bluuebunny/crossref_metadata_2025 huggingface dataset:
Strategies for feeling secure influence parents’ participation in care
Authors: Kristensson‐Hallström Inger
Published: March 2003

• This study investigates what makes parents of hospitalized children feel secure and factors influencing their level of participation. It also studies whether the degree to which parents participate affects their child’s pain and sleep during hospitalization.

• Questionnaires were distributed to a series of parents whose children were discharged from two paediatric surgical wards and one paediatric medical–surgical ward at two university hospitals in Sweden.

• Parental security is almost equally distributed among three given alternatives: security derived from trusting that professionals know how to take care of the child; security derived from having control over what is happening to the child; and security derived from being the one who knows the child best. Depending upon the strategy chosen, parents want to participate at different levels in their child’s care. The results indicate a relationship between parental participation and their estimation of their child’s pain.

• The study confirms a pattern, developed in a previous study, in how parents adopt different strategies affecting their participation during their child’s hospitalization. Some parents who wanted to participate in more aspects of their child’s care seemed to think that their child had less pain than parents who preferred more limited participation.
The success of an integrated care programme for patients with ischaemic heart disease: the practice nurses’ perspective of SHIP
Authors: Wright Lucy , Jolly Kate , Speller Viv , Smith Helen
Published: March 2003

• Follow‐up care of patients with angina and myocardial infarction after hospital discharge is known to be suboptimal across the UK.

• The employment of cardiac liaison nurses ensured timely notification of hospital discharge and good communication of each patient’s current and planned care.

• The direct ongoing support of the liaison nurse was valued by more practice nurses than educational support meetings and the initial counselling skills course.

• The most important factor which enabled practice nurses to expand their role to provide post‐hospital follow‐up care was the support of the doctors in the practice.

• After the conclusion of the Southampton Heart Integrated Care Project (SHIP) and the withdrawal of cardiac liaison nurses, the lack of hospital discharge notification was the most important reason for practice nurses discontinuing follow‐up care.
Stress amongst district nurses: a preliminary investigation
Authors: Rout Usha Rani
Published: March 2003

• This paper presents the results of a pilot study investigating stress among district nurses in the north‐west of England. Nurses completed questionnaires covering job satisfaction, mental health, stress, Type A behaviour, health behaviour, coping skills and demographic details.

• A specific measure of stress was developed following in‐depth interviews with primary care professionals, including district nurses. A total of 79 district nurses took part in the study. The major sources of stress isolated by the district nurses related to: time pressure, administrative responsibility, having too much to do, factors not under their control, interruptions, keeping up with National Health Service (NHS) changes, and lack of resources.

• Factor analysis of stress questionnaire responses identified five major factors: demands of the job and lack of communication, working environment, problems with patients, work/home interface and social life, and career development.

• The highest levels of satisfaction were reported for the amount of variety in their job and the lowest level of job satisfaction was reported for chance of promotion. The results revealed that the mental wellbeing of the nurses was higher than that of the other population groups.

• Furthermore, multivariate analysis revealed three major stressors that were predictive of high levels of job dissatisfaction: demands of the job and lack of communication, working environment, and career development. The implications of the findings for further research are considered.
The effect of an acute pain service on nurses’ knowledge and beliefs about post‐operative pain
Authors: Mackintosh Carolyn , Bowles Sandra
Published: March 2003

• The management of post‐operative pain has been an area of concern for many years, with many studies focusing on the knowledge and beliefs of nurses working in this area.

• Following the report of the Royal College of Surgeons & College of Anaesthetists (1990) in the UK, there has been a rapid expansion in the development of Acute Pain Services (APS) in an attempt to counter these concerns.

• This descriptive study considers the possible impact the introduction of an APS had on the knowledge and beliefs of nurses working in the surgical area.

• A closed‐answer questionnaire was used to replicate an earlier study ( Mackintosh, 1994) which took place before the introduction of the APS.

• Findings demonstrate a consistent but mainly statistically non‐significant trend in all areas towards an improved knowledge base and more appropriate beliefs about pain.
Pain and nutrition as experienced by patients with hip fracture
Authors: Hallström Inger , Elander Gunnel , Rooke Liselotte
Published: March 2003

• The purpose of this study was to investigate patients’ experiences of care in connection with hip fracture.

• The care process was examined through non‐participant observation, informal field interviews and healthcare records.

• The findings showed that many factors in the healthcare services directly or indirectly influence patients’ perceptions of the quality of care. Some of these factors may depend upon a varying knowledge and empathy, while others are due to a lack of agreed protocols/procedures. Patients’ needs with respect to pain relief and nutrition are discussed.
Competence and British nursing: a view from history
Authors: Bradshaw Ann
Published: March 2003

• In the light of current political and professional debate in the United Kingdom concerning preparing nurses for competence, this paper takes an historical perspective, and considers how nursing competence was defined historically through an analysis of statutory syllabuses and nursing textbooks 1874–1977.

