bluuebunny/crossref_metadata_2025 huggingface dataset:
Hydration mechanisms of mineral trioxide aggregate
Authors: Camilleri J.
Published: May 2007

Aim  To report the hydration mechanism of white mineral trioxide aggregate (White MTA, Dentsply, Tulsa Dental Products, Tulsa, OK, USA).

Methodology  The chemical constitution of white MTA was studied by viewing the powder in polished sections under the scanning electron microscope (SEM). The hydration of both white MTA and white Portland cement (PC) was studied by characterizing cement hydrates viewed under the SEM, plotting atomic ratios, performing quantitative energy dispersive analyses with X‐ray (EDAX) and by calculation of the amount of anhydrous clinker minerals using the Bogue calculation.

Results  Un‐hydrated MTA was composed of impure tri‐calcium and di‐calcium silicate and bismuth oxide. The aluminate phase was scarce. On hydration the white PC produced a dense structure made up of calcium silicate hydrate, calcium hydroxide, monosulphate and ettringite as the main hydration products. The un‐reacted cement grain was coated with a layer of hydrated cement. In contrast MTA produced a porous structure on hydration. Levels of ettringite and monosulphate were low. Bismuth oxide was present as un‐reacted powder but also incorporated with the calcium silicate hydrate.

Conclusions  White MTA was deficient in alumina suggesting that the material was not prepared in a rotary kiln. On hydration this affected the production of ettringite and monosulphate usually formed on hydration of PC. The bismuth affected the hydration mechanism of MTA; it formed part of the structure of C‐S‐H and also affected the precipitation of calcium hydroxide in the hydrated paste. The microstructure of hydrated MTA would likely be weaker when compared with that of PC.
A comparative study of three periapical radiographic techniques for endodontic working length estimation
Authors: Kazzi D. , Horner K. , Qualtrough A. C. , Martinez‐Beneyto Y. , Rushton V. E.
Published: May 2007

Aim  To compare the diagnostic quality of endodontic working length estimation films produced using film holders with those taken using the bisecting angle technique and to assess the level of acceptance of film holders by operator and patient.

Methodology  Five post‐graduate and 20 final year undergraduate students attending a UK Dental School produced working length radiographs using either the paralleling or the bisecting angle technique. The paralleling group used one of two film holders, the Endoray II or the XCP Endodontic Instrument, on alternate patients. An assessment of the ease of use of the device and the patients’ views on the comfort of the examination were recorded. Each radiograph was examined simultaneously by two assessors, scored for film faults and diagnostic acceptability. Statistical data was derived using the Mann–Whitney U test and Cohen's kappa.

Results  The rates of unacceptable radiographs for the XCP Endodontic Instrument, Endoray II and the bisecting angle techniques were 12.2%, 21.4% and 48.6%, respectively. The combined percentage of unacceptable paralleling technique films (16.7%) was highly significantly different (P < 0.001) when compared with the bisecting angle technique (48.6%). The paralleling technique produced a significant reduction in incorrect vertical angulation (P < 0.001), cone cutting (P < 0.001) and incorrect film placement (P < 0.001). Film holders were rated either excellent or good in 90% of examinations by operators and 47.5% of patients reported no discomfort.

Conclusions  These results support the use of the film holders for endodontic working length estimation.
Leakage of food‐borne Enterococcus faecalis through temporary fillings in a simulated oral environment
Authors: Kampfer J. , Göhring T. N. , Attin T. , Zehnder M.
Published: May 2007

Aim  To evaluate the hypothesis that food‐borne viable Enterococcus faecalis cells could enter the root canal space via coronal leakage.

Methodology  In a simulated oral environment under mastication the capacity of a calcium sulphate‐based temporary filling material (Cavit W) to prevent leakage of E. faecalis from a cheese through the endodontic access cavity into the pulp chamber was assessed. Standardized class I access cavities were prepared in human maxillary molars. These were filled with Cavit of either 2 or 4 mm thickness (n = 16, each). Empty access cavities served as positive, teeth filled with a light‐curing composite material acted as negative controls (n = 8, each). A cheese containing viable E. faecalis cells was placed on the occlusal aspects of test and control teeth, which were subsequently subjected to 680 mastication loads per day for 1 week in a masticator device perfused with artificial saliva at 37 °C. Leakage of E. faecalis from the cheese into the pulp chamber was assessed by culture on a kanamycin aesculin azide agar and compared between groups using Fisher's exact test.

Results  All of the positive controls showed pure growth of E. faecalis. In addition, one of the negative control teeth leaked. The 4 mm application of Cavit prevented leakage of E. faecalis significantly better than the corresponding 2 mm application: 1 of 16 specimens compared with 6 of 16 specimens had leakage, respectively (P < 0.05).

