrocolloids are frequently used in the treatment of grade 2 and 3 pressure ulcers and are more effective and less expensive than gauze dressings. Compared with alginates, polyurethane dressings, less‐contact layers, topical enzymes and biosynthetic dressings, hydrocolloids are less effective.
A critical literature review exploring the challenges of delivering effective palliative care to older people with dementia
Authors: Birch Deborah , Draper Jan
Published: April 2008

Aim.  This paper considers the challenges of delivering effective palliative care to older people with dementia and the possible strategies to overcome barriers to end‐of‐life care in these patients.

Background.  In UK alone, approximately 100 000 people with dementia die each year and as the number of older people increases, dementia is set to become even more prevalent. Dementia is a progressive terminal illness for which there is currently no cure. Patients dying with dementia have significant health‐care needs and in recent years it has been recognised that palliative care should be made available to everyone regardless of diagnosis, as this improves comfort and quality of life. Despite this, patients dying with dementia are often still not given access to palliative care services.

Method.  A review of English language literature published after 1996 to the present day relating to older people with dementia during the terminal phase of their illness.

Results.  Twenty‐nine articles met inclusion criteria for the review. Most originated from North America and UK and were mostly quantitative in nature. Four key themes were identified: difficulties associated with diagnosing the terminal phase of the illness (prognostication); issues relating to communication; medical interventions; and the appropriateness of palliative care intervention.

Conclusions.  This review reinforces the importance of providing appropriate palliative care to individuals suffering from end‐stage dementia and identifies some of the barriers to extending such specialist palliative care provision.

Relevance to practice.  There is an urgent need to improve palliative care provision for older people with end‐stage dementia and, in addition, more research is required on the needs of patients entering the terminal phase of dementia to assist the allocation of appropriate resources and training to ensure quality and equality in the provision of end‐of‐life care.
Differences in prevalence of pressure ulcers between the Netherlands and Germany – associations between risk, prevention and occurrence of pressure ulcers in hospitals and nursing homes
Authors: Tannen Antje , Dassen Theo , Halfens Ruud
Published: April 2008

Aim.  This study compares pressure ulcer prevalence and prevention activities in nursing homes and hospitals within two European countries.

Background.  Over three years stable differences have been found between the Netherlands (NL) and Germany (GER) with higher pressure ulcer rates in the NL. As previous analyses have shown, the differences cannot be entirely explained by differences in the population’s vulnerability to pressure ulcers because they still remain after risk adjustment. Therefore, the differences in prevalence must be caused by other factors. The purpose of this study is to analyse if any potential differences in preventive activities can account for the varying occurrence of pressure ulcers.

Method.  In both countries, nation‐wide surveys were conducted annually using the same standardised questionnaires. Trained nurses examined all consenting patients of the voluntarily participating facilities. This examination included a skin assessment of the entire body. Data regarding risk factors, prevention and details about wounds were then collected.

Results.  In‐patients of 29 German (n = 2531) and 71 Dutch (n = 10 098) nursing homes and 39 German (n = 8515) and 60 Dutch (n = 10 237) hospitals were investigated. The use of pressure‐reducing devices was more common in the NL than in GER, but all other interventions were more frequently provided to German risk patients than to their Dutch counterparts. The pressure ulcer prevalence was significantly higher in the Dutch sample. After adjusting for gender, age, Braden Score and prevention, the probability of having a pressure ulcer was 8·1 times higher for Dutch nursing home residents than for German residents.

Conclusion.  Some of the variance in pressure ulcer prevalence between the two countries can be explained by varying pressure ulcer prevention. However, some remarkable differences still remain unexplained.

Relevance to clinical practice.  The extent of pressure ulcer prevention, especially repositioning and nutrition intervention provided to patients at risk, is not in accordance with international guidelines.
Nursing competence 10 years on: fit for practice and purpose yet?
Authors: Bradshaw Ann , Merriman Clair
Published: April 2008

Aims and objectives.  This paper examines how nurses are prepared to be clinically competent and safe at registration, so that they are fit for practice and purpose. It follows up two papers on competence published in 1997 and 1998 and investigates subsequent developments.