• Competence was perceived by nursing textbook writers to have four facets. Firstly, it involved the moral character of the nurse; secondly, it required technical knowledge, practical skill and procedure; thirdly, it depended on the role of the ward sister; and fourthly, it relied on the professional etiquette of right relationships.

• The analysis shows that the traditional system of nursing competence presumed a clearly defined purpose: the production of the bedside nurse, whose function was to care for the sick person. This raises a fundamental question for nursing today: what is the purpose of the modern nurse?
Nurse–patient relationships and partnership in hospital care
Authors: McQueen Anne
Published: March 2003

• In the reformed UK National Health Service, shaped by government initiatives ( Department of Health, 1989,
1990,
1998), those receiving health care are encouraged to take an active part in decision‐making affecting their therapy and care and to take steps to improve their health and well‐being. This is endorsed by the United Kingdom Central Council for Nursing, Midwifery and Health Visiting.

• To enable this, healthcare consumers require information, education, encouragement and support, and nurses are in an ideal position to meet this need.

• Fundamental to this is the formation of a trusting professional relationship, the importance of which is arguably overshadowed by more observable nursing work.

• The argument here is that forming such a therapeutic relationship involves the nurse in work of an interpersonal and emotional nature that is required to be recognized in clinical practice, education and research.
Hospital care pathways for patients with schizophrenia
Authors: Jones Adrian
Published: March 2003

•  Greater emphasis is being placed on reducing clinical variation in managing patient groups in the reformed National Health Service (NHS) in the United Kingdom (UK).

•  The use of a care pathway to enable greater control over the process and quality of care will be explored for patients suffering from schizophrenia.

•  The paper addresses three main factors for the development of care pathways for people suffering from schizophrenia: predictability of the illness; nature of standardized care; and role autonomy.

•  It is argued that the diagnosis of schizophrenia does not lend itself easily to predicting care and treatment within a care pathway framework. However, a care pathway may bring other benefits, such as standardized care and a greater control over the delivery of care.

•  Development and implementation of hospital care pathways require extensive research. Qualitative research directions are advocated due to the possible difficulties of conducting an experimental study.
Functionalism and holism: community nurses’ perceptions of health
Authors: Long Ann , Baxter Rosario
Published: March 2003

• This paper reports the results of a study that was designed to explore and examine the perceptions of two groups of newly qualified community nurses about the factors they considered to be embedded within the concepts of health, health‐enhancing behaviours at individual, family and community levels and their ‘innermost self ’.

• The research was exploratory in nature, and included two sample groups: group 1 comprised 16 newly qualified health visitors; group 2 comprised 16 newly qualified community mental health nurses. Purposive sampling was used and data were collected using semi‐structured interviews.

• The group of health visitors perceived health in terms of physical fitness and functional states. At a global level they perceived the need to provide education on health matters. They gave generously to ‘charities’ and perceived the ‘inner self’ as ‘that part that matters’.

• The group of community mental health nurses perceived health in terms of holism and being states. Their concept of health was related to listening to each individual’s perception of what is ‘right’ and ‘health‐enhancing’ for them. At a global level they considered the protection of the ozone layer and the promotion of a just and equitable society which focused on the reduction of poverty, to be key health‐enhancing activities. They perceived their ‘innermost self’ to be ‘that part of me that makes life worth living’, and the soul.

• The findings have implications for developing new and creative approaches for teaching the holistic concept of health and healing. Educational activities could be designed which strive to ensure that nurses themselves have safe and health embracing opportunities for exploring all the elements that are embedded within the topic of health. Their role in facilitating holistic health promoting activities for all clients also needs to be addressed.
Studying complex caring interfaces: key issues arising from a study of multi‐agency rehabilitative care for people who have suffered a stroke
Authors: ALLEN DAVINA , LYNE PATRICIA , GRIFFITHS LESLEY
Published: March 2003

• Ensuring `seamless' health and social services provision has been a concern of policy makers for many years but our understanding of this complex system of work remains underdeveloped.

• This article reports selected findings from a series of ethnographic case studies of health and social services provision to adults recovering from a first acute stroke.

• Flexible working, the need for a lead professional and the transition from hospital to home are themes considered.

• The need for high quality data in order to develop our existing understanding of complex caring interfaces is underlined.
Role boundaries – research nurse or clinical nurse specialist? A literature review
Authors: RAJA‐JONES HANSA
Published: March 2003

• This paper focuses on issues relating to the role components of clinical nurse specialists and clinical research nurses working in breast cancer care.

• Identified issues relate to the lack of agreement as to the role and definition of clinical nurse specialists. At the same time there has been an increase and emergence of clinical research nurses, both within the NHS and university departments.

• The review fails to reveal the relationship between these two specialist groups in terms of role overlap and role boundaries.

• The lack of knowledge in this area substantiates the need for further research to be carried out.
An empowerment approach to needs assessment in health visiting practice
Authors: HOUSTON ANNA M. , COWLEY SARAH
Published: March 2003

• This paper examines the usefulness of an integrated approach to needs assessment using an empowerment framework, within a health visitor/client interaction, in the home setting.