Conclusions  The current results substantiate the suspicion that food‐derived microbiota could enter the necrotic root canal system via microleakage.
The influence of sodium hypochlorite and EDTA on the chemical composition of dentine
Authors: Ramirez‐Bommer C. , Gulabivala K. , Figueiredo J. A. P. , Young A.
Published: May 2007

Aim  To characterise changes in the chemical composition of dentine after exposure to sodium hypochlorite and ethylenediaminetetracetic acid (EDTA) using ATR‐FTIR and Raman spectroscopy.

Methodology  Crown dentine was acquired from recently extracted molars stored in formal‐saline (group A) or saline and frozen at −2oC (group B); it was then ground and sieved into a range of particle sizes. Samples from both groups (n = 5 each) were analysed with FTIR to investigate the influence of storage medium and to assign FTIR spectral peaks for collagen, carbonate, phosphate. As no differences were found, the samples were pooled for subsequent experiments. Ten samples of particle size range 38–75 μm were used to study the effect of mass ratio of NaOCl (2.5%): dentine over 5–10 min. Thirty samples of all sizes were reacted with 2.5% sodium hypochlorite at 1:0.5 (dentine:NaOCl) mass ratio for 2–10 min; EDTA (n = 90) for 5–1440 min; NaOCl for 10 min followed by EDTA for 10 mins (n = 30); the latter samples were further exposed to NaOCl for 10 min after obtaining FTIR spectra.

Results  FTIR spectra from the surface of the particles (~1.5 μm depth) were obtained for all the samples and Raman spectra (40 μm depth) were obtained for one sample each reacted either with NaOCl or EDTA. Spectral peak assignment was confirmed by previous data. Storage media had no effect on outcome measures used. The dentine:NaOCl ratio influenced collagen depletion. NaOCl affected the collagen FTIR peaks, mostly in the first 2–4 min, but only influenced the phosphate and carbonate peaks slightly. EDTA affected the phosphate:collagen peaks, which reduced over time, whilst the collagen peak values showed an increase. The two solutions (NaOCl and EDTA) used alternately, respectively increased collagen or phosphate peaks depending on the final solution used.

Conclusions  These series of investigations confirmed that sodium hypochlorite depletes the organic content of dentine and EDTA depletes the inorganic content. Used alternately, they have the ability to progressively degrade dentine structure.
Outcome of secondary root canal treatment – Systematic review of the literature
Authors: Ng Y.‐L. , Mann V. , Gulabivala K.
Published: May 2007

Aims  To assess the success rates of secondary root canal treatment (2oRCT) and identify factors influencing outcome.

Methodology  Longitudinal clinical studies investigating outcome of 2oRCT were identified by electronic (medline) and hand searches. Inclusion criteria were data on: number of samples, those successful and definition of success. Two reviewers independently assessed the studies and extracted the data onto a proforma. The pooled weighted success rates by each potential prognostic factor were estimated using the binomial random effect model (MLwiN version 2.02) whilst their pooled effects (expressed as odds ratio) on success rates were estimated using fixed and random effects meta‐analysis with DerSimonean and Laird's methods (Stata version 9.2). Meta‐regression models were used to explore potential sources of statistical heterogeneity. Study characteristics considered in the meta‐regression analyses were: decade of publication, study‐specific criteria for success (radiographic, combined radiographic & clinical), unit of outcome measure (tooth and root), duration after treatment when assessing success (at least 4 years or shorter), geographic location of the study (North American, Scandinavian and other countries), and qualification of the operator (undergraduate students, postgraduate students, general dental practitioners, specialist or mixed group).

Results  Of the 41 studies identified, 18 studies published between 1921 and 2005 were included. The majority of studies were retrospective (n = 13) and only five prospective. The pooled weighted success rate of 2oRCT judged by complete healing was 77.6% (95% CI 73.2%, 81.4%) and by incomplete healing, 77.4% (95% CI 64.1%, 86.7%). The success rates were similar by ‘year of publication’ and ‘country of study’. Eighteen clinical factors were investigated in various combinations in previous studies. The most frequently investigated were ‘periapical status’ (n = 13), ‘size of lesion’ (n = 7), ‘culture results prior to RF’ (n = 5), and ‘apical extent of root filling (RF)’ (n = 4). The effect of different aspects of previous treatment and re‐treatment technique has been poorly tested.

Conclusions  The pooled weighted estimated success rate of 2oRCT was 77%, which was significantly (P ≤ 0.001) influenced by the presence and size of pre‐operative periapical lesion. The effects of existing canal content, procedural error and re‐treatment technique were poorly investigated.
Development of an ex vivo model for the study of microbial infection in human teeth
Authors: Patel B. , Pratten J. , Mordan N. , Gulabivala K.
Published: May 2007

Aims  (1) To infect human teeth artificially to mimic root canal and dentine infection, using the Constant Depth Film Fermenter (CDFF); (2) To verify the similarity of the infections to those found, in vivo, using culture and microscopy (SEM, LM and TEM).

