bluuebunny/crossref_metadata_2025 huggingface dataset:
Thomas More's Richard III: probing the limits of humanism
Authors: Yoran H
Published: September 2010

The paper examines the ambiguous relation of Thomas More's The History of Richard III to humanist thought. My central contention is that the work reproduces the presuppositions of humanist discourse but at the same time challenges and subverts them. First I analyse the content of the text – its argumentation and its moral and political lessons – to demonstrate that it may legitimately be read in two contradictory ways. Richard III can be read as an unequivocal condemnation of an ‘external’ evil that overturns the natural order of things. This reading neatly places the text in the mainstream of didactic and moralistic humanist history. When, on the other hand, Richard III's more sinister passages and equivocal moments are highlighted, the text's implied message is that human politics are irredeemably corrupt, a message that contradicts the basic assumptions of humanist ethical and political thought. Secondly, in order to account for this ambiguity, I examine the text against the background of the conventions of the humanist genre of history. I try to demonstrate that while Richard III usually obeys the technical rules of the genre, it defies the genre's more basic assumptions. In particular, it undermines the humanist notion of rhetoric – the presiding idea of humanist history – and thus subverts the basic epistemological presuppositions of humanist discourse.
Beyond Affect and Cognition: Identification of the Informational Bases of Food Attitudes1
Authors: Aikman Shelley N. , Crites Stephen L. , Fabrigar Leandre R.
Published: September 2010

Two studies were conducted to identify the informational bases of food attitudes. Study 1 was an exploratory study in which participants indicated the importance of food characteristics and emotional reactions for determining their attitudes toward a variety of foods. On the basis of a series of exploratory factor analyses, 5 informational bases of food attitudes were identified: positive affect, negative affect, specific sensory qualities, abstract cognitive qualities, and general sensory qualities. A second confirmatory study corroborated the appropriateness of this 5‐factor structure. Furthermore, the food‐specific attitude structure model was found to have better fit than a more traditional attitude structure model. The implications of these findings for attitude theory, understanding eating behavior, and changing food selection are discussed.
Sex Differences in Self‐Estimates on Two Validated IQ Test Subscale Scores
Authors: Furnham Adrian , Crawshaw Julia , Rawles Richard
Published: September 2010

Two related studies investigated sex differences in self‐ and parental estimates of IQ scores on specific scales derived from standardized and validated IQ tests. In the first study 210 participants were asked to estimate their scores on the 11 WAIS‐R subtests as well as their overall general IQ. Results showed males estimated their overall score, plus their total WAIS score, significantly higher than females, with effect sizes around 0.5. Factor analysis showed participants did differentiate between verbal and performance subscale scores on this test. In the second study 117 participants performed a similar task, but this time on the 12 subscales of the Stanford‐Binet test. Males estimated their overall score higher than females. Factor analysis also showed 2 clear factors that reflected exactly the verbal and performance subscale scores.
Support for Affirmative Action Initiatives Among Diverse Groups: The Role of Ethnic Identity
Authors: Snyder Lori Anderson , Cleveland Jeanette N. , Thornton George C.
Published: September 2010

This study investigates the relationships among demographic factors (race/ethnicity, color, and gender), ethnic identity (i.e., the degree to which one identifies with and feels a part of one's racial or ethnic group), and support for affirmative action initiatives. Using a sample of 1,880 university employees, the results of this survey study reveal that women and minority group members express higher levels of ethnic identity and support for affirmative action initiatives, mirroring previous research. In addition, the findings indicate that ethnic identity and support for affirmative action initiatives are correlated and that ethnic identity serves as a mediator and moderator in the relationship between demographic variables and support for affirmative action for some subgroups.
The Role of Trait Emotional Intelligence in a Gender‐Specific Model of Organizational Variables1
Authors: Petrides K. V. , Furnham Adrian
Published: September 2010

This article investigated the relationships between trait emotional intelligence (“trait EI” or “emotional self‐efficacy”) and 4 job‐related variables (perceived job control, job stress, job satisfaction, and organizational commitment). Gender‐specific data (N=167, 87 females) were analyzed via multigroup structural equation modeling. Perceived job control had a negative effect on stress and a positive effect on satisfaction. Stress had a negative effect on satisfaction, which, in turn, had the strongest positive effect on commitment. There were many gender differences in the model, mainly concerning age, which was negatively related to control and commitment in the female sample only. Trait EI had specific, rather than widespread, effects in the model. Discussion focuses on trait EI's implications in the workplace.
Social and Economic Exchange: Construct Development and Validation
Authors: Shore Lynn M. , Tetrick Lois E. , Lynch Patricia , Barksdale Kevin
Published: September 2010

