bluuebunny/crossref_metadata_2025 huggingface dataset:
A pluralistic evaluation of nursing/practice development units
Authors: Gerrish Kate
Published: March 2003

•  Nursing/practice development units (N/PDU) are perceived as centres for pioneering, evaluating and disseminating innovative practice development and facilitating the professional development of practitioners.

•  This paper reports on a pluralistic evaluation research study of the nursing/practice development unit accreditation programme provided by the University of Leeds, UK. Individual and focus group interviews were undertaken with key stakeholders involved in six nursing/practice development units. These included: clinical leaders, team members, executive nurses, trust board members, general medical practitioners, nursing/practice development unit steering group members, and accreditation panel members. Stakeholder perceptions of what constituted a successful nursing/practice development unit were elicited and then used to judge the success of the programme.

•  Seven criteria for judging the success of nursing/practice development units were identified. These were: achieving optimum practice; providing a patient‐orientated service; disseminating innovative practice; team working; enabling practitioners to develop their full potential; adopting a strategic approach to change and autonomous functioning.

•  The findings highlighted differences between the rhetoric of a successful nursing/practice development unit and the reality in which they function. Whereas all the units were actively involved in innovative practice development, evaluation, dissemination and networking activities, several factors influenced the success of the units, in particular, the role of the clinical leader, the motivation and commitment of nursing/practice development unit members, financial resources, and the nature of support from managers, medical staff and education institutions.

•  Although the nursing/practice development units had made significant progress in developing both healthcare practice and practitioners, there is still a need to consider how the claim that nursing/practice development units benefit patients can be substantiated.
The role of district nurses in caring for people with mental health problems who live in rural settings
Authors: Lauder William , Reynolds William , Reilly Victoria , Angus Neil
Published: March 2003

• District Nurses in rural areas frequently fulfil, in some permutation, the functions of district nursing, health visiting, school nursing, and community midwifery. This complex role can bring them into contact with a wide range of mental health problems.

• The extent, nature and type of mental health problems, and their response to these problems, is not well documented in the literature.

• The findings of this qualitative study indicate that District Nurses do in fact have contact with a wide range of mental health problems. The role of District Nurses in caring for this client group is more substantial than has been previously recognized.

• It is suggested that this role be formally acknowledged and that systems put in place to optimize the effectiveness of District Nursing interventions.
Evaluating a community nursing service: listening to the voices of clients with an intellectual disability and/or their proxies
Authors: Koch Tina , Marks June , Tooke Elaine
Published: March 2003

• The aim of this study was to evaluate a specialist nursing service programme for people with an intellectual disability residing in the community. It is important to correct the imbalance in the literature that has neglected the voices of the clients themselves or denied expression by their proxies.

• The aim of the study was to gain a better understanding of matters of importance for clients and their families and to involve them in the evaluation of a service that directly affects their care.

• Only three clients were able to participate; however, 17 parents (next of kin) agreed to be interviewed.

• In‐depth interviews were audio‐taped, transcribed and analysed relating to the questions asked and were checked against the domains of the nursing practice in the disability area: continuity of care, advanced nursing practice, education and credentialling, personal and professional attributes, primary health care, and normalization.

• The findings confirm the high regard in which the programme is held. Service evaluation is crucial in providing evidence for programme funders. The favourable outcome of this evaluation meant that the programme gained funding for another few years.
Introducing an in‐patient treatment for alcohol detoxification into a community setting
Authors: Williams Simon
Published: March 2003

• Alcohol detoxification in the UK is not standardized and treatment is usually determined by local policies.

• Drug regimens are often predetermined and unrelated to the extent and duration of dependence, recent consumption, or previous withdrawal symptoms.

• Diazepam loading shortens the detoxification period and avoids the indiscriminate use of medication. It has been shown to be effective as an in‐patient treatment.

• This paper examines the feasibility of introducing diazepam loading in a community setting, and discusses the implications that this would have for clinical practice.
Reflections on a community action research project: interprofessional issues and methodological problems
Authors: LAX WENDY , GALVIN KATHLEEN
Published: March 2003

• This paper describes an action research study in a community setting.

• A group of residents from a local housing estate and a number of local workers used participative methods to explore local child care issues with the aim of developing initiatives for improved child care.

• The paper describes the study processes and reflects on lessons learnt.

• A discussion of implications for interprofessional working concludes the paper and includes emphasis of the need to focus on shared objectives, and develop appropriate organizational structures and educational provision.
White coat hypertension: understanding the concept and examining the significance
Authors: Tsai Pei‐Shan
Published: March 2003

•  Because the concept of white coat hypertension is evolving, a variety of definitions appear in the literature. There has also been continuing debate as to whether white coat hypertension is a benign clinical condition or is associated with increased hypertensive complications.