Methodology  Human teeth [n = 38 and n = 28, for phases I (preliminary) and II (definitive), respectively] were infected within the CDFF for a period of 28 days and at pre‐selected time points were removed, externally decontaminated using validated protocols and subjected to either culture‐dependent or microscopy protocols. The condition of the teeth was varied in phase I to establish the feasibility of the approach and identify optimal conditions. This informed the selection of optimal conditions for definitive test in phase II. For culture‐dependent analysis in this phase, a dentine filing sample was obtained from the apical 5 mm of the root canal and cultured anaerobically to allow isolation of individual strains. Bacterial DNA was extracted from purified isolates, the 16S rRNA genes amplified by PCR and the amplicons sequenced for identity using sequence databases. Teeth assigned for microscopy were post‐fixed in 3% gluteraldehyde after removal from the CDFF and then subjected to appropriate protocols prior to microscopic evaluation of the infection.

Results  All three microscopy techniques and culture‐dependent analysis confirmed infection of the human teeth using the CDFF, with root canal infections visually resembling closely those seen in vivo. Furthermore, partial 16S rRNA gene sequencing of DNA from cultured isolates confirmed a selective number of 7–9 genera/species in the apical portion of two teeth each at 7 and 28 days; these taxa are also commonly recovered from teeth with apical periodontitis, in vivo. There were no objective measures other than speciation and topographical evaluation to compare the artificial and real (in vivo) infections.

Conclusions  The proposed ex vivo model has the potential for development into an investigative tool for studying the dynamics of bacterial ecology in infected root canals, both before and after treatment. Its advantage is the ability to control both the abiotic and biotic factors. There is a need for the development of objective measures to compare artificial and real bacterial biofilms.
Seminal factor VII and factor VIIa: supporting evidence for the presence of an active tissue factor‐dependent coagulation pathway in human semen
Authors: Lwaleed Bashir A. , Goyal Anuj , Delves George , Gossai Sunil , Greenfield Robert S. , Cooper Alan J.
Published: May 2007

Human semen spontaneously coagulates into a semisolid mass and then wholly liquefies in a process that may have some similarity to that of normal blood. This well described phenomenon is referred to as coagulation and liquefaction of semen. Besides other active components of the haemostatic system, semen contains a significant amount of functional tissue factor (TF). However, TF needs factor (F)VII in order to exert it actions. In this study, we assessed human semen for the presence of FVII and FVIIa, and related their levels to conventional fertility parameters. Using a functional, one stage, clotting assay based upon the prolongation of the prothrombin clotting time, using the ACL 300R analyser and an Imubind® FVIIa ELISA assay, FVII and FVIIa levels were measured in 97 semen specimens obtained from sub‐fertile (sperm counts <20 × 106/mL), normally fertile (sperm counts ≥20 × 106 but <60 × 106/mL), fertile sperm donors (sperm counts ≥60 × 106/mL), vasectomized subjects and in a pooled normal semen parameters group (categorization into groups was based on the World Health Organization guidelines on fertility criteria). In addition, conventional semen parameters were analysed on all semen samples. Both FVII and FVIIa were quantifiable in human semen. The mean levels of FVII and FVIIa were 4.4 IU/dL and 12 ng/mL respectively. Despite the observed variations of FVIIa levels in the studied groups they did not meet statistical significance when the groups were tested against each other. However, seminal FVIIa levels showed a significant positive association with semen liquefaction time, sperm motility and semen volume. The anti‐sperm antibodies and sperm‐agglutination groups were also associated with raised seminal FVIIa levels. We observed no significant relationship between FVIIa levels and total sperm concentration, sperm count per mL (sperm density), sperm progression and days of sexual abstinence. This study demonstrates that human semen contains appreciable amounts of FVII and FVIIa. It is possible to quantify these using commercially available assays. There also appears to be a direct correlation between the levels of these factors and certain seminal parameters. This finding reinforces the concept of an active clotting system in human semen, by establishing the missing link in the activation of a TF‐dependent pathway.
Age at voice break in Danish boys: effects of pre‐pubertal body mass index and secular trend
Authors: Juul Anders , Magnusdottir Steinunn , Scheike Thomas , Prytz Sven , Skakkebæk Niels E.
Published: May 2007

Voice break is a late, but characteristic event in male puberty. Assessment of age at voice break may be a relevant marker for epidemiological studies of male pubertal development. We investigated the timing of voice break and its association with explanatory variables [calendar year of admission in the boys choir and pre‐pubertal body mass index (BMI)] by survival analysis techniques based on retrospective analyses of age at voice break in 463 Danish choir boys who were studied over a 10‐year period. We found an overall median age at voice break of 14.0 [13.9–14.6] years, and a statistically significant downwards trend in age at voice break in the 10‐year period (1994–2003) (log‐rank test p = 0.0146). There was a statistically significant difference in age at voice break between boys in the different BMI quartiles in pre‐puberty (p = 0.00822) with a tendency towards early voice break with increasing BMI standard deviation scores. Thus boys in the heaviest quartile at 8 years of age had an increased risk of early voice break (RR of 1.74 [1.14–2.65]) approximately 6 years later, compared with boys in the thinnest quartile. The earlier voice break seen during the 10‐year observation period could however not exclusively be explained by a general increase in BMI in that period. Our findings indicate that puberty, as assessed by age at voice break in boys, may be starting earlier in Denmark as it has been observed in the USA, and suggest a relationship between pre‐pubertal BMI and the timing of puberty.
Meiotic segregation analysis in male translocation carriers by using fluorescent in situ hybridization
Authors: Nishikawa N. , Sato T. , Suzumori N. , Sonta S. , Suzumori K.
Published: May 2007