This study examined the economic and social exchanges between employee and employer within a model in which perceived organizational support and affective and continuance commitment served as predictors and performance, altruism citizenship behavior, absence, and lateness served as outcomes. Two samples were used. 384 master of business administration students participated in Study 1, and Study 2 consisted of 181 aerospace employees and their managers, working for a single organization. Both studies supported the distinctiveness between economic and social exchanges. Study 2 showed the overall fit of the proposed model was adequate, though only social exchange, and not economic exchange, directly predicted the performance outcomes. These results suggest the importance of perceived exchanges between employee and employer.
Rental Discrimination and Ethnicity in Names1
Authors: Carpusor Adrian G. , Loges William E.
Published: September 2010

Laboratory studies have demonstrated the ability of names to prime stereotypes. To apply these theories and test the effect of name‐based ethnic stereotypes on housing discrimination, 1,115 inquiry e‐mail messages were sent to landlords advertising apartment vacancies in Los Angeles County over 10 weeks (6 weeks before the conflict with Iraq began in March 2003 and 4 weeks during the conflict). One of three names that implied either Arab, African American, or White ethnicity was randomly assigned to each of the messages sent. African American and Arab names received significantly fewer positive responses than the White name, and the African American name fared worst of all. This pattern held true in all rent categories, in corporate and privately owned apartment complexes, and before and during the war in Iraq.
The Impact of Goal‐Performance Discrepancies, Self‐Efficacy, and Goal Orientation on Upward Goal Revision1
Authors: Donovan John J. , Hafsteinsson Leifur Geir
Published: September 2010

The present study examined the role of positive goal‐performance discrepancies (GPDs), self‐efficacy beliefs, and dispositional goal orientation on goal revision processes following performance feedback in a sample of 129 Icelandic job applicants. The results indicated that goal revision was primarily a function of the positive GPD encountered by individuals. However, this relationship was moderated by self‐efficacy, performance goal orientation, and learning goal orientation. Implications of these findings and directions for future research are discussed.
Perceptions of Police Use of Deadly Force
Authors: Perkins James E. , Bourgeois Martin J.
Published: September 2010

Recent police shootings of unarmed suspects have brought to bear harsh criticism of law enforcement use of deadly force. Two studies sought to investigate perceptions of police misuse of deadly force. Study 1 showed that as number of officers decreased and number of shots increased, perceptions of misuse of force were augmented. Number of shots per officer significantly predicted perceptions of misuse of force. Study 2 investigated the effects of social dominance orientation, blind patriotism, and right‐wing authoritarianism. Results showed a significant interaction between number of officers, number of shots fired, and social dominance orientation. This personality variable was an especially strong predictor of misuse of force in situations involving the largest number of shots fired per officer.
A Compositional Analysis of the Organizational Climate‐Performance Relation: Public Schools as Organizations
Authors: Griffith James
Published: September 2010

The present study examined specific aspects of organizational climate related to job satisfaction, employee turnover, and organizational performance in public elementary schools. Survey data were obtained from school staff and students and from school district archives. Hypotheses tested included: (1) Employee perceptions of organizational climate and job satisfaction, when aggregated to an organizational level, would represent group‐level constructs; (2) Employee perceptions of positive organizational climate would be associated with higher levels of job satisfaction and organizational performance and with lower levels of employee turnover; (3) Relations of organizational climate to organizational performance and to employee turnover would be mediated by employee job satisfaction; and (4) Employee perceptions of positive organizational climate and job satisfaction would be associated with less achievement disparity between minority and non‐minority students. Study results supported all but one hypothesis. There was no evidence for the mediating effects of job satisfaction on relations of organizational climate to organizational performance and to employee turnover. Results were consistent with the broader organizational literature, which has shown the importance of orderly work environments, collegial relations, and supportive leaders for effectively functioning groups and organizations.
Money Attitudes and Emotional Intelligence
Authors: Engelberg Elisabeth , Sjöberg Lennart
Published: September 2010

As the notion of money tends to be imbued with salient emotions, it is plausible that emotional intelligence (EI) has a bearing on the efficacy to cope with emotion‐eliciting issues involving money. The purpose of the present study was to investigate the extent to which money attitudes relate to EI. The study included a sample of 212 respondents who filled out a questionnaire with items of the Money Attitude Scale (MAS) developed by Yamauchi and Templer (1982). The questionnaire further contained a test of EI performance consisting of judging emotions in facial expressions, and of self‐report measures considered to be subscales of EI. Results suggested that high levels of EI imply a less pronounced orientation toward money and a greater sense of economic self‐efficacy. Furthermore, money orientation seemed to be linked to worse adjustment of work vs. family/leisure time.
The limits and relationships of the acanthomorph teleosts
Authors: Stiassny Melanie L. J.
Published: September 2010

The phylogenetic status of the speciose euteleostean assemblage, the Acanthomorpha, is investigated. For the purposes of cladistic analysis attention is centred upon an examination of euteleostean buccal ligament systems, the occipital and ethmoid regions of the neurocranium, and the posttemporal/neurocranial association.