•  This paper summarizes and evaluates the literature on white coat effect/hypertension, with a focus on the following aspects of the concepts: (1) alternative definitions, (2) prevalence and predictors, (3) prognostic significance, and (4) implications for clinical practice.

•  The evidence suggests that white coat hypertension is not a harmless phenomenon. It is frequently associated with increased target‐organ damage and often coexists with other cardiovascular risk factors. The extent of the presence of other risk factors may determine the risks associated with white coat hypertension. It is important for clinicians to understand the concept, learn to diagnose it properly, and develop strategies for evaluating risk levels so that patients receive the proper treatment.
Handling of drug‐related inquiries by hospital nurses
Authors: Rahman  , Budiarti
Published: March 2003

Objective:
To determine how nurses handled drug‐related questions in the work environment of a teaching hospital in Malaysia and the type of information sources they used

Method:
Questionnaires were distributed in August 1996 to nurses working in various wards. The majority of respondents were staff nurses. They rated their patients as the most common category of individuals with drug‐related inquiries

Results: About 58% of nurses said the most common source of reference text available at the workplace was the
Drug Index of Malaysia and Singapore (DIMS) and that it was the text most of them used to answer drug‐related inquiries. Although the majority of them knew the existence of a drug information centre at the hospital, 73% of nurses referred to pharmacists working in satellite pharmacies to solve drug‐related inquiries

Conclusion:
This survey also showed that nurses sought information on drugs from various sources and that satellite pharmacies served an important purpose in this respect.
Paradise Lost: Children, multimedia and the myth of interactivity
Authors: Lewis R. , Robertson J.
Published: March 2003

Abstract The dramatic expansion of IT use in the primary schools of South‐West Scotland, in the mid‐1980s, centred on highly interactive and pupil‐empowering forms such as LOGO or database management software. While later forms of IT in education which have come to dominate computer‐use in the same area, such as multimedia encyclopaedias and ‘living books’, are worthwhile, their surface sophistication and information richness does not compensate for reduced interactivity levels and the consequent loss of learner engagement and control. The uncritical adoption of technological advances combined with reduced local authority resources to drive curriculum development have resulted in failure to embed one of the most radical educational initiatives of the late twentieth‐century.
School programming as literacy: the case for BOXER
Authors: Lewis R. , O′Reilly D.
Published: March 2003

Abstract This paper considers the role of school programming using the BOXER environment. It gives details of a two‐year research project in which a group of primary school children (aged 9 ‐ 11) developed their understanding of number through programming in BOXER. It argues that such programming should be regarded as a new form of literacy and as such, developed in concert with subject knowledge, and evaluated over the whole of schooling.
Dialogues in support of qualitative reasoning
Authors: Pilkington R.
Published: March 2003

Abstract Do students always interact with computers reflectively on tasks and improve qualitative reasoning? It seems that students often manipulate software without changing existing conceptions or exploring the implications of their conceptions to generate deeper explanations. This undermines the educational value of such interactions — though dialogue with a peer or adult can make the interaction more valuable. However, it is uncertain when and how such dialogues work. If high quality educational interactions with computers are to take place, then it is necessary to understand the situations in which particular dialogue forms are effective and to find ways of modelling these. In this paper a framework for the design of such interactions is proposed based on a dialogue analysis that employs transactional analysis and logical dialogue game theory. The framework is applied to a medical (simulation‐based) learning context to illustrate how it may enhance interactions with such systems.
Cognitive development and qualitative modelling
Authors: Ogborn J.
Published: March 2003

Abstract This paper argues that in order to encourage the learning of high level cognitive skills through the use of computers, it is necessary to use systems which are adapted to forms of natural human reasoning. This is specifically the case in using modelling programs. Two kinds of such reasoning are identified, both qualitative: reasoning using imagined objects and events, and semi‐quantitative reasoning. Modelling systems which support each form are described. Some results of research with them are outlined.
Student opinions on an interactive arithmetic test
Authors: Hippisley J. , Houghton S.
Published: March 2003

The aim of this study was to assess student attitudes towards an interactive arithmetic test. A sample of 45 primary school children from Years 1 and 2 in two Western Australian primary schools participated in the study. After using the test for a period of six weeks students were invited to detail what they liked and disliked about the test and how they might improve it. Analysis of this written feedback revealed a generally positive attitude towards the test. There were just a few negative responses, mainly pertaining to the slow speed of the program on the computers used in the study.
Gender differences in an on‐line learning environment
Authors: Barrett E. , Lally V.
Published: March 2003