Balanced reciprocal and Robertsonian translocations are the most common structural chromosome abnormalities in humans, with incidences of 0.7 and 1.23 per 1000. These translocations can affect fertility and/or pregnancy outcome because of possibly impaired production of gametes with an unbalanced zygote caused by the parental arrangement. Fertility problems in male translocation carriers are because of various degrees of sperm alterations that are directly related to the disturbance of the meiotic process. Investigation of human sperm chromosomes was performed by karyotyping spermatozoa after penetration of zona‐free hamster oocytes, karyotype analysis now being possible to analyse the segregation patterns by using fluorescent in situ hybridization (FISH). Here, we document the results of meiotic segregation analysis for four Robertsonian and four reciprocal translocation carriers by FISH. In the sperm of Robertsonian translocation males, the majority of spermatozoa were normal/balanced. On the other hand, males with reciprocal translocations demonstrated a high rate of unbalanced spermatozoa of about 50% on meiotic segregation, with an unusually high rate (23.5%) of 3 : 1 segregation. This knowledge can be used for genetic counselling of families with these types of translocations.
Development of the role of public health nurses in addressing child and family poverty: a framework for action
Authors: Cohen Benita E. , Reutter Linda
Published: May 2007

Title. Development of the role of public health nurses in addressing child and family poverty: a framework for action

Aim. The purpose of this paper is to invite dialogue about how public health nurses could best address child and family poverty. Their current role is reviewed and a framework for expanding this role is presented.

Background. The negative health consequences of poverty for children are well‐documented worldwide. The high levels of children living in poverty in wealthy industrialized countries such as Canada should be of concern to the health sector. What role(s) can public health nurses play in addressing child and family poverty?

Method. A review of scholarly literature from Canada, the United States of America and the United Kingdom was conducted to ascertain support for public health nurses’ roles in reducing poverty and its effects. We then reviewed professional standards and competencies for nursing practice in Canada. The data were collected between 2005 and 2006.

Findings. Numerous nursing scholars have called for public health nurses to address the causes and consequences of poverty through policy advocacy. However, this role was less likely to be identified in professional standards and competencies, and we found little empirical evidence documenting Canadian public health nurses’ efforts to engage in this role. Public health nurses’ roles in relation to poverty focus primarily on assisting families living in poverty to access appropriate services rather than directing efforts at the policy level. Factors associated with this limited involvement are identified. We suggest that the conceptual framework developed by Blackburn in the United Kingdom offers direction for a more fully developed public health nursing role. Prerequisites to engaging in the strategies articulated in the framework are discussed.

Conclusion. Given more organizational support and enhanced knowledge and skills, public health nurses could be playing a greater role in working with others to make child and family poverty history.
Influence of rainfall seasonality on African lowland vegetation during the Late Quaternary: pollen evidence from Lake Masoko, Tanzania
Authors: Vincens Annie , Garcin Yannick , Buchet Guillaume
Published: May 2007

Aim To determine if changes in the key bioclimatic parameters associated with rainfall seasonality can be quantified from fossil sequences and to distinguish them from changes in the total annual rainfall.

Location Lake Masoko, southern Tanzania (9°20′ S, 33°45′ E, 840 m a.s.l.).

Methods Fossil pollen was extracted from a long and well‐dated sedimentary sequence spanning the period 45,000–4400 cal. yrbp. The modern habitat, geographical distribution and climatic range (mean annual rainfall and temperature, and length of the dry season) of selected East African plants were used to infer past rainfall attributes for the most characteristic fossil pollen taxa identified from the sediments of Lake Masoko.

Results In the Masoko pollen sequence it has been possible to identify changes in the length/severity of the dry season during the last 45,000 cal. yrbp, which are interpreted to reflect shifts in the mean position of the Intertropical Convergence Zone (ITCZ) over the southern tropics. We suggest that this bioclimatic parameter has been the main driver of the vegetation dynamics in this area. The major inferred change occurred at the Younger Dryas–Holocene transitionc. 11,800 cal. yrbp, when semi‐deciduous forest disappeared, being replaced in the lake catchment by woodland, which persists to the present day in spite of locally high rainfall.