Background.  In 1979, major changes in nursing affected nurse education and preparation for competence. In the following two decades, it became clear that nurses lacked clinical skills. This paper examines subsequent changes and asks the question whether this crucial shortcoming has now been remedied. This paper considers the background and context of change in nursing and nurse education in the 1980s. It looks at the new ideology, to prepare the ‘knowledgeable doer’ and examines the consequences of the change on nursing competency from the 1990s to the present day.

Methods.  This is a position paper. Professional policy documents from the English National Board for Nursing, Midwifery and Health Visiting, United Kingdom Central Council for Nursing, Midwifery and Health Visiting and Nursing and Midwifery Council, government reports and legislation on nursing and relevant nursing literature are examined and critically analysed and conclusions drawn.

Conclusions.  From 1923–1977, mandatory nursing syllabuses set by the General Nursing Council of England and Wales required the registered nurse to have acquired certain specific clinical skills. These were rigorously tested to an explicit standard set by the General Nursing Council before a nurse was awarded state registration. Twenty‐five years later, the loss of this system for ensuring this competence and the implications of this loss, have been widely recognised. As a result, many nurse training institutions have introduced clinical skills laboratories, simulation of practice and the Objective Structured Clinical Examination. However, to the authors’ surprise and contrary to their initial expectations, the Nursing and Midwifery Council has not made these systems uniform or mandatory and so still has no way of ensuring all nurse training is producing safe nurses in the United Kingdom. The authors conclude that the untested educational ideology that brought root and branch change to nurse training in 1983 and which failed to produce nurses ‘fit for practice and purpose’ may still prevail.

Relevance to clinical practice.  The present paper demonstrates that United Kingdom nurse training still has no uniform and mandatory system in place to ensure, as far as is possible, that all registered nurses are clinically competent and safe to practice.
Just how male are male nurses..?
Authors: Loughrey Mark
Published: April 2008

Aim.  The aim of the present research study was to elucidate, quantitatively, the gender role perceptions of male nurses in Ireland.

Background.  Caring, women and the female gender role are all historically and fiercely synonymous. However, not all carers are women. For instance, male nurses also assume caring roles. What we do not know is how these men actually relate to their own gender role. Is it possible that because of their immersion in a stereotypically caring career they actually occupy the female gender role?

Design.  A quantitative non‐experimental descriptive design was adopted.

Method.  Short‐form Bem sex role inventory was mailed to a random sample of 250 male registered general nurses in Ireland to ascertain whether they perceived themselves to occupy the male or female gender role.

Results.  One hundred and four men completed the inventory. Overall, the sample identified with more female than male gender norms. Specifically, 78 respondents identified themselves as adhering to more female gender role norms than male gender role norms, whereas 21 respondents identified more strongly with male gender role norms. Five respondents identified equally with both gender roles.

Conclusion.  This study quantitatively elucidates the gender perceptions of male nurses in Ireland for the first time.

Relevance to clinical practice.  Adherence to the female gender role may be an important prerequisite to caring. If this is true, then this study supports the notion that many male nurses occupy this gender role. However, adoption of facets of the female gender role may not be unique to male nurses. Many men may occupy this role and perhaps resultantly be attracted to or well‐suited to caring careers. Attracting such men may help in solving the recruitment and retention issues that surround caring careers. Furthermore, the attraction of more men to caring careers may subside the stigma for the minority of men already in such careers.
Development and psychometric evaluation of workplace psychologically violent behaviours instrument
Authors: Dilek Yildirim , Aytolan Yildirim
Published: April 2008

Aim.  To develop an instrument to determine nurses’ perceptions of psychologically violent behaviours that they are exposed to in the workplace.

Background.  According to Leymann, psychological terror or mobbing in work life involves hostile and unethical communication, which is directed in a systematic way towards one individual who, due to mobbing, is pushed into a helpless and defenceless position, and being held there by means of continuing mobbing activities.

Design.  Survey.