• It is intended to demonstrate the existence of a flexible approach to assessing need that is based on research about necessary processes for carrying out health visiting.

• The design of the tool described in this paper allows the use of professional judgement as well as fulfilling commissioning requirements to address health outcomes.

• Health promotion and empowerment are central to health visiting practice and should be reflected in the way needs are assessed.

• Many NHS trusts have introduced a system of targeting and prioritizing health visiting through a system of questioning to assess needs. This may reveal the work that health visitors do, but may also inhibit the open, listening approach required for client empowerment.

• Different methods of assessing need can be used that do not compromise the commissioning requirements, the health visitor's duty of care or professional accountability.

• The empowerment approach is key to the philosophy of health visiting.

• There are ways of approaching needs assessment that do not compromise the ethos of partnership‐working in a health promoting way.
Nursing documentation of postoperative pain management
Authors: Idvall Ewa , Ehrenberg Anna
Published: March 2003

? Previous studies have shown that nursing documentation is often deficient in its recording of pain assessment and treatment. In Sweden, documentation of the care process, including assessment, is a legal obligation.

? The aim of this study was to describe nursing documentation of postoperative pain management and nurses' perceptions of the records in relation to current regulations and guidelines.

? The sample included nursing records of postoperative care on the second postoperative day from 172 patients and 63 Registered Nurses from surgical wards in a central county hospital in Sweden.

? The records were reviewed for content and comprehensiveness based on regulations and guidelines for postoperative pain management. Three different auditing instruments were used. The nurses were asked if the documentation concurred with current regulations and guidelines.

? The result showed that pain assessment was based mainly on patients' self‐report, but less than 10% of the records contained notes on systematic assessment with a pain assessment instrument. Pain location was documented in 50% of the records and pain character in 12%. About 73% of the nurses reported that the documentation concurred with current regulations and guidelines.

? The findings indicate that significant flaws existed in nurses' recording of postoperative pain management, of which the nurses were not aware.
Developing palliative care practice in nursing and residential care homes: the role of the clinical nurse specialist
Authors: Froggatt Katherine A. , Hoult Lizzy
Published: March 2003

? The development of practice is but one aspect of Clinical Nurse Specialists' (CNSs) work, and a number of factors act to shape the extent to which CNSs are able to work with and develop practice with nursing and residential care homes.

? A postal survey of 730 community CNSs in palliative care working in the UK was undertaken to explore the involvement of these nurses with nursing and residential care homes.

? Much of the focus of the involvement was reactive work meeting the direct clinical needs of residents, primarily with cancer.

? Although the CNSs perceived that there were some educational and care deficits in these care settings, the amount of proactive work undertaken to improve practice was limited.

? The development work undertaken was focused on educational initiatives and establishing link nurse systems.

? There is potential to develop palliative care practice in nursing and residential care homes through practice development initiatives.
Adolescent access to emergency contraception in A and E departments: reviewing the literature from a feminist perspective
Authors: Fallon Debbie
Published: March 2003

• Recent moves in parts of UK to provide opportunities for ‘over the counter’ purchasing at pharmacies, has meant that access to emergency oral hormonal contraception for adolescents is undergoing something of a revolution.

• The provision of emergency contraception (EC) to adolescents in Accident and Emergency (A and E) departments, however, is nothing new and is now an established component of the current government objective to reduce teenage pregnancy rates in this country.

• The tensions apparent in A and E departments related to the provision of EC, particularly to adolescents, have recently been recognized, but little attention has been paid to analysing the reasons why such tensions might exist.

• This article is based on a literature review carried out as part of a study of nurses' encounters with adolescents accessing EC in A and E departments in the North‐west of England.

• It is a reappraisal of the salient issues in this arena from a feminist perspective, aiming to provide an alternative with which to view the encounter between adolescents and service providers in A and E.
Influence of diagnostic and treatment factors in the population pharmacokinetics of gentamicin
Authors: Romano  , González  , Tejada  , Antón  , Aguado  , Lanao
Published: March 2003

Using the NONMEM program, the population kinetics of gentamicin were retrospectively studied in a series of 51 patients with different pathologies undergoing treatment (single or three daily doses) with gentamicin whose serum gentamicin levels were being monitored. Renal function, the type of treatment and cancer proved to be the covariates which affected drug clearance, while patient weight was found to govern the distribution volume. The distribution coefficient of gentamicin in the patients was 0·37 litres/kg, justifying gentamicin doses higher than those used conventionally. The optimized population model allowed us to simulate drug serum levels at 8 and 12 h, as well as the area under the curve of gentamicin and its variability in patients with high distribution volumes when dosage regimens based on a single daily dose administration are implemented.
Drug monitoring during the treatment of AIDS‐associated Pneumocystis carinii pneumonia with trimethoprim‐sulfamethoxazole
Authors: Klinker Hartwig , Langmann Peter , Zilly Michael , Richter Ernst
Published: March 2003

Objective: To monitor trimethoprim and sulfamethoxazole plasma levels in patients with AIDS‐associated
Pneumocystis carinii pneumonia