Main conclusions In tropical regions under the influence of the ITCZ, the position and strength of which determine the distribution of rainfall through the year, more attention must be paid to the impact of the length and intensity of the dry season on the modern and past distribution and dynamics of the vegetation. This climatic parameter is as important as the total annual amount of rainfall, and probably one of the most relevant in lowland areas.
Uniform phenotype conceals double colonization by reed‐warblers of a remote Pacific archipelago
Authors: Cibois Alice , Thibault Jean‐Claude , Pasquet Eric
Published: May 2007

Aim Remote oceanic islands often provide good illustrations of adaptive radiations, but phylogenetic studies have also demonstrated unexpected multiple colonization events for a given archipelago. In this study we investigate the relationships among endemic populations of the Marquesas reed‐warbler,Acrocephalus mendanaeTristram, 1883, which have colonized nearly all islands of this remote Polynesian archipelago, and which exhibit a very uniform plumage pattern. We study the phylogeny and morphology of all subspecies in the Marquesas, providing an examination of the position of the Marquesas lineages in relation to reed‐warblers distributed across multiple Polynesian archipelagos.

Location This study focused on all the main islands of the Marquesas archipelago, along with samples from other Polynesian archipelagos (Society, Tuamotu, Austral, Cook, Kiribati) and Australia.

Methods We used mitochondrial DNA markers (cytochrome b and ND2 genes) to develop a phylogeny of the main eastern Polynesian taxa. All subspecies for the Marquesas were investigated, including multiple individuals per island. Phylogenetic analyses using maximum‐likelihood and Bayesian approaches were employed to infer relationships amongA. mendanaepopulations and between the main Polynesian archipelagos. Morphometric analyses based on 110 specimens from museum collections were performed on external characters to investigate the differences between islands, and these results were compared to the phylogeny.

Results Our data indicate that the Marquesas reed‐warbler is in fact a polyphyletic taxon including two independent lineages: the northern Marquesas reed‐warbler, closely related to the Tuamotu reed‐warbler, and the southern Marquesas reed‐warbler, sister taxon to that endemic to the Kiribati. Analyses of morphological characters show that the size and shape features of the Marquesas reed‐warblers exhibit high plasticity linked to adaptation to ecological factors, particularly habitat richness (the diversity of vegetation structure that provides suitable resources and habitat for reed‐warblers, simplified here as the number of indigenous plant species).

Main conclusions Our results suggest that reed‐warblers have successfully colonized the Marquesas archipelago, one of the most remote groups of islands in the Pacific Ocean, at least twice. Both events occurred more or less simultaneously atca. 0.6 Ma, and are more recent than the islands' formation. We outline the taxonomic consequences of our phylogeny and discuss the supertramp strategy of reed‐warblers in the Pacific.
The association between caregiving satisfaction, difficulties and coping among older family caregivers
Authors: Ekwall Anna Kristensson , Hallberg Ingalill Rahm
Published: May 2007

Aims and objectives.  The aim was to study the association between gender, extent and content of care, satisfaction, coping and difficulties in the caregiving situation among older (75+) caregivers and to identify clusters of caregivers. The aim was also to explore psychometrically two instruments assessing satisfaction and difficulties in family caregivers.

Background.  Caregiving is a complicated phenomenon. Much of the research has focused on negative aspects, such as the burden, stress and emotional strain. Caregiving is known to affect health negatively for the caregivers. Little is known about satisfaction and motivation in voluntary work, such as informal caregiving, especially among older persons.

Design and methods.  Cross‐sectional. The sample for this study consisted of 171 informal caregivers aged 75 and over, identified from an age‐stratified sample in a postal survey among older people in the southern part of Sweden.

Results.  Male caregivers proved to be more satisfied than female caregivers; caregiving had seemingly widened their horizon and had helped them to grow as persons. Based on satisfaction scores, those satisfied had a higher proportion of male caregivers and a significantly higher amount of caregiving hours per week. They used other coping strategies than the respondents in the other cluster, i.e. less satisfied in using more problem‐solving strategies.

Conclusions.  The instruments tested were appropriate for work in clinical and research settings, although the internal dropout indicates that a shorter version would be more useful. Those who found satisfaction in care used more problem‐focused coping strategies and were more often men than women. From a salutogenic point of view, this may give important knowledge about factors that can promote health. The findings indicate that women deserve extra attention as informal caregivers as they did not find caregiving as rewarding as the men did. This may in turn make them less protected against the negative consequences of caregiving.

Relevance to clinical practice.  Reinforcing the health‐promoting qualities in caregivers who are not feeling well, with women as a particularly vulnerable group, may restrict unnecessary suffering for both the caregiver and the person cared for.
Nurses’ perceptions of quality and the factors that affect quality care for older people living in long‐term care settings in Ireland
Authors: Murphy Kathy
Published: May 2007

Aim. The aim of this research was to determine the factors that facilitate or hinder high quality nursing care for older people in long‐term care settings in Ireland.

Background. The quality of care for older people living in long‐term care has been identified as an issue of concern in many nursing research studies. While many factors which have an impact on care have been identified, it is difficult to determine key factors from current research.

Method. This was a mixed method study, which involved qualitative and quantitative approaches. A self‐response questionnaire was generated from data gathered by interview and analysis of literature. Information was collected from 498 nurses working in long‐term care settings within a Health Board. A 68% response rate was achieved. Factor analysis was used to identify facilitating and hindering factors of quality care for older people.