In this study four derived morphological features are identified which support the monophyly of the Acanthomorpha, and the previously ‘problematical’ genus Polymixia is determined to be the sistergroup of all the remaining acanthomorphs. The phylogenetic integrity of the sistergroup of the entire Acanthomorpha, the Myctophiformes (sensu Rosen, 1973), is attested by the presence of four derived features, and the monophyly of its major subdivisions (the Myctophidae and Neoscopelidae) is resolved.

Additional problems of euteleostean systematics and systematic methodology are discussed.
Nests, eggs, and embryonic development of Carettochelys insculpta (Chelonia: Carettochelidae) from Northern Australia
Authors: WEBB GRAHAME J. W. , CHOQUENOT DAVID , WHITEHEAD PETER J.
Published: September 2010

Ten Curettochelys insculptu nests from the Daly River, in the Northern Territory of Australia, are described. Eggs were in sand banks beside the river and were laid during August and September, in the dry season. Mean clutch size was 12.7±3.3 eggs (SD). Eggs are hard‐shelled and spherical (mean egg diameter 38.7 k0.13 mm) and weigh 33.7±3.5 g. Embryonic development rate varies as a function of incubation temperature. Using as an endpoint the stage at which residual yolk is internalized, incubation times are approximately 53 days (at 32° C), 69 days (30° C) and 101 days (28° C). Embryonic metabolic rate increases exponentially during early development and is highest when the residual yolk is internalized. Hatching is delayed for a considerable period after yolk internalization (224±8.6 days at 30° C and 32° C). During the period between yolk internalization and hatching (the ‘hatching delay’) metabolic rate decreases precipitously, embryonic growth ceases and 0.04‐0.05 g of yolk (at 28° C to 32° C) plus an unmeasured amount of body fat are used for maintenance each day. Hatching can be stimulated by reducing oxygen availability, either through submerging eggs in water or perfusing them with nitrogen. In the field hatching is probably stimulated by early wet season rains and/or rises in water level. Total egg weight losses during incubation varied between 1% and 11% of the original weight, but no significant relationship between weight loss and hatchling size could be demonstrated. Hatchling size is largely determined by egg size and development rate. Formulae for predicting various hatchling dimensions from each other and from egg size are presented. The redistribution of egg contents that occurs during development and the spreading field of shell opacity that accompanies development are both described. The proportion of albumen and yolk in Curettochelys insculpta eggs is similar to that in marine turtle eggs, which is consistent with a minimum amount of water‐laden albumen being necessary for yolk rotation to occur after laying (to position the embryo on the upper surface of the egg). Curettochelys insculptu has environmental sex determination. Embryos incubated at 28° C and 30° C become males whereas those incubated at 32° C become females. Females have smaller body sizes and a greater mass of residual yolk than males from eggs of the same size, but these differences appear to be consequences of varying development rates rather than being linked in any causal fashion with sex.
Barriers to accessing care in patients with chronic hepatitis C: the impact of depression
Authors: Evon D. M. , Simpson K. M. , Esserman D. , Verma A. , Smith S. , Fried M. W.
Published: September 2010

Aliment Pharmacol Ther2010;32:1163–1173

Background Patients with hepatitis C viral (HCV) may perceive barriers to accessing speciality care for HCV, and these barriers may be related to depressive symptoms.

Aim To evaluate the relationship between barriers to care, demographics, and depressive symptoms.

Methods A cross‐sectional analysis of 126 patients referred for HCV at two speciality HCV clinics. Barriers to care, depressive symptoms and sociodemographics were measured using standardized instruments. A retrospective chart review was conducted to collect clinical outcome data.

Results Depressive symptoms were reported in 26%. Common barriers included lack of personal financial resources; lack of HCV knowledge in the community; lack of professionals competent in HCV care; stigmatization of HCV; and long distances to clinics offering care. After we controlled for sociodemographics, depression accounted for an additional 7–18% of variability in all barriers (all p values <0.01). Lower depression, marital and employment status were associated with subsequent receipt of HCV treatment in 38% (45/120) of patients; perceived barriers were not.

Conclusions Depression is independently associated with perceived barriers to care. Higher depressive scores, but not perceived barriers, were associated with nontreatment. Healthcare providers who diagnose HCV need to be cognizant of numerous perceived barriers to accessing HCV care, and the impact that depression may have on these perceptions and receipt of treatment.
Specific information about the WHO guidelines for gestational diabetes screening improves clinical practices
Authors: Gayet‐Ageron Angèle , Poncet Bénédicte , Guerre Pascale , Rocher Laure , Dureau‐Drevard Elisabeth , Colin Cyrille , Orgiazzi Jacques , Berland Michel , Touzet Sandrine
Published: September 2010

Rationale, aims and objective  To evaluate the impact of specific information on World Health Organization (WHO) guidelines for gestational diabetes mellitus (GDM) screening on clinical practices and to estimate its acceptance by women.