Method: Trimethoprim–sulfamethoxazole steady‐state plasma concentrations were measured by high‐pressure liquid chromatography during 37 episodes of
Pneumocystis carinii pneumonia in patients with AIDS. Initially, 15–23 mg/kg/day trimethoprim and 75–115 mg/kg/day sulfamethoxazole were given i.v. Assuming a therapeutic range for trimethoprim from 4 to 10 μg/ml, the doses were adjusted if trimethoprim levels were found to be outside this range

Results:
Mean concentrations were 6·7±3·3 μg/ml for trimethoprim and 187±56 μg/ml for sulfamethoxazole. A widespread inter‐patient range was found and could be decreased after dose adjustment. Enzyme inducing co‐medication did not influence plasma concentrations. In patients with coexisting chronic liver disease, significantly increased sulfamethoxazole plasma levels were observed. A correlation could be demonstrated between serum creatinine and trimethoprim plasma levels. Adverse reactions associated with co‐trimoxazole occurred during 65% of treatment periods and increased with increasing trimethoprim‐sulfamethoxazole levels, as well as increasing length of treatment. Therapy only had to be prematurely discontinued in one patient. Overall mortality was 2·7%Conclusion: Monitoring of co‐trimoxazole levels during the treatment of
P. carinii pneumonia in AIDS may help in reducing the high variability of plasma‐concentrations and in avoiding severe side‐effects especially associated in patients with chronic liver disease or renal failure
Implementing a CMC tutor group for an existing distance education course
Authors: Weller M
Published: March 2003

Abstract  ‘Artificial Intelligence for Technology’ (T396) is a distance learning course provided by the Open University of the UK using face‐to‐face tutorials. In 1997 a pilot study was undertaken of a computer‐mediated communication (CMC) tutor group which consisted of volunteers from around the UK. The student feedback raised a number of issues including: the need for a distinct function for the tutor group conference, the role of and demands on the tutor, and the benefits perceived by students. It is suggested that some issues arise from a conflict of cultures each with their own implicit assumptions. The traditional face‐to‐face tutorial model is sometimes at variance with the demands of the new CMC based tuition.
Socializing consumers in a global marketplace
Authors: McGregor Sue L. T.
Published: March 2003

Abstract: People now make consumption decisions in a global marketplace. Slowly, society is collectively gaining painful awareness of the impact of these decisions. Contemporary consumerism is the product of long‐term historical changes and, by implication, can be further changed. This paper develops the position that enriching our conventional understanding of consumer socialization from a global perspective is one way that family and consumer scientists can impact the future direction of modern consumption in a global market. By adopting this role within civil society, members of the profession can contribute to the process of resocializing the existing generation, and socializing entire new generations, of consumers to be globally conscious. By implication, business and governments’ trade, production and foreign policies will be challenged as well, leading to an even more profound change in consumption patterns around the world.
Seed bank dynamics in abandoned meadows during a 20‐year period in the Białowieża National Park
Authors: Falińska Krystyna
Published: March 2003

1 The relationship between size and floristic composition of the seed bank and vegetation dynamics was studied between 1976 and 1996 in 0.75 ha of an abandoned Cirsietum rivularis meadow. The plot was divided into 100‐m2 (10 × 10 m) quadrats and sampled 5‐yearly to map the vegetation and determine the soil seed bank.

2 Densities of seeds in the soil fluctuated as succession proceeded. The initially small seed bank trebled by 15 years after abandonment, before falling, after 20 years, to approximately the same as in the initial stage.

3 The floristic richness of the seed bank decreased during succession, with the number of species falling from 38 to 25. The diversity of life forms, however, increased in later periods, with tall herbs, shrubs and trees appearing after 10 years.

4 Seed bank floristic composition is apparently both a product of the species composition of the current vegetation and a record of the long‐term substitution of species. Other factors, including the structure of the vegetation, also influence the accumulation of seeds in the soil.

5 Although changes in number of species show a directional pattern, the seed bank size fluctuated in the course of succession on these fertile wet meadows.
Variation in floral sex allocation and reproductive success within inflorescences of Corydalis ambigua (Fumariaceae): pollination efficiency or resource limitation?
Authors: Kudo Gaku , Maeda Toshihiko , Narita Kenji
Published: March 2003

The variation of floral sex allocation with flower position within inflorescences was investigated in the spring ephemeral, Corydalis ambigua. Investment in female function (pistil), attraction (corolla) and nectar production decreased from bottom to top flowers, whereas male investment (stamen) did not differ.

 This self‐incompatible species appears to set seeds as a result of visitation by nectar robbing bumblebee queens. The tendency of bees to visit lower flowers first and then move upwards within an inflorescence should result in directional pollen flow from bottom to top flowers.

 Naturally pollinated upper flowers set fewer seeds than intermediate and lower flowers due to pollen limitation. The lack of differences in seed set and seed mass per pod following artificial outcrossing indicated that resource limitation did not explain the variation in seed production of flowers in different positions. Pollen viability also did not differ significantly between flower positions.

