bluuebunny/crossref_metadata_2025 huggingface dataset:
Reporting health care performance: learning from the past, prospects for the future
Authors: Mannion Russell , Davies Huw T. O.
Published: March 2003

In the USA, where public reporting of data on clinical performance is most advanced, comparative performance information, in the form of ‘report cards’, ‘provider profiles’ and ‘physician profiling’, has been published for over a decade. Many other countries are now following a similar route and are seeking to develop comparative data on health care performance. Notwithstanding the idiosyncratic nature of US health care, and the implications this has for the generalizability of findings from the USA to other countries, it is pertinent to ask what other countries can learn from the US experience. Based on a series of structured interviews with leading experts on the US health system, this article draws out the key lessons for other countries as they develop similar policies in this area. This paper highlights three concerns that have dominated the development of adequate measures in the USA, and that require consideration when developing similar schemes elsewhere. Firstly, the need to develop indicators with sound metric properties – high in validity and meaningfulness, and appropriately risk‐adjusted. Secondly, the need to involve all stakeholders in the design of indicators, and a requirement that those measures be adapted to different audiences. Thirdly, a need to understand the needs of end users and to engage with them in partnerships to increase the attention paid to measurement. This study concludes that the greatest challenge is posed by the desire to make comparative performance data more influential in leveraging performance improvement. Simply collecting, processing, analysing and disseminating comparative data is an enormous logistical and resource‐intensive task, yet it is insufficient. Any national strategy emphasizing comparative data must grapple with how to engage the serious attention of those individuals and organizations to whom change is to be delivered.
At what degree of belief in a research hypothesis is a trial in humans justified?
Authors: Djulbegovic Benjamin , Hozo Iztok
Published: March 2003

Rationale, aims and objectives Randomized controlled trials (RCTs) have
emerged as the most reliable method of assessing the effects of health care interventions
in clinical medicine. However, RCTs should be undertaken only if there is substantial
uncertainty about which of the trial treatments would benefit a patient most. The
purpose of this study is to determine the degree of uncertainty in a research hypothesis
before it can empirically be tested in an RCT. Methods We integrated arguments
from three independent lines of research – on ethics, principles of the design
and conduct of clinical trials, and medical decision making – to develop a
decision model to help solve the dilemma of under which circumstances innovative
treatments should be tested in an RCT. Results We showed that RCTs are
the preferable option to resolve uncertainties about competing treatment alternatives
whenever we desire reliable, undisputed, high‐quality evidence with a low likelihood
of false‐positive or false‐negative results. Conclusions When the expected benefit : risk ratio of a new treatment is small, an RCT is justified to resolve uncertainties over a wide range of prior belief (e.g. 10–90%) in the accuracy of the research hypothesis. Randomized controlled trials represent the best means for resolving uncertainties about health care interventions.
Do abnormal liver function tests predict inpatient imaging yield? An evaluation of clinical decision making
Authors: Rothschild Jeffrey M. , Khorasani Ramin , Hanson Richard W. , Fiskio Julie M.
Published: March 2003

Rationale, aims and objectives Diagnostic abdominal imaging is frequently performed in hospitalized patients to assess the cause of abnormal liver function tests (LFTs). We undertook this study to assess whether the extent and severity of LFTs abnormalities predicted the yield of inpatient imaging.

Methods We retrospectively reviewed inpatients’ abdominal imaging studies performed for abnormal LFTs during a 27 month period. Imaging results were matched to LFTs performed during a 5 day collection window surrounding the image request date. Five LFTs were categorized by severity of abnormality and were then collapsed into three classes based on pathophysiology.

Results Among 759 imaging studies completed for the indication of abnormal LFTs, 196 (26%) were positive (abnormal and explained the abnormal LFTs). Among the LFT classes, severity of laboratory test abnormality correlated with positive imaging examinations yield only for the transaminases: 18% for the normal–mildly abnormal transaminases compared with 31% for moderately–severely abnormal transaminases. The number of abnormal LFT classes per study correlated only slightly better: 21% of patients with none or one abnormal LFT class had a positive imaging study compared with 35% of patients with all three abnormal LFT classes.

Conclusions The yield of inpatient abdominal imaging for abnormal LFTs correlates only weakly with both the severity and the extent of different abnormal LFTs. Further research is needed to define the optimal imaging strategies for evaluating inpatients with suspected hepatobiliary disease.
Development of a polymerase chain reaction (PCR) procedure for the detection of baculovirus associated with white spot syndrome (WSBV) in penaeid shrimp
Authors: Kim  , Kim  , Sohn  , Sim  , Park  , Heo  , Lee  , Lee  , Jun  , Jang
Published: March 2003