Methods  A non‐randomized interventional study, comparing two periods, that is, before (period I) and after (period II) the implementation of the WHO guidelines during year 2000 in three obstetrical units, using reminders, meetings and pre‐printed prescription sheets. Women were interviewed on GDM screening acceptance.

Results  A total of 333 pregnant women were included in period I and 345 in period II. The proportion of women who were screened significantly increased between period I and period II (0.9% in period I, 59.1% in period II, P < 10−3). The screening test was realized in accordance with guidelines for 80% of women in period II. The acceptability of the test by women was estimated at 98%. Furthermore, 90% of them would accept to be screened again during another pregnancy.

Discussion  Specific information about WHO screening guidelines improves doctor practices. Moreover, the high rate of acceptance by women is an argument to promote more widespread WHO screening for GDM during pregnancy.
Heart failure and sudden death in dilated cardiomyopathy: a hidden competition we should not forget about when modelling mortality
Authors: Gregori Dario , Rosato Rosalba , Zecchin Massimo , Baldi Ileana , Di Lenarda Andrea
Published: September 2010

Rationale, aims and objectives This paper discusses the use of bivariate survival curve estimators jointly with a competing risk Cox model to analyse mortality in dilated cardiomyopathy due to heart failure (HF) or sudden death (SD), without assuming independence between outcomes. The goal of the manuscript is to suggest a possible protocol for the analysis of competing risk events, mimicking the common approaches used in the univariate case.

Methods The non‐parametric bivariate survival estimators are used to estimate a multivariate proportional hazard model for dealing with SD or HF in a long‐term prospective cohort of 235 patients, recruited from 1978 to 1992. Patients have been stratified, among others, by age, severity and treatment. The latter has been considered under two specific protocols of analysis: intention to treat and actual treatment.

Results The bivariate survival curves show different survival probabilities for HF and SD. For HF the force of mortality acts early and then slows down as follow‐up increases, while for SD the mortality is lower initially and increases later in time. Under competing risk analysis, evidence of treatment effect is shown only in the actual treatment protocol, in contrast with the results provided by standard Cox regression.

Conclusions One of the advantages of non‐parametric bivariate survival estimation in the presence of competing risks is that parameters may be interpreted in much the same way as those estimated by the standard Cox regression. Moreover, ignoring the competing risk structure may provide a misleading interpretation of the results.
Prioritizing surgical waiting lists
Authors: Testi A. , Tanfani E. , Valente R. , Ansaldo G. L. , Torre G. C.
Published: September 2010

Rationale, aims and objectives  This paper deals with the problem of surgical waiting lists and is aimed, in particular, at comparing two different prioritization approaches: (1) the clinical assessment of treatment urgency aimed at categorizing patients into urgency‐related groups (URGs) with a given recommended maximum waiting time for treatment; and (2) the implementation of an original prioritization scoring algorithm aimed at determining the relative priority of each patient in the waiting list and the corresponding order of admission.

Methods  A modelling exercise based on a cohort of 236 patients enrolled on the waiting list of a surgical department in an Italian public university hospital, from 1 January to 30 June 2004, is presented. The comparison is based on a measure called need‐adjusted‐waiting‐days, which allows to take into proper account both urgency and priority.

Results  The results show that both methods should be implemented simultaneously for increasing the department’s performance in terms of both efficiency– outcome gained from a given amount of resources – and equity– how patients are admitted according to their need.

Conclusions  Waiting list prioritization should not be limited to classifying patients into URGs, but to using a scoring system as well, in order to schedule patient admissions in an explicit and transparent way.
Interactive patient decision aids for women facing genetic testing for familial breast cancer: a systematic web and literature review
Authors: Williams Lisa , Jones Wendy , Elwyn Glyn , Edwards Adrian
Published: September 2010

Objective  A systematic review to identify and appraise interactive decision aids that are designed for consumer use, in the field of hereditary breast cancer and genetic testing.

Methods  An Internet (Google, Alta Vista) and literature search (Medline) was conducted for suitable decision aids. The decision aid had to (inclusion criteria): be about genetic testing for familial breast cancer; fulfil the criteria of a decision aid; use multimedia IT; be interactive (user does something that influences the decision pathway); and be for patient/public use. Exclusion criteria were decision aids that: had no interactivity (e.g. leaflet, video); discussed management decisions after gene status confirmed; non‐English; aids that required membership/subscription. Once aids had been selected for further appraisal they were assessed against a recognized framework for the evaluation of decision aids – the International Patient Decision Aid Standards (IPDAS) criteria.

Results  On Google 595 web pages were assessed, as were 382 Google directory entries. Alta Vista revealed fewer results and revealed no new sites. Twenty‐four web sites and four CD‐ROMs with the most potential as stand alone decision aids were then selected for further assessment. On Medline 776 citations were reviewed, of these only one CD‐ROM and no web sites were found. After initial appraisal only two CD‐ROMs and one web site met the criteria for further consideration. Assessed against the IPDAS criteria, the decision aids scored poorly with no aid scoring more than 50%.