 A model of pollination was developed that incorporated the visitation pattern of bumblebees and observed variations in nectar distribution between flower positions. This predicted that receipt of outcross pollen would decrease from bottom to top flowers, but that pollen export to other plants would not differ between flower positions provided that the pollen exchange rate of pollinators was either small or positively correlated with nectar content of each flower position. The observed pattern of floral sex allocation would then be parallel to relative success of pollen export and import between flower positions within inflorescences.
Systematic validation of disease models for pharmacoeconomic evaluations
Authors: Sendi Peter P. , Craig Bruce A. , Pfluger Dominik , Gafni Amiram , Bucher Heiner C.
Published: March 2003

Abstract: Pharmacoeconomic evaluations are often based on computer models which simulate the course of disease with and without medical interventions. The purpose of this study is to propose and illustrate a rigorous approach for validating such disease models. For illustrative purposes, we applied this approach to a computer‐based model we developed to mimic the history of HIV‐infected subjects at the greatest risk for Mycobacterium avium complex (MAC) infection in Switzerland. The drugs included as a prophylactic intervention against MAC infection were azithromycin and clarithromycin. We used a homogenous Markov chain to describe the progression of an HIV‐infected patient through six MAC‐free states, one MAC state, and death. Probability estimates were extracted from the Swiss HIV Cohort Study database (1993–95) and randomized controlled trials. The model was validated testing for (1) technical validity (2) predictive validity (3) face validity and (4) modelling process validity. Sensitivity analysis and independent model implementation in DATATM (PPS) and self‐written Fortran 90 code (BAC) assured technical validity. Agreement between modelled and observed MAC incidence confirmed predictive validity. Modelled MAC prophylaxis at different starting conditions affirmed face validity. Published articles by other authors supported modelling process validity. The proposed validation procedure is a useful approach to improve the validity of the model.
Meretricious mensuration
Authors: Morgan W. Keith C.
Published: March 2003

Lord Kelvin made the observation in the 1890s that ‘When you can measure what you are speaking about, and express it in numbers, you know something about it; but when you cannot measure it, when you cannot express it in numbers, your knowledge is of a meagre and unsatisfactory kind’. Kelvin's major interests were physics and mathematics, but measurement is often more difficult in other sciences, and in particular in the social sciences. Perhaps Ludwig von Mises had a point when he wrote ‘There are in the fields of economics no constant relations and consequently no measurement is possible (Von Mises 1949). He might well have applied the same strictures to psychology and to some aspects of biology.
Selecting a mental health needs assessment scale: guidance on the critical appraisal of standardized measures
Authors: Evans S. , Greenhalgh J. , Connelly J.
Published: March 2003

The assessment of need has become a central element of the NHS policy on mental health care. Despite the importance placed on a needs‐led mental health service, little guidance has been provided as to the most appropriate means of assessing need. The use of standardized instruments can facilitate a systematic approach to the needs assessment process. However, available mental health needs assessment scales (MHNAS) vary considerably. Care is required to ensure that the scale selected is appropriate to the proposed purpose. This paper presents practical guidance on instrument selection for potential users of MHNAS including: (1) a review of the key issues to be considered when selecting an assessment scale, (2) a critical appraisal checklist for use in the review of needs assessment scales, and (3) a comparative analysis of three of the most commonly cited needs assessment scales. In addition, recommendations are made of ways to improve both the accessibility of MNHAS and to facilitate their appraisal prior to application in a clinical or research setting.
Palliative radiotherapy of bone metastases: an evaluation of outcome measures
Authors: Barton M.B. , Dawson R. , Wk B Soc , Jacob S. , B D. Currow , Stevens G. , Morgan G.
Published: March 2003

The objective of this study was to identify and evaluate important patient‐based outcomes that are specific to the palliative radiotherapy of bone metastases. We first conducted a literature review to identify and evaluate outcomes that are currently in use. To identify outcomes that are important to patients, in‐depth patient interviews were conducted. Finally, issues identified through the interviews were quantified through a prospective survey, in which patients completed a questionnaire prior to commencing radiotherapy and again after 6 weeks. In our literature review, we found that there was no standardized definition of either response to radiotherapy or assessment of pain relief. Pain measurement in many studies was undertaken using very simple measures, which could possibly yield inaccurate results. The vast majority of studies did not include quality of life as an endpoint. The patient interviews and survey showed that chronic pain and associated limitation of movement were the disease symptoms causing the most concern. Having a clear, alert mind and being able in self‐care were the aspects of daily living given the highest priority. Sustained pain relief and minimizing the risk of future complications were the main priorities relating to radiotherapy treatment. The practical aspects of treatment (travelling distance, remaining at home and brevity of treatment) were of least importance. This study indicates the complexity of evaluating the outcomes of palliative interventions, and confirms the deficiencies of pain relief as the primary end‐point. The patient's quality of life is affected by many factors other than pain (such as limited mobility, reduced performance, side effects and impaired role functioning); hence a wider range of end‐points is required. Greater sensitivity is required than in currently used end‐points. Concurrent diseases as well as concurrent therapies can make it difficult to attribute effects with precision. Unless such factors are considered in research design, the results may prove unreliable.
Rationality in medical decision making: a review of the literature on doctors’ decision‐making biases
Authors: Bornstein Brian H. , Emler A. Christine
Published: March 2003