The causative viral agent was purified from diseased shrimp Penaeus japonicus with white spot syndrome (WSBV). Several hundred clones were obtained from libraries of the purified viral genomic DNA. According to the results of nucleotide sequence analysis, none of the WSBV clones showed considerable sequence homology with those of other known viruses, indicating that WSBV is a new virus causing a serious disease in shrimp. Based on the sequence data of WSBV genomic DNA, a pair of polymerase chain reaction (PCR) primers was designed. After 30 cycles of PCR amplification of viral genomic DNA extracted from WSBV, a single product of the expected size was detected. Southern blot hybridization confirmed that the amplified product was specific to the DNA of WSBV. The PCR system was able to detect 1 pg of WSBV DNA after 30 cycles, and efficiently amplify the target region of WSBV gene in the total nucleic acids extracted either from the diseased shrimp or hatchery shrimp with no signs of viral infection.
Influences of Aeromonas salmonicida lipopolysaccharide, prednisolone and water temperature on plasma protein composition in salmonids
Authors: Simko E. , Kocal T. E. , Quinn B. A. , Ostland V. E. , Ferguson H. W. , Hayes M. A.
Published: March 2003

To further characterize the putative role of constitutive and inducible plasma proteins in innate resistance to furunculosis, the present authors compared the alterations in profiles of plasma proteins in resistant and susceptible salmonids, i.e. rainbow trout, Oncorhynchus mykiss (Walbaum), and brook trout, Salvelinus fontinalis (Mitchill), respectively. Rainbow trout were injected with prednisolone acetate and exposed to higher water temperature (18 °C versus 10 °C), or injected with purified lipopolysaccharide (LPS) from a virulent strain of Aeromonas salmonicida, and plasma components were examined by two‐dimensional polyacrylamide electrophoresis. Two days after A. salmonicida LPS exposure, rainbow trout had a four‐ to five‐fold increase in concentrations of plasma proteins composed of p48, p19 and p16 subunits, and a significant decrease in a 100‐kDa protein group. Consistent elevation or depletion of proteins corresponding to previously reported rainbow trout A. salmonicida LPS‐binding pentraxins and lectins in plasma were not observed. Brook trout exposed to A. salmonicida LPS did not have any consistent plasma protein changes. There were no significant alterations in major plasma proteins following temperature shock and prednisolone acetate administration in rainbow trout plasma. These studies demonstrate that rainbow trout with LPS‐induced sterile inflammation have few alterations in major plasma proteins or LPS‐binding proteins, and do not exhibit the spectrum of acute phase changes induced by inflammation in mammals.
Experimental infection of Atlantic salmon, Salmo salar L., with infectious salmon anaemia virus: a histopathological study
Authors: Simko E. , Brown L L. , MacKinnon A M. , Byrne P J. , Ostland V E. , Ferguson H W.
Published: March 2003

Recent reports of the isolation of infectious salmon anaemia virus (ISAV) from Atlantic salmon, Salmo salar L., affected by haemorrhagic kidney syndrome (HKS) suggest that ISAV can cause severe renal haemorrhage and necrosis in addition to well‐known pathognomonic hepatocellular necrosis and haemorrhage. The prevalence of ISAV‐induced pathognomonic renal HKS lesions and their correlation to pathognomonic hepatic lesions of infectious salmon anaemia (ISA) is not known. The present experimental infection of Atlantic salmon with a Canadian isolate of ISAV found that pathognomonic hepatic ISA lesions were present in 90.6% and pathognomonic renal HKS lesions in 78.1% of fish which died after the experimental challenge. Both pathognomonic hepatic ISA lesions and pathognomonic renal HKS lesions were found together in 65.6% of fish which died after ISAV challenge. The present study clearly demonstrates that ISAV can cause a very high prevalence of both HKS and ISA pathognomonic lesions.
Effects of infection with the ectoparasite Argulus japonicus (Thiele) and administration of cortisol on cellular proliferation and apoptosis in the epidermis of common carp, Cyprinus carpio L., skin
Authors: Van Der Salm A L , Nolan D T , Spanings F A T , Wendelaar Bonga S E
Published: March 2003

The host‐parasite interaction between juvenile carp, Cyprinus carpio, and the ectoparasitic branchiuran, Argulus japonicus, together with the role of cortisol in this interaction, was examined at the level of the host skin epidermis. Epidermal mucous cell numbers, and proliferation and apoptosis of the epithelial cells were studied over 32 days. Apoptotic cell numbers in the uppermost epidermis were reduced at 26 days post‐infection with A. japonicus, while the other parameters were unaffected. Administration of cortisol‐containing food resulted in reduced apoptosis in the cells in the upper skin epidermis at 24 h and at 28 days post‐feeding. Cortisol feeding combined with A. japonicus infection reduced numbers of apoptotic cells in the upper epidermis more than either individual treatment. Further, combining the treatments also significantly increased apoptosis in the lower epidermis in cells morphologically identified as leucocytes apparently migrating macrophages and lymphocytes. Using immunohistochemistry, we demonstrated cortisol receptor presence and cellular localization in the teleost epidermis. Receptors only occurred in pavement cells in the upper epidermis and in leucocytes in the lower parts of the epidermis. The ectoparasites, or administered cortisol, induced effects which may be functionally adaptive in the upper pavement cells, while combining the two treatments also induced changes indicative of immunosuppression.
Bacterial pathogens in rainbow trout, Oncorhynchus mykiss (Walbaum), reared at Danish freshwater farms
Authors: Dalsgaard I , Madsen L
Published: March 2003