Results. Nine factors where identified six facilitating factors of quality and three hindering factors of quality care. The six factors, which facilitate quality, were: an ethos of promoting independence and autonomy; a homelike social environment; person centred, holistic care; knowledgeable, skilled staff; knowing the person and adequate multidisciplinary resources. The three factors which hindered quality care; these were: a lack of time and patient choice, resistance to change and bound by routine.

Conclusions. The findings of this research provide nurses with a clear set of facilitating and hindering factors of quality care for older people and reveal some of the complexities and challenges of providing this care.

Relevance to clinical practice. Long‐term care is the home of many older people and attention within these environments to the facilitating and hindering factors of quality is required. It is hoped that the factors generated in this study add to understanding in relation to quality care and the factors that influence this.
Admitted with a hip fracture: patient perceptions of rehabilitation
Authors: Olsson Lars‐Eric , Nyström Anne EM , Karlsson Jòn , Ekman Inger
Published: May 2007

Aims and objectives.  The aim of this study was to describe the hip fracture patients’ own perceptions of their situation and views of their responsibility in the rehabilitation process.

Background.  Although much research has been conducted on various aspects of the rehabilitation process in patients with a hip fracture, no attention has been given to the patients’ own views of their situation at the start of this transitional process.

Method.  Thirteen informants with a hip fracture, aged 71–93 years, were interviewed postoperatively at a Swedish hospital. Phenomenographic analysis of the interview transcripts was performed.

Results.  The informants varied greatly in their engagement in the rehabilitation process, in their conceptions of who was responsible for their recovery and in their views on the need for information pertinent to their condition. Three categories of description were formulated: the Autonomous, i.e. patients who were self‐sufficient and used to taking care of themselves and who searched for relevant information; the Modest, i.e. frail patients in need of more support who wanted information, but did not ask for it; and the Heedless, i.e. patients who were already dependent, who were not aware of their own responsibility and not interested in information. The informants also shared some traits: they all needed more information although not all were aware of it, they all worried about their future ability to walk again and they all had a strong zest for life.

Relevance to clinical practice.  Our results suggest that differences in patients’ perspectives on the rehabilitation process need to be taken into account to enhance outcomes. Inadequate knowledge and engagement on the part of patients, with a hip fracture, probably have an impact on their rehabilitation outcome, but the degree of impact is uncertain.
Predictors of psychological health in spouses of persons affected by stroke
Authors: Franzén‐Dahlin Åsa , Larson Jenny , Murray Veronica , Wredling Regina , Billing Ewa
Published: May 2007

Aim.  To identify predictors of psychological health and examine if these predictors change over time in spouses of stroke patients during the first year after stroke. A second aim was to identify gender differences in psychological health among the spouses.

Background.  The impact of burden in long‐term caregivers may result in psychological consequences for the spouse. The rehabilitation process for the patient can be negatively affected by a stressed caregiver and result in long‐term hospitalization. To identify spouses at risk for physical and psychological distress is, therefore, essential to support those in need.

Design.  Longitudinal, comparative study.

Methods.  One hundred spouses of stroke patients were assessed at baseline, as well as after six and 12 months, regarding psychological health, well‐being, own illness, need of assistance from general practitioner and/or district nurse, social network and knowledge about stroke. Stepwise multiple regression analyses were conducted for baseline, six‐ and 12‐month assessments, respectively, with psychological health as the dependent variable.

Results.  General well‐being and presence of illness in spouse were the most prominent predictors of psychological health, throughout the first year.

Conclusions.  Enhancing psychological health and preventing medical problems in the caregiver are essential considerations to enable patients with stroke‐related disabilities to continue to live at home.

Relevance to clinical practice.  Evaluating the situation for spouses of stroke patients is an important component when planning for the future care of the patient.
Betwixt and between: a critical ethnography of comfort in New Zealand residential aged care
Authors: Bland Marian
Published: May 2007

Aims and objectives.  This research sought to explore the nature of comfort within the context of three New Zealand nursing homes and examine how nursing and other actions contribute to residents’ comfort.

Background.  Comfort has been acknowledged as a key nursing goal since the days of Florence Nightingale, but the nature of comfort and how nurses can contribute to and enhance patient/resident comfort is unclear. Comfort is often considered to be merely the absence of discomfort.

Design.  A critical ethnographic approach was used to facilitate understanding of nursing home residents’ comfort. Fieldwork included 90 days of participant observation, interviews with 27 residents and 28 staff and extensive document examination.

Results.  Comfort was multidimensional, idiosyncratic, dynamic and context dependent, rather than merely the absence of discomfort. This multidimensional nature meant residents could be ‘betwixt and between’ comfort and discomfort simultaneously. The constraints of one‐size‐fits‐all care delivery practices and the tensions inherent in communal living compounded residents’ discomfort.

Conclusions.  Individualized care, based on comprehensive and accurate nursing assessment, is fundamental to the comfort of residents.