Conclusions  Although there is a significant amount of interest in genetic testing to determine whether a woman is at high risk of breast cancer, the current genetic services are having difficulty coping with the demand. Alternatives such as decision aids have been suggested. There are many sources of information available, but few are truly interactive or designed for patient use. Of the three evaluated, all were from the USA and are likely to require modification for patients elsewhere.
Open label extension studies and patient selection biases
Authors: Hemming Karla , Hutton Jane L. , Maguire Melissa J. , Marson Anthony G.
Published: September 2010

Rationale  Long‐term observational studies are essential in assessing the effect of interventions for chronic diseases on long‐term safety and tolerability, as well as informing on efficacy in a non‐clinical trial setting. Concerns over the scientific validity of open label extension studies to randomized controlled trials have recently been raised. Patients experiencing adverse events will be withdrawn before the follow‐on period of the study, and those experiencing milder side‐effects will be less likely to opt to continue into the open label extension.

Methods  The usual method of analysis of the open label extension study, which ignores any patients not continuing into the follow‐on period of the study, is outlined. It is shown that ignoring patients who exit the trial is equivalent to assuming the outcome data are missing completely at random. Where this assumption is not met, treatment effect estimates will be biased. An alternative method of analysis is proposed, which does not rely on the often unjustifiable assumption of outcomes being missing completely at random.

Results  In an example open label extension study, with reported responder rate 43%, we show how an analysis allowing for patient selection biases produces a responder rate of just 28%.

Conclusions  The method of analysis proposed here, minimizes the effect of patient selection biases. Future reporting ideals for open label extension studies are recommended to minimize future biases. For studies which have not reported results in detail we suggest a sensitivity based on the worst case scenario, as a minimum treatment effect estimator.
Individualized population care: linking personal care to population care in general practice
Authors: Buetow Stephen , Getz Linn , Adams Peter
Published: September 2010

Background  General practice is increasingly expected to deliver population care to individual patients. The feasibility and ethics of this policy shift have been challenged.

Aim  Our aim is to suggest how to deliver population care while protecting personal care.

Methods  We outline and discuss concepts of these types of care, their relation to the prevailing discourse regarding intervention benefits, and arguments for individualized population care.

Results  Individualized population care can enable general practice to meet the health targets of individual patients in the light of population‐based goals. It unifies the concepts of personal care and whole population care. Personal care focuses on the individual good in particular consultations. Whole population care focuses on the overall health good of a population without reference to the individuality of each population member. These types of care constitute elements of a continuum that varies in purpose and objects of focus. The limitations of a crude dichotomy of personal care and population care are made explicit in a series of five arguments that lend support to the concept of individualized population care.

Conclusions  We advocate a constructive but critical attitude towards the idea of population‐based interventions in everyday general practice. Traditional personal care and whole population care can theoretically be integrated into individualized population care. However, this presupposes clinical–epidemiological expertise and moral awareness in practising clinicians.
Do we practice what we preach? A qualitative assessment of resident–preceptor interactions for adherence to evidence‐based practice
Authors: Tilburt Jon C. , Mangrulkar Rajesh S. , Goold Susan Dorr , Siddiqui Nazema Y. , Carrese Joseph A.
Published: September 2010

Background  Evidence‐based medicine (EBM) is important in training doctors for high‐quality care. Yet little is known about whether ambulatory precepting incorporates the concepts and principles of EBM.

Methods  The authors observed and audiotaped 95 internal medicine residency precepting interactions and rated interactions using a qualitative analytic template consisting of three criteria: (1) presence of clinical questions; (2) presence of an evidence‐based process; and (3) resident ability to articulate a clinical question.

Results  Sixty‐seven of 95 audio tapes (71%) were of acceptable quality to allow template analysis. Thirty (45%) contained explicit clinical questions; 11 (16%) included an evidence‐based process. Resident ability to articulate a clinical question when prompted was rated as at least ‘fair’ in 59 of 67 interactions (88%).

Conclusions  EBM was not optimally implemented in these clinics. Future research could explore more systematically what factors facilitate or impair the use of EBM in the real‐time ambulatory training context.
User‐driven health care – answering multidimensional information needs in individual patients utilizing post–EBM approaches: a conceptual model
Authors: Biswas Rakesh , Martin Carmel M. , Sturmberg Joachim , Shanker Ravi , Umakanth Shashikiran , Shanker Shiv , Kasturi A. S.
Published: September 2010