During a 2‐year period, bacterial fish pathogens were monitored on five rainbow trout, Oncorhynchus mykiss (Walbaum), freshwater farms in Denmark. A total of 1206 fish were examined and 361 bacterial isolates were identified phenotypically. Enteric redmouth disease, furunculosis and rainbow trout fry syndrome/coldwater disease were recorded. Infections caused by Flavobacterium psychrophilum occurred most frequently, but only one outbreak of enteric redmouth disease caused by Yersinia ruckeri serotype O1 and one of furunculosis caused by Aeromonas salmonicida were recorded during the monitoring period. Flavobacterium psychrophilum was isolated on all farms, both during disease outbreaks and from fish without any signs of disease. Serological investigations of F. psychrophilum showed that serotype Th was the dominant serotype found. The serotypes Th and Fd were involved in disease outbreaks of fry and larger fish. All isolates of F. psychrophilum showed proteolytic activities; however, a few isolates, belonging to serotype FpT did not degrade elastin and were not associated with mortality. Increasing resistance problems to oxytetracycline were demonstrated. More than half of the F. psychrophilum isolates showed resistance to oxolinic acid and oxytetracycline. No antibiotic resistant isolates were found among Y. ruckeri and A. salmonicida.
A mycosis of juvenile spiny rock lobster, Jasus edwardsii (Hutton, 1875) caused by Haliphthoros sp., and possible methods of chemical control
Authors: Diggles B K
Published: March 2003

Mortalities of puerulus and juvenile rock lobsters, Jasus edwardsii (Hutton, 1875), held in shore‐based ongrowing facilities at water temperatures between 10 and 18 °C were associated with infection by an invasive oomycete identified as Haliphthoros sp. Gross signs of disease included loss of appetite, lethargy and 1–3 brown/black focal necrotic lesions in the gills near insertion of the walking legs. Hyphae were observed in wet preparations of gill filaments excised from lesions. Histology of gill lesions showed hyphae inside the gill cuticle, invasion and lysis of the skeletal muscle and massive haemocyte infiltration and melanization at the base of walking legs adjacent to infected gill filaments. Lobsters over approximately 30 mm carapace length appeared resistant to infection. Death of affected lobsters usually occurred prior to or during the moult and in some cases may have been associated with secondary bacterial infection. Haliphthoros sp. was isolated in pure culture and marine agar 2216 was the medium that produced best growth in vitro. Two isolates were exposed in vitro to five chemicals to determine if an effective treatment could be found. Chemicals that interrupted the life cycle by killing zoospores or preventing sporulation included malachite green, trifuralin, formalin and copper sulphate. The appearance of the disease was associated with poor hygiene and its elimination may be achievable by improving husbandry practices.
Real‐time PCR for the detection and quantitative analysis of IHNV in salmonids
Authors: Overturf K , LaPatra S , Powell M
Published: March 2003

The rapid identification and quantification of virus in diseased fish is a goal both conservationists and commercial aquaculturists have struggled to attain. Recently a technique for the detection of viral mRNA particles that uses fluorescent tagging and amplification has been developed. Utilizing primers and fluorescent labelled probes generated for the specific identification of the nucleocapsid (N) and glycoprotein (G) genes of infectious haematopoietic necrosis virus (IHNV), and an instrument that measures cyclic emittance of fluorescence, the presence or absence of virus can be easily and rapidly confirmed. This method is not only useful in confirming viral presence but is effective in measuring the relative or absolute quantity of virus present within the sample. This allows for the determination of the health status of a carrier fish by measuring the quantity of viral genomes or transcribed viral genes present. Because this method is based on sequence detection, instead of virus isolation in cell culture, it is also effective in determining the presence of pathogenic organisms from water, fish feeds, or other potential reservoirs of infection.
Propagation of yellow grouper nervous necrosis virus (YGNNV) in a new nodavirus‐susceptible cell line from yellow grouper, Epinephelus awoara (Temminck & Schlegel), brain tissue
Authors: Lai Y‐S , Murali S , Chiu H‐C , Ju H‐Y , Lin Y‐S , Chen S‐C , Guo I‐C , Fang K , Chang C‐Y
Published: March 2003

A nodavirus was isolated from diseased yellow grouper, Epinephelus awoara, larvae cultured in southern Taiwan. The histopathology and RT–PCR results confirmed that it was a fish nodavirus; its coat protein gene sequence was similar to that of red spotted grouper nervous necrosis virus (RGNNV) and it is named yellow grouper nervous necrosis virus (YGNNV). A new nodavirus‐susceptible cell line, grouper brain (GB) was established and characterized from the brain tissue of yellow grouper. The GB cells multiplied well in Leibovitz’s L‐15 medium supplemented with 10% foetal bovine serum at temperatures between 24 and 32 °C, and have been subcultured more than 80 times, becoming a continuous cell line. The GB cell line consists of fibroblast‐like cells and some epithelioid cells. The cell line yielded titres of YGNNV up to 108.5 TCID50 mL–1. The GB cells effectively replicated the virus at 28 °C, which could be purified to homogeneity by caesium chloride gradient centrifugation. Electron microscopy studies showed that purified virus particles were 25–30 nm in diameter. The cytoplasm of infected cells was filled with aggregates of virus particles. These results indicate that the GB cell line is a significant tool for the study of fish nodaviruses.
Development of improved PCR to prevent false positives and false negatives in the detection ofTetracapsula bryosalmonae, the causative agent of proliferative kidney disease
Authors: Morris D C , Morris D J , Adams A
Published: March 2003