This paper focuses upon the use of Computer Mediated Communication (CMC) in a specific learning context by a small community of postgraduate (MEd) distance learners and their tutors. Content analysis of on‐line dialogues was used to investigate learning and socio‐emotional behaviour within this community. The data presented suggests that men and women took distinctively different roles in the on‐line learning environment. Most significantly, the cognitive and metacognitive (learning) content of on‐line seminar contributions by men and women was found to be similar, but their social and interactive behaviour was significantly different. In particular, it was found that within a formal on‐line learning environment men sent (on average) more messages than women; they wrote messages which were twice as long as those sent my women; and made more socio‐emotional contributions than women. Women, however, were found to contribute more ‘interactive’ messages than men. This paper concludes that the application of CMC technology to a specific learning context may reproduce gender differences within a learning community.
Evaluation of hypertext in an activity learning environment
Authors: Scherly D. , Roux L. , Dillenbourg P.
Published: March 2003

Abstract This paper presents a study which evaluates the use and efficiency of two computer learning tools for basic virology. The first, VIROLAB, is a simulation of a biology laboratory in which the learner uses virtual lab facilities to help defective viruses to multiply. The system also includes a hypertext that provides learners with some knowledge on virology. The second tool is the hypertext which has been extracted from VIROLAB and which is now considered as an independent learning environment. This study addressed two specific questions: (1) which of the two tools was the most efficient for knowledge acquisition, and (2) were there any differences in the use of the two hypertexts? Comparison of pre‐ and post‐test scores showed that neither of the two learning tools is better than the other. However, analysis of the navigation paths showed that VIROLAB users dissociated the reading of the integrated hypertext from the problem resolution activities. The implications of this finding for the design of the learning environment are discussed.
Banking, financial services and consumer protection: Introduction
Authors: Mitchell Jeremy
Published: March 2003

In December 1996, the Canadian Government set up a Task Force on the Future of the Canadian Financial Services Sector. One of the terms of reference of the Task Force was to make recommendations to enhance the contribution that financial services could make ‘...to the best interests of Canadian consumers’. To inform its approach to this aspect of its work, the Task Force commissioned research papers on consumers in the financial services sector, drawing not only on Canadian experience, but also on past and present developments in other parts of the world, including Australia, the United States and the European Union. The results of the international research were initially published by the Canadian Government Department of Finance in September 1998 as an appendix to Change, Challenge and Opportunity, the Report of the Task Force (Crown Copyright in this material is noted).1 It was felt that the papers on the situation in the European Union and some of its member states were of interest to a much wider audience, and the Department of Finance gave permission for publication as this special issue of the Journal of Consumer Studies and Home Economics, which invited me to be Guest Editor. I am especially grateful to the authors of three of the national country studies – Joop Koopman (The Netherlands), Rainer Metz (Germany) and Susanne Storm (Denmark and Sweden) – as well as to John Chant and Robert R. Kerton in Canada, whose imaginative approach to the work of the Task Force led to this study being carried out.
Policy and practice in the Netherlands
Authors: Koopman Joop
Published: March 2003

Abstract: As in many other areas of public policy in the Netherlands, development of consumer protection in banking and financial services has been characterized by a consensual approach. Consumer organizations have been involved along with representative business bodies in building self‐regulatory systems within a statutory framework, especially in relation to issues related to overindebtedness. This approach has characterized dispute settlement procedures as well as a code of conduct on good lending practice and a national credit registration system. The Consumer Credit Act provides a system of maximum interest rates for different kinds of credit, which may be varied according to market conditions. The needs of consumers at the lower end of the credit market are specifically catered for by a network of municipal credit banks, which also provide debt settlement services.
The relative contributions of sexual reproduction and clonal propagation in Opuntia rastrera from two habitats in the Chihuahuan Desert
Authors: Del Carmen Mandujano María , Montanā Carlos , Méndez Ignacio , Golubov Jordan
Published: March 2003

1 The clonal cactus Opuntia rastrera shows predominantly sexual reproduction in grasslands (GH) and clonal propagation in nopaleras (NH). We assessed the effects of light, herbivory, water availability and the habitat an offspring came from on the survival and growth of sexual or clonal offspring (i.e. seedlings and cladodes), through 3‐ and 4‐year common garden and short‐term greenhouse experiments.

2 Shading by nurse plants increased seedling survival in the field by an order of magnitude, and a small additional advantage due to predator protection by grasses was observed. Strong herbivory transforms a facultative nurse–protégé relationship for seedlings into an obligatory one.

3 In the greenhouse seedlings grew better under shade, but in the field the production of the first cladode was delayed in seedlings in the more shaded GH. Competition for soil resources may be more intense under a dense grass tussock than under a open shrub, thus affecting the nurse–protégé relationship. Seedling survival under nurse plants was similar in GH and NH, but higher plant cover suggests that a larger number of seedlings will establish in GH in the long term.