Evidence based on average patient data, which occupies most of our present day information databases, does not fulfil the needs of individual patient‐centred health care. In spite of the unprecedented expansion in medical information we still do not have the types of information required to allow us to tailor optimal care for a given individual patient. As our current information is chiefly provided in disconnected silos, we need an information system that can seamlessly integrate different types of information to meet diverse user group needs. Groups of certain individual medical learners namely patients, medical students and health professionals share the patient's need to increasingly interact with and seek knowledge and solutions offered by others (individual medical learners) who have the lived experiences that they would benefit to access and learn from. A web‐based user‐driven learning solution may be a stepping‐stone to address the present problem of information oversupply in medicine that mostly remains underutilized, as it doesn't meet the needs of the individual patient and health professional user. The key to its success would be to relax central control and make local trust and strategic health workers feel more engaged in the project such that it is truly user‐driven.
Harnessing experience: exploring the gap between evidence‐based medicine and clinical practice
Authors: Hay M. Cameron , Weisner Thomas S. , Subramanian Saskia , Duan Naihua , Niedzinski Edmund J. , Kravitz Richard L.
Published: September 2010

Rationale, aims and objectives  There is mounting evidence of a gap between Evidence‐based Medicine (EBM) and physician clinical practice, in part because EBM is averaged global evidence gathered from exogenous populations which may not be relevant to local circumstances. Local endogenous evidence, collected in particular and ‘real world’ patient populations may be more relevant, convincing and timely for clinical practice. Evidence Farming (EF) is a concept to provide such local evidence through the systematic collection of clinical experience to guide more effective practice.

Methods  We report on the findings of a pilot study of 29 individual and three focus group (n = 10) interviews exploring physicians' evaluations how they use multiple sources of information in clinical decision making and their thoughts on EF.

Results  Physicians recognize a gap in translating EBM to practice. Physicians reported that when making clinical decisions, they more often rely on clinical experience, the opinions of colleagues and EBM summarizing electronic clinical resources rather than refer directly to EBM literature. Confidence in making decisions based on clinical experience increases over time, yet few physicians reported having systems for tracking their clinical experience in designing treatment plans and patient outcomes. Most physicians saw EF as a promising way to track experience, thereby making scientific evidence more relevant to their own clinical practices.

Conclusion  Clinical experience is relatively neglected by the EBM movement, but if that experience were systematically gathered through an approach such as EF, it would meet a need left unfulfilled by EBM.
Evaluation of the Evidence‐Based practice Attitude and utilization SurvEy for complementary and alternative medicine practitioners
Authors: Leach Matthew J. , Gillham David
Published: September 2010

Rationale  This paper describes the development of the Evidence‐Based practice Attitude and utilization SurvEy (EBASE), which was designed to measure complementary and alternative medicine (CAM) practitioner attitude to and utilization of evidence‐based practice (EBP).

Aim  The aim of this study was to evaluate the validity and reliability of the EBASE as a measure of CAM practitioner skill, attitude and use of EBP in order to adequately inform clinicians and researchers about this comprehensive survey tool.

Methods  EBASE and the clinical effectiveness and EBP questionnaire (EBPQ) were distributed to nine experts in CAM education, research, questionnaire design and/or EBP. Responses to these questionnaires were used to evaluate the content validity, convergent validity, test‐retest reliability and internal consistency of EBASE.

Results  EBASE has found to have good internal consistency (Cronbach's alpha = 0.84) and acceptable test‐retest reliability (ICC = 0.578–0.986). The instrument also demonstrated good content validity (CVI = 0.899), and adequately measured practitioner skill and utilization of EBP when compared to the EBPQ.

Conclusion  The current study supports the validity and reliability of EBASE as a measure of CAM practitioner skill, attitude, experience and training in, as well as barriers and facilitating factors of EBP.
Urinary incontinence management in women: audit in general practice
Authors: Gerrits Marloes , Avery Tony , Lagro‐Janssen Antoine
Published: September 2010

Objectives  In several Western European countries guidelines regarding urinary incontinence (UI) management in general practice have been drawn up. The aim of this study was to evaluate guideline adherence with feedback in general practice in order to improve UI management.

Methods  First, a retrospective audit of female patient records was performed with Egton Medical Information System compared with the NICE Guideline regarding UI. Between 1 January 2000 and 31 December 2006 patients, 18–65 years of age, with newly diagnosed UI (ICPC U04) were included in two general practices in Nottingham, UK. Second, results were presented to the general practitioners (GPs) in a feedback session.

Results  Sixty‐five patients were identified to have newly reported UI. Gynaecological examination was performed in 51% of cases. Additionally, in 40% of patients a urine sample was obtained for dipstick. Follow‐up was performed in 34% of the 65 cases. During a feedback session GPs became aware they do not adhere to these guideline items consistently. Patients often report UI as final after several other problems during one single consultation.

Conclusion  Most women with UI were not managed according to the NICE Guideline. Audit feedback created awareness of current UI management in general practice and can therefore be used in improving UI management.
Improved guideline adherence to pharmacotherapy of chronic systolic heart failure in general practice – results from a cluster‐randomized controlled trial of implementation of a clinical practice guideline
Authors: Peters‐Klimm Frank , Müller‐Tasch Thomas , Remppis Andrew , Szecsenyi Joachim , Schellberg Dieter
Published: September 2010

Rationale and aims  Clinical practice guidelines (CPG) reflect the evidence of effective pharmacotherapy of chronic (systolic) heart failure (CHF) which needs to be implemented. This study aimed to evaluate the effect of a new, multifaceted intervention (educational train‐the‐trainer course plus pharmacotherapy feedback = TTT) compared with standard education on guideline adherence (GA) in general practice.