Proliferative kidney disease (PKD) is an economically significant disease caused by the myxozoan parasiteTetracapsula bryosalmonae. Polymerase chain reaction (PCR) protocols using primers specific for the small subunit ribosomal RNA (18S rDNA) gene of the parasite enable detection, however, false positive and negative results can render detection inconclusive. In this study a decontamination protocol was developed, using hydroxylamine hydrochloride (H), to prevent false positives by blocking re‐amplification of carry‐over contaminants. A mimic molecule was also developed and used as a competitive internal standard coamplified with target DNA in PCRs, revealing both true and false negatives. The sensitivity of one new and two existing primer sets was assessed with all primers detecting DNA equivalent to at least eight parasite cells per gram of tissue. This improved PCR protocol canprovide more reliable testing forT. bryosalmonae.
Ribosomal DNA sequences indicate isolated populations of Ichthyophonus hoferi in geographic sympatry in the north‐eastern Pacific Ocean
Authors: Criscione C D , Watral V , Whipps C M , Blouin M S , Jones S R M , Kent M L
Published: March 2003

Infections of Ichthyophonus hoferi, a cosmopolitan parasite of marine fish, have recently been reported in rockfish, Sebastes spp., from the north‐eastern Pacific. Because I. hoferi also infects Pacific herring, Clupea pallasi Valenciennes, and salmonids in this region, we wanted to determine if Ichthyophonus parasites from rockfishes, Pacific herring and chinook salmon, Oncorhynchus tshawytscha (Walbaum), were the same. Small subunit ribosomal deoxyribonucleic acid sequence data revealed two haplotypes that were fixed among host species in geographic sympatry, one from rockfish and the other from both Pacific herring and salmon. These isolated populations of Ichthyophonus could be part of the same species that are ecologically separated because of host behaviours, or they could be distinct species that are host specific. Dietary patterns of the hosts indicate that ecological separation among hosts is possible, but the presence of distinct species may better explain the observed Ichthyophonus haplotype association with host species.
An alkaline phosphatase‐based method for the detection of infectious salmon anaemia virus (ISAV) in tissue culture and tissue imprints
Authors: Wilson L , McBeath S J , Adamson K L , Cook P F , Ellis L M , Bricknell I R
Published: March 2003

Currently, the presence of infectious salmon anaemia virus (ISAV) is often detected in Atlantic salmon by the use of an indirect fluorescent antibody test. This test is limited by the poor stability of fluorescein isothiocyanate which fades after about a week in storage, preventing the development of stained archive material as a reference source. One possible alternative would be the use of immunohistochemical staining methods to detect ISAV. An immunohistochemical method is presented that uses alkaline phosphatase‐conjugated antibodies and Vector® Red as a substrate, to detect ISAV in kidney imprints. This paper also describes a procedure where Bouin's fluid is used to successfully inhibit endogenous alkaline phosphatase in tissue samples, prior to immunohistochemical processing. This method provides a stable stain that can be read for many weeks after staining or archived for future reference.
Investigation of media formulations promoting differential antigen expression by Photobacterium damsela ssp. piscicida and recognition by sea bass, Dicentrarchus labrax (L.), immune sera
Authors: Bakopoulos V , Pearson M , Volpatti D , Gousmani L , Adams A , Galeotti M , Dimitriadis G J
Published: March 2003

Photobacterium damsela ssp. piscicida (Phdp) isolates were grown in various bacteriological media, in eukaryotic cell culture media and in the presence of fish cells (resembling some aspects of in vivo growth environments). Bacterial cells, extracellular products (ECPs) and crude capsular polysaccharide were isolated and analysed by electrophoresis and Western blot using sea bass sera. Growth in bacteriological media conserved the synthesis of cell and extracellular components when these were compared with those prepared under near‐in vivo growth conditions. In fact, synthesis of a larger range of cell components was induced after growth in bacteriological media. Certain media based on yeast extract and peptones from various sources and a specific salt formulation induced the synthesis of novel cell components at approximately 21.3 and 14 kDa. These antigens were recognized by sea bass sera collected after natural pasteurellosis outbreaks and other sea bass sera raised against live or inactivated Phdp cells. The ECPs of the pathogen were not good immunogens in their soluble form despite various treatments prior to immunization. The results are discussed with respect to vaccine development.
Hepatic cholangiocarcinoma and testicular mesothelioma in a wild‐caught blue shark, Prionace glauca (L.)
Authors: Borucinska J D , Harshbarger J C , Bogicevic T
Published: March 2003