Methods.  Because nurses who work in hospitals are generally the principle victims of physical, emotional and verbal violence due to the nature of their work environment, the research sample comprised 476 hospital nurses. Data were collected via self‐administered questionnaires.

Results.  The instrument to determine the perception of workplace psychologically violent behaviours contains 33 items and four factors (individual’s isolation from work, attack on professional status, attack on personality and direct attack). All items have shown statistically significant correlation (p < 0·01); the instrument’s total Cronbach’s α internal consistency coefficient was found to be 0·93.

Conclusions.  The findings show that the instrument’s validity and reliability are within the limits of an acceptable level and that it is an instrument that will encourage more studies on this subject.

Relevance to practice.  Defining the psychological pressure that nurses are exposed to in the workplace and determining its negative effects on the victim of workplace psychological pressure and on the institution will make it possible to protect individuals and the institution from psychological violence with both individual and institutional practices.
Reliability and validity of the CCNCS: a dependency workload measurement system
Authors: Brady Anne‐Marie , Byrne Gobnait , Horan Paul , Macgregor Catriona , Begley Cecily
Published: April 2008

Aim.  To refine, test and evaluate the Community Client Need Classification System (CCNCS).

Background.  Workload assessment in community nursing is complicated by the range of services that may be delivered in one patient interaction. The CCNCS is a workload measurement system designed to capture the direct and indirect elements of community nursing work and is suitable for use with all care groups in the community.

Design.  Survey.

Method.  Forty‐four community nurses implemented the CCNCS with all clients in their caseload for four weeks. Community nursing in the Irish Republic is known as public health nursing. The Public Health Nurses (PHNs) recorded the total time in minutes that was spent on each client each week. The satisfaction with and experiences of PHNs using the CCNCS during the study period was also recorded.

Results.  Participants endorsed the utility of the CCNCS for use in community nursing. Inter‐rater and intra‐rater reliability results were positive with high level of agreement between raters in relation to scoring community clients. The amount of time the PHNs spent with clients correlated with ascending level of client need.

Conclusions.  The CCNCS affords insight into the complex nature of community nursing. It discriminates between levels of need and has potential to provide a standardised assessment of need in all community‐nursing clients. Adequate resources are required to conduct further testing of the reliability and predictive validity of this system.

Relevance to clinical practice.  The CCNCS can provide objective evidence of community nursing workload and thus facilitate workforce planning.
Against all odds: a retrospective case‐controlled study of women who experienced extraordinary breastfeeding problems
Authors: Hegney Desley , Fallon Tony , O’Brien Maxine L
Published: April 2008

Aims.  The study investigated factors empowering women to continue breastfeeding despite experiencing extraordinary difficulties. The study documented the experiences and characteristics of women who continued to breastfeed (continuing cohort) and those who weaned (non‐continuing cohort) despite extraordinary difficulties.

Design.  Retrospective case control.

Methods.  The study was undertaken in south‐east Queensland, Australia in 2004. Forty women (20 in each cohort) were recruited over six months. Both quantitative (breastfeeding knowledge questionnaire) and qualitative (semi‐structured interviews) data were collected. This paper describes the qualitative data.

Results.  Women from both cohorts expressed idealistic expectations about breastfeeding and experienced psychological distress due to their breastfeeding problems. Those who continued breastfeeding used coping strategies and exhibited personal qualities that assisted them to overcome the difficulties experienced. Women who continued to breastfeed were more likely to report relying on a health professional they could trust for support. This latter cohort were also more likely to report having peers with which they shared their experiences. Non‐continuing women expressed feelings of guilt and inadequacy following weaning and were more likely to feel isolated.

Conclusions.  This study has highlighted the methods women use to deal with breastfeeding problems. It has also revealed modificable factors that can improve breastfeeding duration.