4 Cladode survival was higher in NH. Cladodes were more successful than seedlings at establishing in intercanopy areas, possibly due to physiological differences as well as their ability to survive partial predation. Cladode survival in intercanopy areas may explain the enhanced clonal propagation in the more open NH scrubland, together with their susceptibility to the flooding which affects GH.

5 The high seedling and cladode survival in the greenhouse experiments contrasted with that observed in the field, indicating that survival is determined by the interaction between herbivores, plants and abiotic conditions rather than the physiological aptitude of the plants.
A 6000‐year soil pollen record of subalpine meadow vegetation in the Olympic Mountains, Washington, USA
Authors: Gavin Daniel G. , Brubaker Linda B.
Published: March 2003

1 Subalpine meadow communities are influenced by edaphic and microclimatic gradients, and should be affected by climate change that affects these local controls. We used pollen preserved in meadow soils to investigate the long‐term interaction of these factors in a 1‐ha subalpine meadow in the Olympic Mountains, Washington, USA.

2 To describe the spatial scale at which soil pollen is related to neighbouring vegetation, pollen in 46 soil surface samples was compared with plant cover within concentric circular plots (0.5–1 m radii). Regression analysis of percentage pollen with plant cover at different distances from the surface sample had the highest correlation with radii < 1 m, confirming that entomophilous meadow species have very small relevant pollen source areas.

3 We analysed pollen records in soil columns at three sites representing a range of growing season lengths and community types within the meadow. Soils had aggraded by the deposition of eolian silt. Radiocarbon dates of pollen concentrates were similar to or older than radiocarbon dates on charcoal pieces at the same depth, suggesting negligible downwards movement of pollen in the soil profile.

4 The oldest soil pollen profile was from the wettest microsite, currently dominated by a snowbed Carex nigricans community. This site was occupied by a dry Juniperus community prior to c. 6000 bp (before present), when it shifted to more mesic communities dominated by Poaceae and Polemonium. The first appearance of a snowbed Carex nigricans community at this site, c. 2500–1500 bp, suggests a change to cooler and/or wetter regional climate.

5 High levels of Polygonum bistortoides at all sites indicated a shift to long snow‐free periods and mesic summer conditions during an interval corresponding to the Medieval Warm Period (c. 1200–700 bp). After 500 bp (during the Little Ice Age) Carex nigricans re‐established in the wet microsite, while relatively little change occurred at the other two sites. Overall, the greater magnitude of change at this microsite than at the longer growing‐season sites indicates that, in these subalpine meadows, short growing season sites are most sensitive to regional climate change.
Effects of habitat fragmentation on choke disease (Epichloë bromicola) in the grass Bromus erectus
Authors: Groppe Kathleen , Steinger Thomas , Schmid Bernhard , Baur Bruno , Boller Thomas
Published: March 2003

The fungal endophyte Epichloë bromicola causes choke disease on Bromus erectus, thereby suppressing maturation of host inflorescences. We conducted a 3‐year field experiment to investigate the effects of small‐scale habitat fragmentation on the occurrence of choke disease in three calcareous grasslands in the Swiss Jura Mountains, where, overall, 4.3% of all flowering tillers had diseased inflorescences.

 The number of diseased B. erectus plants (presumed genets), the number of tillers with diseased inflorescences, and the number of tillers with healthy inflorescences were counted over 3 years, but healthy tillers could not be allocated to particular genets. Each of 12 blocks contained one large (4.5 × 4.5 m), one medium (1.5 × 1.5 m) and two small (0.5 × 0.5 m) fragments and corresponding control plots. The percentage of tillers in the plots that were infected but did not show disease symptoms (asymptomatic plants) was estimated in the final year of the study using a diagnostic polymerase chain reaction. On average 1.7% of all tillers without disease symptoms were infected.

 There were significantly more diseased plants in fragment than in control plots, particularly in small fragment plots or in the third year of the study, indicating that disease incidence in the host plant increased after fragmentation if assessed at the level of the genet population. This was probably due both to a switch of genets from the asymptomatic to the symptomatic state and to increased horizontal transmission of the disease in fragments.

 The increase in the number of flowering tillers with diseased inflorescences was outweighed by that in the number of tillers with healthy inflorescences. Disease incidence was therefore decreased by fragmentation if assessed at the level of the host flowering tiller population. The effect on healthy plants was probably due to beneficial abiotic edge effects following fragmentation.

 Plot size affected fragmentation response, with the largest increases in small, followed by medium and large fragments. Similarly, the strength of fragmentation responses increased through time over the 3‐year study period.