An adult male blue shark, Prionace glauca (L.), caught in July 2000 by a recreational fisherman off Long Island, New York, USA, had a retained fishing hook from a previous capture. The hook penetrated the gastric wall and lacerated the right liver lobe. Macroscopic lesions consisted of transmural gastritis and peritonitis. Alteromonas sp. and Vibrio alginolyticus were isolated from the peritoneal fluid. In addition, a well delineated, sessile mass was found on the otherwise normal serosa of the right testis. Histopathological findings included mesothelial hyperplasia and hypertrophy involving diffusely the gastric, hepatic and parietal serosae, and forming a discrete testicular capsular mass compatible with mesothelioma. In the liver an intrahepatic cholangiocarcinoma, chronic hepatitis, biliary hyperplasia and increased numbers of melanomacrophages were found. In addition organisms compatible with histozoic and coelozoic myxosporeans were found within the skeletal muscle of the abdomen and intrahepatic bile ducts, respectively. This is the third literature report of a liver tumour and the first report of a coelomic mesothelioma from a shark.
Influence of enteric helminths on the distribution of intestinal endocrine cells belonging to the diffuse endocrine system in brown trout, Salmo trutta L.
Authors: Dezfuli B S , Giari L , Arrighi S , Domeneghini C , Bosi G
Published: March 2003

The presence of intestinal helminths in the alimentary canal of brown trout, Salmo trutta L., can alter the number of cells that synthesize modulatory peptides. A total of 167 brown trout were collected from tributaries of the River Brenta (northern Italy), of which 119 (71.3%) specimens were infected with enteric helminths, 28 with the acanthocephalan Pomphorhynchus laevis Müller, 1776 with intensity of infection ranging from 1 to 162 (18.57 ± 30.79) worms per host and 67 fish with the cestode Cyathocephalus truncatus Pallas, 1781. Intensity of infection with C. truncatus ranged from 1 to 85 (6.87 ± 12.59) per fish. In 24 fish there were concurrent infections of both species of helminths. The caecal and middle regions of the intestine were the most heavily parasitized. Immunohistochemical tests showed a decrease in endocrine cells (ECs) of the diffuse endocrine system (DES) positive to gastrin, cholecystokinin‐8, bombesin and secretin antisera in the intestine of the infected trout. The number of ECs immunoreactive to anti‐glucagon serum did not show differences in the digestive tract of uninfected brown trout and in conspecifics parasitized with P. laevis. The density of cells containing glucagon‐like material was low in the fish parasitized with C. truncatus. The results suggest that endoparasitic helminths induce alterations in the DES of infected S. trutta.
Bacterial contamination of enteral feeding systems due to faulty handling procedures—a comparison of a new system with two established systems
Authors: Beattie  , Anderton
Published: March 2003

Background: The purpose of this study was to compare the risks of introducing microbial contamination when assembling and running two commonly used, ready‐to‐hang, enteral feeding systems (Nutrison glass bottles and Steriflo) with a newly introduced system (Nutrison pack).

Methods: The nutrient container tops of all systems were deliberately touched during assembly by a researcher wearing gloves contaminated with
Klebsiella aerogenes. After touching, half the containers were immediately connected to giving sets, the other half were disinfected using alcohol wipes before connection to the giving sets. Systems were run for 24 h, with a change of nutrient container at 12 h for the Steriflo (2×1000 ml), Nutrison pack (2×1000 ml) and Nutrison glass bottles (2×500 ml), and at 6 h for the Nutrison glass bottles (4×500 ml). Feed samples for microbiological analysis were taken from feed in the systems at the 0 h assembly, and from residual feed in all discarded nutrient containers. Each protocol was repeated five times.

Results: The percentage of feed samples in which K. aerogenes was detected reduced significantly from 68% for non‐disinfected Nutrison glass bottles changed every 6 h, to 59% after disinfection, and from 51% to 0% after disinfection of Steriflo systems (Mann–Whitney,
P< 0.05). For Nutrison glass bottles changed every 12 h the fall from 51% with no disinfection to 49% after disinfection was not significant (Mann–Whitney,
P< 0.05). Nutrison packs were not disinfected and yet K. aerogenes was only detected in 2% of feed samples. This rate of contamination was significantly less than that for all the other non‐disinfected systems (Mann–Whitney,
P< 0.05).