The objectives of this study were to describe ways in which doctors make suboptimal diagnostic and treatment decisions, and to discuss possible means of alleviating those biases, using a review of past studies from the psychological and medical decision‐making literatures. A number of biases can affect the ways in which doctors gather and use evidence in making diagnoses. Biases also exist in how doctors make treatment decisions once a definitive diagnosis has been made. These biases are not peculiar to the medical domain but, rather, are manifestations of suboptimal reasoning to which people are susceptible in general. None the less, they can have potentially grave consequences in medical settings, such as erroneous diagnosis or patient mismanagement. No surefire methods exist for eliminating biases in medical decision making, but there is some evidence that the adoption of an evidence‐based medicine approach or the incorporation of formal decision analytic tools can improve the quality of doctors’ reasoning. Doctors’ reasoning is vulnerable to a number of biases that can lead to errors in diagnosis and treatment, but there are positive signs that means for alleviating some of these biases are available.
Macrophage or fibroblast‐conditioned medium potentiates Growth of Trypanosoma danilewskyi Laveran & Mesnil 1904
Authors: Bienek D. R. , Belosevic M.
Published: March 2003

Little is known about the role of macrophage products in blood‐borne parasitic infections of fish. This study determined the effects of soluble products of goldfish macrophages on the growth of the haemoflagellate, Trypanosoma danilewskyi Laveran & Mesnil. Cell‐free supernatants were collected from macrophage cultures that were derived from infected or uninfected goldfish. Trypanosomes were seeded into wells containing conditioned or control medium, incubated for seven days, and enumerated using flow cytometry. Supernatants collected from macrophages isolated from infected or uninfected fish, supported parasite growth significantly better (P < 0.05) compared to control medium. Supernatants, collected on day 12, 15, and 18 from macrophage cultures, induced a greater than 25% increase in the number of parasites. Moreover, the growth of T. danilewskyi was related to the number of macrophages seeded into cultures. This growth‐enhancing activity was not specific to species or cell‐type, as medium conditioned by mammalian macrophages or fibroblasts (fish or mammalian) significantly enhanced (P < 0.05) parasite growth. While compound(s) that are necessary for proliferation remain unidentified, our results suggest that over the prolonged evolutionary relationship with teleosts, T. danilewskyi has evolved to utilize soluble products of macrophages and fibroblasts as growth‐enhancing factors.
Characterization of extracellular products from an isolate of Vibrio harveyi recovered from diseased post‐larval Penaeus vannamei (Bonne)
Authors: Montero A. B. , Austin B.
Published: March 2003

Vibrio harveyi recovered from diseased post‐larval Penaeus vannamei produced a thermostable exotoxin, which was lethal to Dublin Bay prawns, Nephrops norvegicus L., when injected intramuscularly. The extracellular products (ECPs) concentrated from tryptone soya broth supplemented with 1% (w/v) sodium chloride or from cellophane overlays on marine 2216E agar with incubation at 15, 22 and 27 °C were toxic, with the lethal dose 50% of the crude ECPs estimated to be 4.4 μgprotein prawn−1. Proteolytic, haemolytic and cytotoxic activities were detected, although the occurrence and quantity of these activities were influenced by cultural conditions. The ECPs which had been heated (100 °C for 10 min) or digested with protease K produced the same pathology as crude, untreated ECPs. Western blotting demonstrated that all the ECP preparations contained low molecular weight lipopolysaccharides, which may constitute the lethal toxin of V. harveyi.
Effects of cecropin peptides on bacteria pathogenic to fish
Authors: Kjuul A. K. , Büllesbach E. E. , Espelid S. , Dunham R. , Jørgensen T. Ò. , Warr G. W. , And . , Styrvold O. B.
Published: March 2003

The antibacterial effects of synthetic cecropin B and cecropin P1 were tested against the fish‐pathogenic bacteria Vibrio anguillarum, Vibrio salmonicida, Aeromonas salmonicida, Edwardsiella ictaluri and Yersinia ruckeri. Both cecropins were active against all bacteria tested, but the effect was strongly influenced by the growth media used. In brain heart infusion medium, the minimum inhibitory concentrations of cecropin B ranged from 0.3 to 1.3 μm and from 0.3 to 1.0 μm for cecropin P1, except for E. ictaluri, which was noticeably less sensitive to cecropin P1 (61 μm). The present authors have compared the bactericidal activity of these two peptides, showing that the killing rate for the selected bacteria was higher for cecropin B than for cecropin P1. V. anguillarum was the most sensitive to the cecropins, and in the present study, no colony forming units were detected after 4 and 8 min of treatment with cecropin B and P1, respectively. Electron microscopy was performed to document the effect of cecropin on the bacterial surface.
Characterization of grouper nervous necrosis virus (GNNV)
Authors: Chi S C , Lo B J , Lin S C
Published: March 2003