 Significant site to site and year to year variation in the number of diseased plants and in the number of tillers with diseased inflorescences suggested that separate experiments with replication within site and year would have yielded a series of interesting but individually different results. Only by repeating the experiments at several sites and over several years was it possible to obtain the general results reported in the previous points.
Inferring landscape dynamics of bog pools from scaling relationships and spatial patterns
Authors: Belyea Lisa R. , Lancaster Jill
Published: March 2003

1 On many peatlands, a patterned landscape is formed by clusters of open‐water pools enclosed by the peat of surrounding terrestrial and semi‐aquatic habitats. Processes governing development of pool complexes operate over long time‐scales (decades to millennia) that preclude direct observation and necessitate inferential analysis.

2 We used present‐day scaling relationships and spatial patterns of pools to test multiple hypotheses for development and dynamics of a bog pool complex in the Flow Country of northern Scotland. The complex included 641 permanent pools, ranging in surface area from 2.3 to 1930 m2.

3 Allometric scaling relationships and spatial analysis showed that the shape and distribution of pools is size‐ (or age‐) dependent. With increasing size, pools became deeper relative to their surroundings and more convoluted and elongated in shape. Pool orientation and bathymetry were related to direction of slope. Small pools were located on the periphery of a focus now occupied by the largest pools. Peat depth varied systematically across the complex, leading to changes in both direction and gradient of water flow.

4 The evidence suggests that pools formed initially where water tended to pond, and subsequently spread outward as the flat plateau expanded. Pools have accumulated sediment more slowly than surrounding areas, and the continued initiation of new pools seems to depend on this spatial variation in rates of sediment accumulation. Our study provides both a fuller understanding of the development of one pool complex, and techniques for comparative analysis of others.
The effects of fertilization and herbivory on the herbaceous vegetation of the boreal forest in north‐western Canada: a 10‐year study
Authors: Turkington Roy , John Elizabeth , Watson Sally , Seccombe‐Hett Pippa
Published: March 2003

1 The influence of fertilizer addition and mammalian herbivore exclosures (a 2 × 2 factorial design, with four replicates at each of two sites) on the cover, species composition and diversity of the understorey vegetation of the boreal forest in the south‐western Yukon, Canada, were investigated from 1990 to 1999. This was done to test whether vegetation composition was controlled by resource level alone (bottom‐up control), herbivory alone (top‐down control), or by both (interactive control).

2 The density of the major herbivore, the snowshoe hare, varied 25‐fold, declining from 148 km−2in 1990 to 8 km−2in 1994, and increasing to a second peak of 198 km−2in 1998.

3 In control plots most species were remarkably constant in percent cover. After 10 years, most of the major species showed significant responses to fertilizer with four species increasing (Festuca altaica,Mertensia paniculata,Epilobium angustifolium, andAchillea millefolium), and three declining (Linnaea borealis,Lupinus arcticus,Arctostaphylos uva‐ursi). Some species took up to 5 years before a response was detected.

4 Fertilization caused (i) a decline in the number of species, and species evenness in the community, (ii) a reduction in the proportion of woody species, and (iii) an increase in herbaceous dicotyledons and grasses.

5 The exclusion of herbivores had virtually no impact on the abundance of the vegetation or on species diversity, except in 1990–92 during a decline from a peak of 148 hares km−2to 29 hares km−2.

6 These results suggest that the percentage cover and composition of herbaceous vegetation in the boreal forest are determined almost exclusively by the productivity of the site (bottom‐up control) and that the activities of mammalian herbivores may be important only during peaks in hare population densities (interactive control).

7 Results were both species‐specific and time‐dependent, suggesting that long‐term studies are needed to discriminate between long‐term responses to treatments and transient phenomena.
A spatial model of coexistence among three Banksia species along a topographic gradient in fire‐prone shrublands
Authors: Groeneveld J. , Enright N. J. , Lamont B. B. , Wissel C.
Published: March 2003

A spatially explicit, rule‐based model for three co‐occurring Banksia species was developed to investigate coexistence mediating processes in a fire‐prone shrubland in western Australia. Fecundity, recruitment, mortality and other biological data for two non‐sprouting (B. hookeriana, B. prionotes) and one resprouting (B. attenuata) species were available from 15 years of empirical field studies.

Without interspecific competition, each species could persist for a wide range of fire intervals (10 to > 20 years). The resprouting species performed better under shorter fire intervals (10–13 years), while both non‐sprouting species were favoured by longer (15 to > 20 years) fire intervals. These results conform with those obtained from single‐species, non‐spatial population models.

When interspecific competition for space was included in the model, all three species exhibited optima at shorter fire intervals and with a narrower range than in isolation. The three species did not co‐occur under any fire regime. At intermediate fire frequencies (11–13 years), B. hookeriana excluded the other species, while for longer intervals between fires B. prionotes became dominant.