Conclusion: The results show a reduction in the incidence of bacterial contamination of the feed samples when systems were disinfected subsequent to being exposed to faulty handling procedures, thus supporting manufacturers recommendations to disinfect systems during assembly. The results particularly highlight the important role played by system design in reducing the levels and incidence of bacterial contamination of enteral tube feeds.
Gastrostomy feeding in advanced Huntington's disease
Authors: Wilson J.
Published: March 2003

This case study reports the progress of a 41‐year‐old man with advanced Huntington's disease (HD) during a 12‐week period when he was fed a high‐energy regimen via percutaneous endoscopic gastrostomy (PEG). The regimen consisted of a low‐protein, low‐mineral, energy‐dense (2 kcal mL−1) carbohydrate polymer. Achieving weight gain with a 1.5 kcal mL−1 feed and carbohydrate polymer had produced steady but slow results (52–56 kg – a rise of 4 kg in 15 months). It was concluded that a more energy‐dense regimen would facilitate faster weight gain.
A9. A study of nutritional intake in surgical patients, pre‐ and post‐operatively
Authors: Trick L. M. J.
Published: March 2003

Background Those who undergo major surgery are at a greater risk of malnutrition than most because of the stress and the concomitant increase in metabolic rate (
Edington, 1997). Malnutrition often goes unrecognized in hospitals (
Lennard Jones, 1992) increasing morbidity and mortality as well as the length of hospital stay and cost to the NHS. Treatment of the malnourished patient by nutritional support (
Rana et al., 1992
) and artificial nutritional support (
Beiser‐Holgeren et al., 1996
) has produced beneficial results.

Aim To examine the nutritional intakes of surgical patients pre‐ and post‐operatively and identify the factors associated with nutritional intake.

Methods The study identified the nutritional intakes of surgical patent’s 1 day preoperatively and on two occasions postoperatively (3–5 days and 7–12 days). Also investigated were reasons why, if any, surgical patients were not meeting their nutritional requirements, the contribution of artificial nutritional support to patients’ requirements and patients’ acceptability of the hospital catering system. 50 surgical patients undertook a 24‐h dietary recall at the stated assessment periods. Statistical tests were used to analyse the variance (anova) and correlation of all data.

Results It was found that only 24% of patients were meeting nutritional requirements preoperatively. Only 6% met their requirements in the first postoperative period and only 18% in the second.

Patients undergoing gastro‐intestinal surgery were found to be at the greatest nutritional risk.

Patients who received artificial nutritional support (naso‐gastric and naso‐jejunal) had the highest nutritional intakes in the postoperative periods.

Supplementary drinks substantially increased nutritional intakes.

Medical and surgical reasons were identified for patients’ reduced intakes not patient dissatisfaction with the hospital catering system.

Conclusion These results show that malnutrition is still apparent on today’s surgical wards. Patients continue to be nutritionally deficient whilst in hospital. The education of all health care professionals on the subject of nutrition must therefore be seen as of paramount importance.
A16. A study of nutritional knowledge and supplement use in pregnant women
Authors: Johnson K.
Published: March 2003

Background Current research recognizes a good nutritional state as essential for the well‐being of the foetus in pregnancy and there is an increasing body of evidence linking nutritional knowledge with an improved nutritional state. Folic acid is of particular importance in pregnancy due to its role in preventing neural tube defects.

Aim This study aimed to determine the effect of the recent Department of Health folic acid campaign on the knowledge and use of folic acid supplements in a group of pregnant women, as well as assessing their use and means of access to other vitamin and mineral preparations. It also aimed to identify the main sources from which parents obtain nutritional information and establish the effect of the St. George’s Hospital ’Guide to Nutrition in Pregnancy’ booklet on the nutritional knowledge of the women using this group.

Methods A self‐administered questionnaire was randomly distributed to 100 pregnant women attending subsequent ante‐natal appointments at St. George’s Hospital in Tooting of which 67 were fully completed and returned. Relationships between variables were investigated using Chi‐squared.

Results 100% of women were aware of folic acid and 66% knew its exact role in preventing neural tube defects, with this knowledge being higher in those who had a job (P = 0.01). 61% of women were taking folic acid supplements with use being higher in those who had planned their pregnancy (P < 0.01), didn’t smoke (P < 0.05), had a job (P < 0.01) and in higher social classes (P < 0.01). 78% of women were taking nutritional supplements with more being taken during pregnancy (60%) than on a regular basis (40%) and most being taken once a day (58%). Supplements were most frequently bought from a chemist (50%) or supermarket (22%) or obtained on prescription from a GP (22%). The most common sources of information on nutrition in pregnancy were The BOUNTY book on having a baby, ’Mum‐to be’ magazines and ’St George’s Guide to Nutrition in Pregnancy’ with the latter two being regarded as giving the best, most useful information. Those who had received the St George’s booklet had better overall nutritional knowledge about pregnancy than those who hadn’t (P < 0.05).

Conclusions The relaunch of the folic acid campaign has succeeded in raising awareness and use of folic acid supplements in this group and the publication of St. George’s ’Guide to Nutrition in Pregnancy’ has increased their general knowledge of the nutrition issues relating to pregnancy.
A4. A retrospective review of the effect of insulin therapy on metabolic control, weight, lipid levels and blood pressure in people with type II diabetes
Authors: Economides C.
Published: March 2003

Background The role of insulin in the treatment of type II diabetes has been the subject of many debates. Exogenous insulin has been suggested to have both beneficial and detrimental effects in the health and well‐being of diabetic patients (
Genuth, 1996). The beneficial effect is the result of reducing hyperglycaemia (
Henry, 1996). On the other hand, insulin treatment is considered to accelerate the development of cardiovascular disease by increasing cardiovascular disease risk factors (
Turner, 1996).