Method  Thirty‐seven participating general practitioners (GPs) were randomized (18 vs. 19) and included 168 patients with ascertained symptomatic CHF [New York Heart Association (NYHA) II‐IV]. Groups received CPG, the TTT intervention consisted of four interactive educational meetings and a pharmacotherapy feedback, while the control group received a usual lecture (Standard). Outcome measure was GA assessed by prescription rates and target dosing of angiotensin converting enzyme (ACE) inhibitors (ACE‐I) or angiotensin receptor blockers (ARB), beta‐blockers (BB) and aldosterone antagonists (AA) at baseline and 7‐month follow‐up. Group comparisons at follow‐up were adjusted to GA, sex, age and NYHA stage at baseline.

Results  Prescription rates at baseline (n = 168) were high (ACE‐I/ARB 90, BB 79 and AA 29%) in both groups. At follow up (n = 146), TTT improved compared with Standard regarding AA (43% vs. 23%, P = 0.04) and the rates of reached target doses of ACE‐I/ARB (28% vs. 15%, P = 0.04). TTT group achieved significantly higher mean percentages of daily target dose (52% vs. 42%, mean difference 10.3%, 95% CI 0.84–19.8, P = 0.03).

Conclusion  Despite of pre‐existing high GA in both groups and an active control group, the multifaceted intervention was effective in quality of care measured by GA. Further research is needed on the choice of interventions in different provider populations.
Towards an evidence‐based ‘Medicine of the Person’: the contribution of psychiatry to health care provision
Authors: Cox John L.
Published: September 2010

The purpose of this essay is to outline how the conceptual and clinical approaches of psychiatry contribute to increased understanding about the nature of evidence, and the art and science of medicine. It is based on the author's search for a more integrative medicine, the influence of Paul Tournier's ‘Medicine de la Personne’ and the Institutional Programme on Psychiatry for the Person led by the World Psychiatric Association. Evidence to support this approach from palliative care and general practice is cited, but new educational and research initiatives from other international organizations, such as the World Medical Association, the World Federation for Medical Education and the World Association of Family Practice and the medical Royal Colleges, are proposed.
Improving participant selection in disease management programmes: insights gained from propensity score stratification
Authors: Linden Ariel , Adams John L.
Published: September 2010

While the randomized controlled trial (RCT) remains the gold‐standard study design for evaluating treatment effect, outcomes researchers turn to powerful quasi‐experimental designs when only observational studies can be conducted. Within these designs, propensity score matching is one of the most popular to evaluate disease management (DM) programme effectiveness. Given that DM programmes generally have a much smaller number of participants than non‐participants in the population, propensity score matching will typically result in all or nearly all participants finding successful matches, while most of the non‐participants in the population remain unmatched and thereby excluded from the analysis. By excluding data from the unmatched population, the effect of non‐treatment in the remaining population with the disease is not captured. In the present study, we examine changes in hospitalization rates stratified by propensity score quintiles across the entire population allowing us to gain insight as to how well the programme chose its participants, or if the programme could have been effective on those individuals not explicitly targeted for the intervention. These data indicate the presence of regression to the mean, and suggest that the DM programme may be overly limited to only the highest strata when there is evidence of a potential benefit for those in all the lower strata as well.
An exploratory investigation into the nursing management of aggression in acute psychiatric settings
Authors: Delaney J. , Cleary M. , Jordan R. , Horsfall J.
Published: September 2010

The management of aggression in inpatient psychiatric facilities is a major concern for nurses. Despite the prevalence of research on aggression within psychiatric settings, very few studies have tracked the clinical management of identified patients in a systematic manner. The overall aim of this study was to explore the clinical management of patients identified as potentially aggressive in psychiatric inpatient settings. A multimethod approach was used to collect the data. This included surveys, focus groups, and a file audit of patients identified from a random sample of completed aggression incident forms. The findings indicated that 88% of nurses who participated in the survey were assaulted and indicated the need for risk assessment; team management and review; and the importance of the first 5 days of admission as crucial for assessment and review. The development of support structures, formal preceptoring and supervisory arrangements and postincident supports were suggested as part of an overall strategy to support nurses working in acute inpatient settings.
Aggressive behaviour by people with dementia in residential care settings: a review
Authors: PULSFORD D. , DUXBURY J.
Published: September 2010