Relevance to clinical practice.  The findings indicate that clinicians should:

Provide information which accurately reflects the breastfeeding experience;

Ensure systems are in place so that effective postnatal support for breastfeeding difficulties is available;

Consider screening to ascertain levels of psychological distress, sadness and disillusionment among breastfeeding women;

Design educational interventions with elements of cognitive skills, problem‐solving and self‐efficacy training to equip women with the skills to overcome any experienced difficulties.
Compliance of children with moderate to severe intellectual disability to treadmill walking: a pilot study
Authors: Vashdi E. , Hutzler Y. , Roth D.
Published: April 2008

Background  Individuals with Intellectual Disability (ID) exhibit reduced levels of compliance to exercise, including treadmill walking. The purpose of this study was to measure the effects of several training conditions on compliance to participation in treadmill walking of children with moderate to severe ID.

Method  Criteria for compliance were the averaged number of times participants attempted to discontinue walking during two 5‐min exercise sessions of treadmill walking at an intensity of 65–75% of predicted maximal HR. Fifteen children aged 5–11 with moderate to severe ID participated in the study. Training conditions were (a) close supervisor's position, (b) distant supervisor's position, (c) positive reinforcement, and (d) paired modeling.

Results  General linear mixed model statistics revealed significant differences in favor of the paired modeling and positive reinforcement compared to the other conditions. Leaning forward was the most frequent type of participants’ attempt to stop exercising.

Conclusions  Paired modeling and positive reinforcement should be considered within treadmill training programs for children with moderate to severe ID.
A survey of people with intellectual disabilities living in residential aged care facilities in Victoria
Authors: Bigby C. , Webber R. , Bowers B. , McKenzie‐Green B.
Published: April 2008

Background  Australia's national ageing policy recognises that people ageing with intellectual disability (ID) require particular attention, yet there is no policy framework concerning this population. This study describes the distribution and characteristics of people with ID in residential aged care in Victoria, provides insights into the pathways they take into aged care, and gives some indications of how facilities adapt to their needs.

Method  A postal survey was sent to 826 residential aged care facilities in Victoria, seeking information from directors about their residents with ID. Facilities that responded were fairly representative of all facilities in Victoria.

Findings  Residents with ID were younger, had entered at an earlier age and remained longer than other residents. Their reported dependency profile was similar to the general aged care population, although the incidence of dementia was lower. Primary areas of concern identified by providers were: inability to fit into the resident community, lack of participation in activities and lack of meaningful relationships.

Conclusion  This study provides a first glimpse into how older people with ID find their way into aged care and how others view their experiences once there. It suggests that further investigation is required into the accuracy of assessment undertaken prior to entry to more clearly understand whether residents with ID are inappropriately placed in residential aged as a result of a shortage of disability accommodation and inadequate resources to support aging in place for those in such accommodation.
Plasma levels of chloramphenicol after oral administration in calves during the first weeks of life
Authors: BACKER P. DE , DEBACKERE M. , CORTE‐BAETEN K. DE
Published: April 2008

Three experiments were carried out to investigate the mechanisms whereby adequate plasma levels of chloramphenicol may be obtained following oral administration in young calves but not in older animals. In the first experiment, plasma levels of chloramphenicol following an oral dose of 50 mg/kg were followed in six calves, given weekly doses for the first 11 weeks of life. A plasma chloramphenicol level of 5 μg/ml, taken as the minimum therapeutic level, was attained only for a few hours in the 1 week old calves. Thereafter plasma levels decreased very rapidly until the fourth week, and rather more slowly between the fourth and eleventh weeks. At 11 weeks the plasma chloramphenicol level fell to around 0.3 μg/ml, which was the lower limit of sensitivity for the assay technique used. In the second experiment, the same single dose was administered to calves in the twelfth or eighteenth weeks of life which had not previously been exposed to the antibiotic. Plasma levels of 1 μg/ml were barely reached. This suggests that the non‐absorbtion of chloramphenicol is unlikely to be related to repeated administration of the antibiotic. In the third experiment, the same single dose was administered orally to two cows. Chloramphenicol could not be detected in the plasma following such administration, and some side‐effects were observed in the 48 h following dosing. It is suggested that rumen function may interfere with the absorbtion of chloramphenicol following oral administration to ruminants, even in relatively young animals.