The introduction of temporal (stochastic) variability in fire intervals (drawn from a normal distribution) failed to produce coexistence, unless spatial variability as a spatial ignition gradient was also included. The spatial arrangement of the non‐sprouters observed in the field was then reproduced.

Observed patterns of coexistence and spatial distributions of all species occurred when a spatial establishment gradient for the resprouter species was included in the model (individuals of B. attenuata are known to produce more seeds in swales than on dune crests and recruit seedlings here more frequently).

Coexistence appears to be highly dependent upon the mean interfire period in combination with subtle gradients associated with fire propagation and recruitment conditions. Variation around the mean fire interval is less critical. When the system is modelled over a long time period (1500 years) coexistence is most strongly favoured for a narrow window of mean fire intervals (12–14 years).
The effect of maternal phenology on offspring characters in the herbaceous plantCampanula americana
Authors: Galloway Laura F.
Published: March 2003

An individual's phenotype may influence the expression of traits in its offspring. I tested whether maternal flowering phenology influenced offspring germination and thus life history schedule in two populations ofCampanula americana. Autumn‐germinatingC. americanagrow as annuals whereas individuals that germinate in the spring are biennials.

Under near‐natural conditions, early‐season flowers produced seeds that were more likely to germinate in the autumn than late‐season flowers, but spring germination was equally likely for all seeds.

Seed mass (two of three years) and percentage and timing of germination under constant environmental conditions (all three years) did not vary across the reproductive season. External environmental factors are therefore more likely to contribute to seasonal changes in the probability of germinating in the autumn than are the characteristics of the seeds.

The frequency of annual offspring varied among maternal plants. The association between the time a flower was open and offspring germination season suggests that evolution of life history schedule may be accomplished by altering maternal flowering phenology.

The association between the time of a flower's anthesis and its fruit maturation was weaker in two years when water was limiting. Limited water also resulted in earlier seed maturation, and consequently a greater proportion of a population's seed being produced during the period when autumn germination was likely. This, in combination with differences between populations, suggests that the magnitude of maternal phenological effects varies across years and populations.
ESSAY: Finding the ethical standard of medical science in the age of the sciences
Authors: Needham Charles W.
Published: March 2003

Science has nothing to do with ethics. Science is blind to good and evil. Ethics is a division of philosophy, not science. Socrates was the father of ethics, not science. The science of his day taught him little about human nature. Searching his soul enlightened. It is therefore odd to find certain modern scientists employing the Socratic method. They ask probing questions. Their questions begin a conversation, as though they know nothing. They do know there are serious limits to knowledge. Like Socrates they may admit their ignorance. They define terms. Then they differentiate between real knowledge and mere opinion. They argue, in order to demolish false opinion. Truth is what is left when the rest has been destroyed by compelling logic.
The role of research evidence in pharmaceutical policy making: evidence when necessary but not necessarily evidence
Authors: Willison Donald J. , MacLeod Stuart M.
Published: March 2003

The use of research evidence in policy making at the legislative and administrative levels would appear to be very selective. Focusing on pharmaceutical policy, this paper argues that research evidence is only one ingredient leading to a policy decision and that any examination of research transfer into policy must take into account the many other factors which impact on decision making. The paper describes the policy making process, barriers to the uptake of research evidence into policy and ways of improving research uptake into policy making. Examples are given from drug licensing, remuneration policies, post‐marketing surveillance and product withdrawal from the market.
The lack of integration of clinical audit and the maintenance of medical dominance within British hospital trusts
Authors: McErlain‐Burns Tracey L. , Thomson Richard
Published: March 2003

Abstract: Concerns have been expressed repeatedly about the effectiveness of clinical audit. Some have argued that this is limited by the lack of integration within day‐to‐day practice and with other NHS policy initiatives. We aimed to explore what mechanisms were being used to develop annual clinical audit programmes within NHS Trusts, and to describe the influence of other initiatives on this; to understand how such influences are exerted; and to understand the role of key players, in order to inform future programme development. Semi‐structured face‐to‐face interviews were performed with Chairs of Clinical Audit Committees, Clinical Audit Managers and Co‐ordinators (N = 15) in the former Yorkshire Region of the NHS in England. Concerns about the development, planning and integration of clinical audit focused upon an almost exclusive medical dominance and upon how audit leadership could be delivered within the context of hospital management structures. The lack of an overall plan for the development of clinical audit in most sites was seen as enabling the doctors’ agenda to dominate. Purchasing authorities were recognized as being important, but often with limited influence. Other influences on the audit agenda, such as research and development (R&D) and clinical risk management, were rarely well co‐ordinated. These findings concur with previous studies in identifying a wide range of constraints on the progress of audit. Several of these constraints operate within the internal environment, for example the doctors’ agenda, and concerns about management involvement. Such constraints require resolution in order to facilitate the integration of audit with other initiatives and to achieve the goals of audit effectively. Clinical effectiveness and clinical governance may offer a means of facilitating this integration.
Principles to govern clinical governance
Authors: Onion Carl W. R.
Published: March 2003