Aim The aim of this retrospective review was to monitor the effect of insulin therapy on metabolic control, and in addition to monitor the contact with a dietitian on starting insulin.

Methods The study involved 202 patients with type II diabetes. Group A: 149 subjects (mean age 64 years) poorly controlled patients who had switched to insulin treatment and Group B: 53 subjects (mean age 68 years) who were maintained on oral hypoglycaemic agents. All variable were collected (a) on starting insulin (or reference date) and (b) one year later.

Changes within each group in glycaemic control, weight serum lipid levels and blood pressure were evaluated using Two‐sample t‐test assuming equal variances. Changes in the two groups were compared using the Two‐sample t‐test assuming unequal variances.

Results Type II diabetic patients who had switched to insulin treatment had experienced a significant increase in body weight (5.4 kg) in comparison to control subjects at the year after insulin commencement. Mean HbA1c and fasting blood glucose (FBG) decreased significantly in the insulin group (from 9.9 ± 2.1 to 8.5 ± 1.6% and from 14.6 ± 5.6 to 10.3 ± 3.9 mmol L−1, respectively). In contrast no statistically significant difference was noted in the control group for either HbA1c or FBG. Blood lipids did not change significantly in either group, and blood pressure also remained statistically unchanged. 36% of the insulin treated patients had dietetic input at the time of insulin commencement.

Conclusions Weight gain and improvement in glycaemic control, has been demonstrated in previous studies. Even though the current study did not show changes in lipid levels, other studies have shown a reduction in both triglyceride and cholesterol levels.

The introduction of insulin treatment in individuals with poorly controlled type II diabetes appears to positively affect metabolic control. Long‐term improvement in metabolic control has been shown to have many effects on the health and longevity of diabetic individuals, as has a reduction in the individual’s weight. Prospective studies in this area could fully determine the effects of insulin introduction on these variables, enabling fuller conclusions to be made with respect to longevity and future disease risks.
Meal patterns and meal quality in patients with leg ulcers
Authors: Wissing U. , Lennernäs M. A‐C. , Ek A‐C. , Unosson M.
Published: March 2003

Background Wound healing is a complex process, which requires adequate energy sources, proteins, and specific minerals and vitamins. If an individual is unable to get or to eat the nutrients required, the wound healing process might be disrupted. The aim of this study was to investigate food‐related factors, meal patterns and meal quality in relation to nutritional status in elderly out‐patients with leg ulcers.

Methods Nutritional status was assessed by use of the Mini Nutritional Assessment in 70 patients living in their own homes. Fifty‐six of the patients recorded actual meals and snacks over four consecutive days. Meal patterns and meal quality were evaluated with the help of a qualitative classification system, the Food Based Concept for Classification of Eating Episodes.

Results Thirty‐six patients were classified as well‐nourished, 32 were at risk of malnutrition and two were malnourished. More patients in the risk group for malnutrition did not buy their own food, and usually ate alone. Incomplete Meals and Low Quality Snacks were the most common eating types. The patients at risk of malnutrition had significantly fewer prepared Complete Meals than the well‐nourished patients.

Conclusion The results show a diet and meal quality which hardly meets the requirements for nutrients that are important in wound healing, especially for those patients assessed at risk of malnutrition.
An audit of the theoretical basis of education during dietetic consultations with diabetic patients
Authors: Parkin T.
Published: March 2003

Background

This article describes my attempts to reflect my current practice. It was conducted in order to determine which of three educational models, Empowerment, Motivational Interviewing and Helping People to Change, were being used during a diabetic dietetic consultation.

Method

Analysis of interviews with 15 patients selected at random from an outpatient clinic was undertaken. Each consultation was assessed and relevance to steps in each model noted.

Results

Overall the results suggest that all three models were used for different reasons. Therefore, I conclude that any one of a number of educational approaches may be used within a consultation, as there may be elements that overlap. The different skills required by each of the models are invaluable at different times to assist patients at different phases in their life.

Conclusions

An understanding of different educational models is therefore useful and has helped to clarify my practice. In future, I anticipate a more formal evaluation of the educational process to help identify steps used. These could then be formally assessed for their impact on patient outcomes, and so identify specific aspects of educational models that assist patient education and help to improve outcomes.
A reliability study of the Spanish version of the Social Behaviour Schedule (SBS) in a population of adults with learning disabilities
Authors: Salvador‐Carulla L. , Garcia‐Mellado M. J. , Velazquez R. , Romero C. , Alonso F.
Published: March 2003