Relevance to clinical practice.  Staff working in nursing homes must re‐examine their care delivery practices to ensure these do not disempower residents. Ensuring the comfort of each resident is a nursing priority and the key component of individualized care.
Effectiveness of bran supplement in older orthopaedic patients with constipation
Authors: Kaçmaz Zennure , Kaşıkçı Magfiret
Published: May 2007

Aim.  The purpose of the study was to evaluate the effectiveness of planned nursing interventions, including bran supplement, on the bowel management of older orthopaedic patients.

Background.  Constipation is prevalent among older people. Constipation is also well‐known to be a problem for a range of orthopaedic patients. Orthopaedic diseases or conditions may, because of the specific problems, cause this. The problem may also arise as a result of the orthopaedic treatment options undertaken by patients.

Design.  A quasiexperimental design was employed.

Methods.  The patients were recruited from an orthopaedic clinic at a university hospital in Erzurum, eastern Turkey. Descriptive statistics, independent sample test t‐test, chi‐square and McNemar test were used to analyse the data. Constipation problems were identified through interviews by using the Constipation Diagnosis Form. Interviews were performed within the fourth postoperative day. After that, while the patients in the control group received routine nursing care according to clinic routine, the patients in the experimental group received bran supplement together with planned nursing interventions. The patents in both groups were followed by using the Constipation Follow Form.

Results.  While patients in the experimental group showed significant improvements in most characteristics of bowel elimination such as time of defecation, intensity of faeces, colour of faeces and amount of faeces, the control group showed a significant improvement in only duration of defecation.

Conclusions.  The results of the study indicate planned nursing interventions including bran supplement are more effective than routine nursing interventions for management of constipation problems in older orthopaedic patients.

Relevance to clinical practice.  Nurses have an important part to play in both prevention and management of constipation. Constipation is a problem especially for older orthopaedic patients. Planned nursing interventions that include bran supplements may be more effective than routine nursing interventions for management of constipation problems in older orthopaedic patients.
A survey of Chinese nurses’ current knowledge of pain in older people
Authors: Yu Hui‐Dan , Petrini Marcia A.
Published: May 2007

Aim.  To investigate the current level of Chinese nurses’ knowledge of pain and pain management in older people.

Background.  Most research about nurses’ knowledge regarding pain has taken place in developed countries; however, limited research in this area has taken place in developing countries and particularly in China.

Methods.  Registered Nurses (n = 621) in three different hospitals were surveyed with the questionnaire about pain and pain management with respect to older people.

Results.  The finding showed that a significant knowledge deficit in this area exists. There were no significant differences among nurses in terms of education background, position and whether or not there was attendance in an educational session on pain management. However, there were statistically significant differences based on age; hospital of employment and clinical area in which employed.

Conclusion.  This survey suggested that nurses’ knowledge of pain in older people should be improved. Basic and continuing education of nurses in this area should be enhanced and their active participation in pain management should be encouraged.

Relevance to clinical practice.  The findings in this survey highlight a significant pain management knowledge deficit among the nurses in the clinical practice. The findings may help the nurses realize their knowledge deficit in this area and may also suggest curriculum changes for the nurses to improve pain management knowledge.
Patients’ experiences of being delirious
Authors: Sörensen Duppils Gill , Wikblad Karin
Published: May 2007

Aim.  The aim was to describe patients’ experiences of being delirious.

Background.  Delirium is a serious psychiatric disorder that is frequently reported from hospital care settings, particularly among older patients undergoing hip surgery. It involves disturbances of consciousness and changes in cognition, a state which develops over a short period of time and tends to fluctuate during the course of the day. It is a certified fact that delirium is poorly diagnosed and recognized although the state often is described as terrifying. To be able to give professional care, it is of the utmost importance to know more about patients’ experience of delirium.

Method.  Included in the interviews were patients who had undergone hip‐related surgery and during the hospital stay experienced delirium. Fifteen patients participated in the interviews. Of these, six had experienced episodes of nightly delirium (sundown syndrome) and nine experienced delirium during at least one day. The interviews were analysed by qualitative content analysis.

Results.  The entry of delirium was experienced as a sudden change of reality that, in some cases, could be connected to basic unfulfilled physiological needs. The delirium experiences were like dramatic scenes that gave rise to strong emotional feelings of fear, panic and anger. The experiences were also characterized by opposite pairs; they took place in the hospital but at the same time somewhere else; it was like dreaming but still being awake. The exit from the delirium was associated with disparate feelings.

Relevance to clinical practice.  It is necessary to understand patients’ thoughts and experiences during the delirious phase to be able to give professional care, both during the delirium phase and after the recovery.
Factors associated with delirium severity among older patients
Authors: Voyer Philippe , McCusker Jane , G Cole Martin , St‐Jacques Sylvie , Khomenko Lioudmila
Published: May 2007

Aim.  The goal of this study was to determine whether the factors associated with delirium varied according to the severity of the delirium experienced by the older patients.