Clinical governance – a new NHS concept that seeks, through clinical guidelines and national service frameworks, to encourage and enforce com‐pliance with nationally‐devised evidence based clinical policies – has manifold and complex implications. This paper reasons that clinical governance is actually a means to promote excellent practice of a particular kind and that non‐compliance does not necessarily equate to bad practice. Therefore, separate means must be utilized to address bad practice. The paper proposes and supports in turn a series of principles to ensure that the potential benefits of clinical governance are maximized and the potential harms are diminished. A similar set of principles is proposed to help govern the management of bad practice. The complementary conclusions of the reasoning are that a) doctors should willingly embrace clinical governance and b) the NHS should not rigidly enforce it. However, as clinical governance restricts clinical freedom and patient choice it is important that ethical principles, such as those proposed, are followed in order to avoid or manage some unhappy conflicts.
Effectiveness of educational interventions on the improvement of drug prescription in primary care: a critical literature review
Authors: Figueiras Adolfo , Sastre Isabel , Gestal‐Otero Juan Jesus
Published: March 2003

This paper is a critical review of studies of educational programmes designed to improve prescription practices in ambulatory care. Scientific articles were selected from the following bibliographical indices: MEDLINE, IME, ICYT and ERIC. The searches covered the time period between 1988 and 1997. The search criteria included: primary‐care, educat*, prescription* and other related keywords. The inclusion criteria were studies describing educational strategies aimed at general practitioners working in ambulatory settings. The study outcome was change in prescribing behaviour of physicians through prescribing indicators. The following data were extracted: study design, target drugs, type of intervention, follow‐up period of the prescription trends, type of data analysis, type of statistical analysis and reported results. We found 3233 articles that met the search criteria. Of these, 51 met the inclusion criteria and 43 studied the efficacy/effectiveness of one or various interventions as compared to no intervention. Among seven studies evaluating active strategies, four reported positive results (57%), as opposed to three of the eight studies assessing passive strategies (38%). Among the 28 studies that tested reinforced active strategies, 16 reported positive results for all variables (57%). Eight studies were classified as a high degree of evidence (16%). We concluded that the results of our review suggest that the more personalized, the more effective the strategies are. We observe that combining active and passive strategies results in a decrease of the failure rate. Finally, better studies are still needed to enhance the efficacy and efficiency of prescribing practices.
Physicians’ attitudes towards voluntary reporting of adverse drug events
Authors: Figueiras Adolfo , Tato Fernando , Fontaiñas Jesus , Takkouche Bahi , Jesus Gestal‐Otero Juan
Published: March 2003

At the time a new drug is placed on the market, information on its therapeutic effect and toxicity is limited. Because of its simplicity and widespread use, the voluntary reporting by clinical physicians is the main method for detecting rare or unexpected adverse drug events (ADEs). However, the usefulness of this method may be compromised if the reporting rate is low. We present the results of a questionnaire‐based case‐control study carried out among 692 physicians from Galicia (north‐west region of Spain), in which we assessed their attitudes and opinions towards ADEs. In general, the Galician physicians think it is difficult to link a given ADE with a drug (P < 0.05) and have very heterogeneous opinions on the fact that very severe ADEs are known before the drug is commercialized. They globally disagree with the proposal that ADE reporting should be remunerated and the fact that ADE reporting can be risky for the physician. Some of the beliefs concerning ADEs are incorrect. It is crucial to improve the training of the physicians through active educational strategies based on personal contact.
Age period cohort analysis of time trends in regional mortality rates in England, Wales and Scotland
Authors: Robertson Chris , Ecob Russell
Published: March 2003