The reliability of the Spanish version of the Social Behaviour Schedule (SBS) was tested in a vocational setting on a sample of 64 subjects with learning disabilities. Test‐retest assessment showed a good percentage of agreement (80%) and adequate kappa values for most SBS items. The overall percentage of agreement of inter‐racer reliability was 85% and kappa values were moderate to nearly perfect for 52% of items. Inter‐informant analyses produced poorer results, with an average agreement of 43% and inadequate kappa values on 42% of items. The intraclass correlation coefficient (ICC) was 0.64 for test‐retest, 0.76 for inter‐rarer assessment and 0.94 for inter‐informant assessment. The Spearman correlation coefficient was adequate on the test‐retest and inter‐rater analyses, but not on inter‐informant analysis. This low inter‐informant agreement could be attributed to environmental factors which alter the reliability of reports from different informants in community settings with high levels of normalization. In such environments, an interview with a key informant may not suffice, and both a careful review of the clinical record and a direct interview with subjects may enhance the reliability of the information attained.
Cooperative learning and social acceptance of children with mild intellectual disability
Authors: Jacques N. , Wilton K. , Townsend M.
Published: March 2003

The effects of the participation of non‐disabled children in a cooperative learning programme on their social acceptance of classmates with mild intellectual disability was examined. A sample of 24 children with mild intellectual disability in the 9–11‐year‐old age‐range was identified from educational psychologists' case records. All of the children were receiving mainstreaming special education programmes at the time of the study. Twelve of the children had previously attended special education classes, while the remainder had always attended regular classes. Half of the children's regular classes were randomly assigned to either receive an experimental cooperative learning programme or to serve as control classrooms. The non‐disabled children in the experimental classes showed significant increases in their social acceptance (sociometric ratings) of the children with mild intellectual disability, both immediately following the programme and 5 weeks later, but no such increases were evident in the children in the control classrooms. This pattern held for both the former special class pupils and the children with mild intellectual disability who had never attended special classes. The results confirm the usefulness of cooperative learning strategies for enhancing the social acceptance of children with mild intellectual disability in mainstreaming special educational programmes, regardless of the nature of their previous special educational provisions.
Reliability and validity of the PAS‐ADD Checklist for detecting psychiatric disorders in adults with intellectual disability
Authors: Moss S. , Prosser H. , Costello H. , Simpson N. , Patel P. , Rowe S. , Turner S. , Hatton C.
Published: March 2003

The PAS‐ADD Checklist is a screening instrument specifically designed to help staff recognize mental health problems in the people with intellectual disability for whom they care, and to make informed referral decisions. The instrument consists of a life‐events checklist and 29 symptom items scored on a four‐point scale. Scores are combined to provide three threshold scores. The crossing of any of these thresholds indicates the need for a fuller assessment. The items are worded in everyday language, making the Checklist suitable for use by individuals who do not have a background in psychopathology. The present paper presents the results of a number of studies evaluating the reliability and validity of the Checklist. Factor analysis of Checklists completed on a community sample of 201 individuals yielded eight factors, of which seven were readily interpretable in diagnostic terms. Internal consistency of the scales was generally acceptable. Inter‐rarer reliability in respect to individual items gave a fairly low average Kappa of 0.42. However, agreement on case identification, the main purpose of the Checklist, was quite good, with 83% of the decision being in agreement. Validity in relation to clinical opinion was also satisfactory, case detection rising appropriately with the clinically judged severity of disorder. The PAS‐ADD Checklist is published and distributed by the Hester Adrian Research Centre, Manchester, England, from where further information and order forms are available on request.
Balancing restriction and freedom in the care of people with intellectual disability
Authors: Crichton J.
Published: March 2003

The case of a 50‐year‐old man with severe intellectual disability is described. After 20 years of institutional care, the subject was moved to a newly opened community group home. His physical and mental health deteriorated at this location after unproven allegations of sexual abuse which had taken place whilst he had been living in the institution. Although the subject's health continued to deteriorate, there was resistance to his re‐admission to the same hospital for assessment. He had always needed to be cajoled into eating, but this approach had not been followed by the home which had contributed towards his weight loss. The situation the subject, the carers and the health personnel found themselves in illustrates how problematic it is to find the right balance between restrictive practices and respect for an individual's choice.
Role clarity, perception of the organization and burnout amongst support workers in residential homes for people with intellectual disability: a comparison between a National Health Service trust and a charitable company
Authors: Blumenthal S. , Lavender T. , Hewson S.
Published: March 2003

Changes in roles and responsibilities brought about by community care and the reorganization of the UK National Health Service (NHS) have resulted in higher levels of stress and insecurity amongst residential nursing staff working with people with intellectual disability. In the light of these organizational changes, questions have arisen about the relationship between role clarity, perception of the organization and occupational stress. A number of studies have investigated these issues amongst staff working with people with intellectual disability, although there have been few investigations in the UK. The present study examines the relationship between these variables in the context of the differences between the employees of an NHS trust and a charitable organization. The present study involved constructing a measure of role clarity and perception of the organization, and the use of the Maslach Burnout Inventory (MBI). The results indicated that most support workers regarded their role as being clear and their levels of burnout to be comparable with UK nursing norms. Charity staff were more likely to view their organization positively and rated their emotional exhaustion as significantly lower than NHS trust staff. A within‐service comparison of homes revealed differences amongst NHS trust and charity homes on sub‐scales of the MBI. The results are discussed in the context of previous research and changes in working practices in the field.