Background.  Delirium among older patients is prevalent and leads to numerous detrimental effects. The negative consequences of delirium are worse among older adults with severe delirium compared with patients with mild delirium. There has been no study identifying those factors associated with delirium severity among long‐term care older patients newly admitted to an acute care hospital.

Design.  This is a descriptive study.

Methods.  This is a secondary analysis study of institutionalized older patients newly admitted to an acute care hospital (n = 104). Upon admission, patients were screened for delirium with the Confusion Assessment Method and severity of delirium symptoms were determined by using the Delirium Index.

Results.  Of the 71 delirious older patients, 32 (45·1%) had moderate‐severe delirium while 39 (54·9%) presented mild delirium. In univariate analyses, a significant positive relationship was observed between the level of prior cognitive impairment and the severity of delirium (p = 0·0058). Low mini‐mental state examination (MMSE) scores (p < 0·0001), the presence of severe illness at the time of hospitalization (p = 0·0016) and low functional autonomy (BI: p = 0·0017; instrumental activities of daily living: p = 0·0003) were significantly associated with moderate‐severe delirium. Older patients suffering from mild delirium used significantly more drugs (p = 0·0056), notably narcotics (p = 0·0017), than those with moderate‐severe delirium. Results from the stepwise regression indicated that MMSE score at admission and narcotic medication use are the factors most strongly associated with the severity of delirium symptoms.

Conclusions.  This present study indicates that factors associated with moderate‐severe delirium are different from those associated with mild delirium. Given the result concerning the role of narcotics, future studies should evaluate the role of pain management in the context of delirium severity.

Relevance to Clinical Practice.  As moderate‐severe delirium is associated with poorer outcomes than is mild delirium, early risk factor identification for moderate‐severe delirium by nurses may prove to be of value in preventing further deterioration of those older patients afflicted with delirium.
Nursing home placement: perspectives of community‐dwelling older persons
Authors: M Y Tse Mimi
Published: May 2007

Objectives.  To explore nursing home‐related beliefs among older Hong Kong Chinese and identify strategies that make nursing homes a better place to live.

Background.  Increased life expectancy has markedly increased the prevalence of age‐related disease and disability, which limits the self‐caring ability of older persons. Nursing home placement offers one possible alternative. However, the perspectives of older persons on nursing home admission have been seriously neglected and under‐reported.

Methods.  The research was a qualitative descriptive study. Clients of a community centre for older people were approached and invited for an interview.

Results.  Participants included 118 older persons (61 female and 57 male) age from 60–89 years. Ninety per cent had chronic diseases and needed regular follow‐up. Half of participants had never visited a nursing home. Of them, 85% would not want to live in a nursing home upon getting old and their nursing home‐related beliefs were found to be negative. Participants expressed the feeling of being abandoned by their family members, insecure and lonely regarding the nursing home placement. Living in a nursing home was considered as ‘living in jail’ and that their privacy would be lost. Nevertheless, positive aspects of nursing home placement were mentioned, and strategies were explored that would make nursing homes a better place for older people to live.

Relevance to Clinical Practice.  Positive aspects of nursing home placement need to be promoted. Nurses should be advocates for the health of the elderly, and help make nursing homes a better place to live.
Violence in municipal care of older people in Sweden as perceived by registered nurses
Authors: Josefsson Karin , Sonde Lars , Wahlin Tarja‐Brita Robins
Published: May 2007

Aims. The main aim was to describe registered nurses’ perceptions of violence and threats, as well as their access to prevention measures and routines for handling violent behaviour in municipal care of older people. Another aim was to compare nurses’ perceptions working solely in dementia care with those working in general elder care where older people have diverse diagnoses.

Background. Violence is often reported in care of older people. The development of dementia units and the implementation of reform have changed care of older people. Dementia disorders have been shown to be a predisposing factor to violence.

Design. A non‐experimental, descriptive design with a survey research approach was used. The setting was 60 special types of housing with subunits in a large town. The response rate was 62% (n = 213). Forty‐five per cent (n = 95) of the nurses worked in dementia care and 55% (118) in general elder care.

Method. A questionnaire.

Results. Nurses had experienced a high degree indirect threats (dementia care, 45%; general elder care, 51%), direct threats of violent acts (dementia care, 35%; general elder care, 44%) and violent acts (dementia care, 41%; general elder care, 43%). Nurses had witnessed violence and threats towards staff (dementia care, 49%; general elder care, 38%). Even care receivers (dementia care, 20%; general elder care, 19%) were subjected to violence and threats. No statistical differences were found between groups. The nurses in dementia care had more access to education in managing violence and threats, as well as routines for handling violence and a door with a lock to their working unit.

Conclusion. Violence occurred frequently in municipal care of older people without any difference between dementia care and general elder care. Nurses in dementia care were more often offered education on how to manage violence and had routines for when violence occurs.

Relevance to clinical practice. Municipal authorities should increase staff education for handling violence and creating safety routines. Violence needs to be taken seriously with a ‘zero tolerance’ attitude.