Previous studies have demonstrated regional variation in mortality rates, this reducing for younger but not older individuals. However, it has not been clear from such studies whether or not the overall findings can or cannot be attributed to particular regions that may have abnormal patterns of change over time. We analyse mortality rates by region using data from the census years from 1931 until 1991 for adults. Age period cohort models, based on the local ‘curvatures’, are used to describe the changes in the rates. We also use estimable contrasts to compare the later periods with the earlier periods and to compare pre‐ and post‐war cohorts. There is strong evidence that the changes in the mortality rates are associated with non‐linear period and cohort effects. There is no evidence that these curvatures vary over regions. There is evidence that the curvatures are not the same among men and women. Among women there is evidence that there is a change in trend in the periods from 1961 to 1991 compared with the trend in the earlier periods from 1931 to 1951, such that the reduction in the mortality rates with time are slowing down for women. Among men who had higher mortality rates, there is not so much evidence of a slowing down of the reduction. Post‐war cohorts of women from 1941 onwards are enjoying a reduction in mortality compared with the cohorts from 1901 to 31, while among men there is no evidence of a change in mortality trends among younger cohorts. Changes in the mortality rates over regions have come about from different long‐term temporal trends in the regions rather than abrupt changes taking place at different times in different regions. The general convergence of mortality rates over regions over time with a consequent reduction in regional variance is masked by two regions, Scotland and East Anglia. These regions appear to differ from the regions as a whole in the relationship of mortality to age at a given period and in the reduction of mortality over time (drift), Scotland having a higher mortality, especially at younger ages, and lower downward trend, and East Anglia vice versa.
Evaluation of chloroquine as a potent anti‐malarial drug: issues of public health policy and healthcare delivery in post‐war Liberia
Authors: Massaquoi Moses B. F. , Kennedy Stephen B.
Published: March 2003

Chloroquine‐resistant plasmodium falciparum malaria is a serious public health threat that is spreading rapidly across Sub‐Saharan Africa. It affects over three quarters (80%) of malarial endemic countries. Of the estimated 300–500 million cases of malaria reported annually, the vast majority of malarial‐related morbidities occur among young children in Africa, especially those concentrated in the remote rural areas with inadequate access to appropriate health care services. In Liberia, in vivo studies conducted between 1993 and 2000 observed varying degrees of plasmodium falciparum malaria infections that were resistant to chloroquine, including sulfadiazine‐pyrimethamine. As the country emerges from a prolonged civil war, the health care delivery system may not be adequately prepared to implement an effective nation‐wide malarial control strategy. As a result, the management of uncomplicated malaria in Liberia poses a significant public health challenge for the government‐financed health care delivery system. Therefore, based on extensive literature review, we report the failure of chloroquine as an effective first‐line drug for the treatment of uncomplicated plasmodium falciparum malaria in Liberia and recommend that national health efforts be directed at identifying alternative drug(s) to replace it.
Observational study of erythrocytic inclusion bodies in farmed Atlantic salmon, Salmo salar L., in the British Isles
Authors: Rodger  , Richards
Published: March 2003

An observational study was conducted of farmed Atlantic salmon, Salmo salar L., in the British Isles with regard to intraerythrocytic inclusions and disease prevalence. Intraerythrocytic inclusions were observed to be widespread in Atlantic salmon from farms in Ireland and Scotland. The percentage of fish infected with these inclusions and the intensity of infection were greater in sea stage salmon than those in fresh water. This corresponded with reduced values for haematological parameters (haematocrit, erythrocyte count, haemoglobin, MCV, MCH, MCHC). There appeared to be a significant association between the presence of the intraerythrocytic inclusions and focal cardiomyopathy, although there was no established association with overt clinical disease and the presence of the inclusions. There was also a significant association between the presence of raised splenic haemosiderin and multiple intraerythrocytic inclusions.
Plasma protein changes in Atlantic salmon, Salmo salar L., with infectious salmon anaemia
Authors: Simko E , Falk K , Poppe T T , Ferguson H W
Published: March 2003

Moderate to severe anaemia and hypoproteinaemia were reported in a Canadian outbreak of ‘haemorrhagic kidney syndrome’ in Atlantic salmon, later shown to be caused by a variant of infectious salmon anaemia virus (ISAV). The progressive anaemia associated with ISA has been previously reported, but hypoproteinaemia in salmon infected with European isolates of ISA virus has not been well documented. The present study showed a very significant positive correlation between decreasing haematocrit values and total plasma protein concentrations in Atlantic salmon infected with two Canadian and two Norwegian ISA viral isolates. However, variations in the concentration of individual plasma proteins, typical of acute phase responses in higher vertebrates, were not observed.
Inhibitory effects of a monoclonal antibody (MAb‐001) on in vitro oxygen consumption and multiplication of the pathogenic haemoflagellate, Cryptobia salmositica Katz
Authors: Hontzeas N , Feng S , Woo P T K
Published: March 2003

A monoclonal antibody (MAb‐001), against a surface glycoprotein on Cryptobia salmositica inhibited the multiplication and oxygen consumption of both virulent and avirulent strains of the parasite. The classical cysteine proteinase inhibitor (E‐64) and a cysteine proteinase activator (EDTA) affected the in vitro multiplication of C. salmositica. Concentrations of E‐64 higher than 10 μM reduced the multiplication of C. salmositica while 5 mM of EDTA enhanced its multiplication. We propose that the cysteine proteinase is an important metabolic enzyme in C. salmositica and that binding of MAb‐001 to the enzyme inhibited parasite multiplication and reduced oxygen consumption.