Grouper nervous necrosis virus (GNNV) was isolated from moribund grouper larvae, Epinephelus sp., using a fish cell line GF‐1. The present study describes the biochemical and biophysical properties of GNNV and the expression of GNNV in diseased grouper larvae. Viral protein was detectable in most of the GNNV‐infected GF‐1 cells by the fluorescent antibody technique (FAT) after 12 h post‐infection (p.i.), although no cytopathic effect (CPE) appeared at that time. Clear CPE developed on the third day, and complete disintegration of the monolayer occurred over the subsequent two days. The infectivity of GNNV can be blocked following treatment at 60 °C for 1 h. GNNV was sensitive to pH 3 and pH 10–12 with a 4 log10 drop in infectivity. Purified GNNV was analysed by SDS–PAGE, and then stained with periodic acid silver. The positive staining indicated that its two capsid proteins were glycoproteins. Genomic RNAs of GNNV were extracted from purified virions and analysed. The molecular weights of genomic RNAs were 1.02 × 106 and 0.50 × 106 Da. The T2 region of the coat protein gene of GNNV was amplified by polymerase chain reaction (PCR), and the multiple alignment of the T2 sequence of two GNNV isolates with four genotypes of fish nodaviruses revealed that these two isolates (GNNV9410 and GNNV9508) belong to the red‐spotted grouper nervous necrosis virus (RGNNV) genotype. The tissue distribution of GNNV in naturally infected grouper larvae was investigated by in situ hybridization using a dig‐labelled probe, which showed that GNNV was not only detected in the brain and retina, but also in the gill, skeletal muscle, liver, pyloric gland, intestine and blood cells in the heart.
Efficacy of manual removal and ivermectin gavage for control of Salmincola californiensis (Wilson) infestation of chinook salmon, Oncorhynchus tshawytscha (Walbaum), captive broodstocks
Authors: Johnson K A , Heindel J A
Published: March 2003

Captive broodstocks of spring chinook salmon, Oncorhynchus tshawytscha, were initiated from collections of naturally produced parr from the Lemhi River, a tributary of the Salmon River, ID, USA. These fish were subsequently demonstrated to be infested with the copepod parasite Salmincola californiensis. The initial prevalence of visible adult parasites for 4 years of observations made shortly after collection varied from 19.7 to 71.6%. Both the prevalence and intensity of the infestation increased in the freshwater culture of these fish. Manual removal was initiated as a means of control and practiced at monthly intervals. The number of Salmincola removed decreased in the ensuing 5 months, but the prevalence was not greatly affected. Ivermectin (22,23 dihydroavermectin), was diluted with saline and delivered by gavage at the rate of 0.20 mg kg−1 body weight when the groups were being handled for the manual removal of parasites. Either two or three ivermectin treatments were given to four broodstocks of chinook salmon depending on the severity of the infestation and on the extent of gill pathology. The combination of manual removal and ivermectin gavage eliminated live Salmincola and resolved all associated necrosis of the gill tissues. There was no trend to indicate that individual chinook salmon possessed a natural resistance to reinfestation.
A herpes‐like virus infecting Crassostrea gigas and Ruditapes philippinarum larvae in France
Authors: Renault T , Lipart C , Arzul I
Published: March 2003

Concomitant sporadic high mortalities were reported in June 1997 among batches of larval Pacific oyster, Crassostrea gigas, and Manila clam, Ruditapes philippinarum, in a French commercial hatchery. Histological observation showed the presence of cellular abnormalities in affected animals. Electron transmission microscopy revealed the presence of herpes‐like virus particles in infected larvae of both bivalve species. Viruses observed in C. gigas and R. philippinarum are closely related with respect to ultrastructure and morphogenesis. They were detected simultaneously in both bivalve species larvae indicating possible interspecific transmission. Moreover, PCR analysis using oyster herpes‐like virus specific primers allowed amplification of fragments of expected sizes for both bivalve species and demonstrated the presence of viral DNA. The PCR products obtained for both bivalve species and digested by restriction enzymes displayed the same patterns. These data suggest that the same herpes‐like virus may infect larval oysters and clams.
Effects of low salinities on Flavobacterium columnare infection of euryhaline and freshwater stenohaline fish
Authors: Altinok I , Grizzle J M
Published: March 2003