This paper considers the phenomenon of aggressive behaviour perpetrated by people with dementia in residential care settings. Aggressive behaviour is defined in the context of people with dementia, and the problem of ascertaining the incidence of aggression among people with dementia is discussed. The emotional impact of assaults on nurses and other professionals is highlighted, and differing perspectives on the causation of aggressive behaviour are considered. Management strategies derived from the physical/pharmacological; environment management; behaviour modification and person‐centred approaches are reviewed. Our conclusion is that while certain strategies appear to reflect good and common sense practice, in particular those deriving from the person‐centred approach, there is no clear research evidence for the general effectiveness of any one management approach, and each has drawbacks of a practical or ethical nature. There is also little empirical information about how professional carers actually manage aggressive behaviour in practice.
Peer support relationships: an unexplored interpersonal process in mental health
Authors: COATSWORTH‐PUSPOKY R. , FORCHUK C. , WARD‐GRIFFIN C.
Published: September 2010

Consumer‐survivors (C/Ss) identify peer support as a resource that facilitates their recovery. However, little is known about the factors that influence or how the peer support relationship (PSR) develops/deteriorates. The purpose of the study was to explore and describe the PSR within the subculture of mental health. Using an ethnonursing method, the study focused on informants from two C/S organizations who received peer support (n = 14). Findings revealed that the PSRs may develop or deteriorate through three, overlapping phases. Contextual factors that influenced the development/deterioration of the PSR are discussed. Understanding the processes and factors that contribute to the development/deterioration of PSRs will enable clinicians and C/Ss to assess and promote the development of healthy, supportive PSRs in mental health.
An analysis of nurses’ post‐incident manual restraint reports
Authors: RYAN C. J. , BOWERS L.
Published: September 2010

Manual restraint techniques are associated with the management of violence in psychiatric settings. Restraint effectiveness and acceptability are under scrutiny, yet the nature and frequency of who or what were involved in restraint episodes have not previously been fully described or understood. The aim of this study was to describe the nature and frequency of manual restraint‐related events and their components. This study was carried out using content analyses of nurses’ post‐incident reports from a psychiatric unit situated within a general hospital, and from its associated medium‐secure unit. Requests for restraint occurred at the rate of about once per day, and the majority related to patients’ ill‐directed frustration, resistance to containment and their desire to leave the ward. Only half of responses to conflicts resulted in restraint implementation. The majority of restraint activities occurred during the afternoon and night. Male patients and detained patients were more frequent participants in restraint interventions. To a lesser extent, police, ambulance, fire services, hospital security, visitors and ex‐patients were also involved in restraint episodes. Injuries were rare. In conclusion, training in restraint skills, clinical audit of adverse incidents, and research into psychiatric aggression all need to take into account the association of restraint with the enforcement of detention and treatment of acutely ill patients. The coupling of restraint with medication requires examination of its safety and efficacy. Interagency training may enable the essential services involved to coordinate restraint activities more effectively.
How newly qualified mental health nurses perceive their role
Authors: RUNGAPADIACHY D. M. , MADILL A. , GOUGH B.
Published: September 2010

This paper reports a follow‐up study of 11 mental health nurses (MHNs) (from an original of 14) who were interviewed about their perception of the role of the MHN while they were still mental health student nurses (MHSNs). These participants perceived the MHN to perform a variety of roles, implementing ward administration, offering physical and psychological interventions, administering drugs and teaching. However, some MHNs were reported to function outside the boundary of professional practice in the form of alleged malpractice, non‐involvement or negative approach to care. This study addresses the research question: ‘how is the role of the MHN perceived after MHSNs have made the transition to MHN?’. The aim of the study is to examine whether nurses have changed the perception of their role having had 6‐month post‐registration experience. This information will inform the training of MHNs and identify possible problems with the way in which the function of the mental health nurse is organized. Semi‐structured interviews were conducted with 11 MHNs at least 6 months post registration. Transcripts were analysed using a qualitative approach based on grounded theory. Analysis of the interviews with post‐registration MHNs produced four main themes: transition, role ambiguity, lack of support and a theory–practice gap. Our conclusion is that there was no drastic change to participants’ pre‐ and post‐registration perception in that the role of the MHN is ambiguous by virtue of their engagement in a variety of tasks. However, post‐registration participants were more able to articulate rationales for their role vis‐à‐vis the practical realities of the clinical areas.
Limit setting in mental health: historical factors and suggestions as to its rationale
Authors: VATNE S. , HOLMES C.
Published: September 2010

The task of enforcing behavioural limits in mental health settings is widely regarded as necessary but also potentially counter‐therapeutic. There has been little discussion of the ideological basis for limit setting in psychiatry, and this paper attempts to locate the progress of this ideology from the moral treatment movement to contemporary medicalized psychiatry. It is suggested that limit setting has its foundations in the Enlightenment tradition of the autonomous individual and the power of reason, and in the dual functions of psychiatry as a therapeutic and social control system. The account draws on the work of critical psychiatry, as well as on recent research concerning the discourses and practices of mental health nurses, and concludes that these dual functions are inherent to the psychiatric project.