Channel catfish, Ictalurus punctatus (Rafinesque), goldfish, Carassius auratus (L.), striped bass, Morone saxatilis (Walbaum), and Gulf sturgeon, Acipenser oxyrinchus desotoi Vladykov, were acclimatized to fresh water or salinities of 9.0‰ or less and then exposed to Flavobacterium columnare (formerly known as Flexibacter columnaris), the bacterial pathogen that causes columnaris disease. None of the fish acclimatized to 3.0 or 9.0‰ salinity died, and all deaths in lower salinities occurred between 1 and 5 days after exposure to F. columnare. Mortality was 97.7% in fresh water and 67.1% in 1.0‰ salinity for channel catfish (model SE, 1.8) and 66.5% in fresh water and 40.8% in 1.0‰ salinity for goldfish (model SE, 1.2); and 96.9% in fresh water and 61.7% in 1.0‰ salinity for striped bass (model SE, 1.8). After exposure to F. columnare, none of the Gulf sturgeon died. Flavobacterium columnare was isolated from the skin and gills of all fish dying during the experiments, but was not isolated from survivors in fresh water and 1.0‰ salinity 21 days after bacterial exposure. In vitro growth of bacteria was significantly higher in 1.0 or 3.0‰ salinity than in control medium (0.3‰ salinity). However, in vitro adhesion of bacteria was reduced with increasing salinity, which could explain the lower mortality of fish at higher salinities.
The effectiveness of adenoviral vectors to deliver and express genes in rainbow trout, Oncorhynchus mykiss (Walbaum)
Authors: Overturf K , LaPatra S , Reynolds P N
Published: March 2003

The efficacy of adenoviral vectors for gene delivery into fish cells, both in vitro and in vivo, was evaluated. Vectors utilized were of human adenovirus serotype 5 (Ad), which are commonly used in human clinical trials, but have not been assessed for gene delivery to fish. Because nothing is known about Ad receptors in fish, both an Ad (Ad5Luc1) with natural tropism for the coxsackie and adenovirus receptor (CAR), as well as an infectivity enhanced Ad (Ad5LucRGD) were included within this study. Gene expression was detected in cell lines using either vector. The levels seen with Ad5LucRGD were much higher than for Ad5Luc1 in most lines except CHSE‐214. Transduction of CHSE‐214 cells with Ad5Luc1 could be blocked with an excess of a competitive inhibitor, suggesting that these cells possess a CAR homologue that mediates attachment of Ad, similar to that seen in mammalian cells. In vivo gene delivery was attempted by several methods, with significant expression seen only via intramuscular injection, although infection efficiency was low. Thus it was observed that several teleost cell lines are capable of being infected and one cell line expressed a human serotype adenoviral receptor homologue that aids in Ad infection. Additionally, in vivo studies indicated that muscle tissue of rainbow trout could be infected with Ad vectors, suggesting an alternative gene delivery strategy for this animal.
A survey of dietetic practice in obesity management
Authors: Cowburn Gill , Summerbell Carolyn
Published: March 2003

Introduction: Little is known about how dietitians organize the management of overweight and obese clients. The aim of this survey was to identify current dietetic practice in the management of such clients.
Methods: In preparation for the joint Association for the Study of Obesity/British Dietetic Association (BDA) symposium in November 1997, a questionnaire was sent to BDA members registered on two BDA databases in order to identify current practice in the dietetic management of obesity. A total of 347 BDA members were contacted; 252 dietetic heads of service (or equivalent) and 95 members on the BDA freelance register. Information relating to referral criteria, organizational details and key features of typical management programmes was collected.
Results: A poor response rate of 40% was achieved, with a similar response rate from dietetic heads of service and freelance dietitians. Of those who did respond, 91% accepted referrals for overweight or obese clients. The majority of respondents allocated up to 30 min for a new client appointment, and offered at least one follow‐up appointment, usually at 4‐week intervals and lasting up to 20 min. Freelance respondents allocated longer times for new client and follow‐up appointments, and also reviewed patients more frequently (but did not allocate more follow‐up appointments), than dietetic heads of service. Most consultations were on an individual basis and were not guided by standardized protocols.
Conclusion: There is clearly an opportunity for dietitians to move towards evidence‐based treatment of obesity, without substantial resource implications, by offering longer‐term treatment using group therapy. The use of clinical guidelines, and auditing future dietetic practice against these guidelines, should be considered.
Efficacy of very low‐energy diets and meal replacements in the treatment of obesity
Authors: Jebb  , Goldberg
Published: March 2003

Background: Low‐energy diets, ideally in combination with increased energy expenditure through physical activity, are the mainstay of obesity treatment. Very low‐energy liquid diets (VLEDs) were developed to provide a safe alternative to starvation, with only a modest attenuation in the rate of weight loss.
Aim: This paper considers the evidence concerning the efficacy of both commercial and milk‐based total liquid diets, which provide a maximum of 800 kcal/day.
Results: Long‐term users of low‐energy formula diets are a self‐selected group who find these preparations acceptable. In these subjects early compliance is often good and weight losses of 8–10 kg in approximately 4–8 weeks are regularly reported. This compares favourably with acute weight losses using other treatment methods. However, there are concerns regarding the composition of tissue lost and the long‐term maintenance of weight loss.
Conclusion: VLEDs are a proven success in achieving significant short‐term reductions in body weight. A subset of patients achieve long‐term weight loss. There is evidence to suggest that meal replacements may make a contribution to the maintenance of weight loss in some individuals. Evaluation of integrated programmes using these methods for weight loss and long‐term weight control is required.