bluuebunny/crossref_metadata_2025 huggingface dataset:
Restraint use in elder care: decision making among registered nurses
Authors: Karlsson Stig , Bucht Gösta , Rasmussen Birgit H. , Sandman
Published: March 2003

•  This study aimed to illuminate nurses’ reasons for using physical restraint in nursing practice, and in addition, to explore the relationship between nurses’ attitudes and decisions regarding physical restraint use.

•  To provide data about nurses’ reasoning when deciding whether or not to use restraints, 30 registered nurses working in two nursing homes were asked to read a written clinical vignette describing a fall‐prone person with dementia who refused to be physically restrained. The association between the decision made and the nurses’ attitudes toward restraint use was measured by Perceptions of Restraint Use Questionnaire (PRUQ).

•  Twenty‐one nurses would at first disregard the patient’s wish and use the restraint in the given situation while nine would not. When new relevant facts were provided all nurses except two were ready to change their decision. A significant relationship between nurses’ decisions and their attitudes toward restraint use was also found.

•  The results showed that, although nurses endeavour to decide what they consider to be in the patient’s best interests, this ambition is affected by a variety of variables, especially in relation to the working conditions and the nurses’ willingness to take the risk when not restraining the patient.
Searching for sustainable change
Authors: Balfour Mags , Clarke Charlotte
Published: March 2003

•  Change in nursing practice has been dogged by factors which have been perceived to be outside the autonomy of nurses. Consequently, projects have been initiated which have then faltered or even ceased altogether.

•  This paper reports on an action research study that was carried out in Newcastle from 1997 to 1999 and used the process within a focus group setting to rekindle and sustain an innovative change.

•  The aim of the study was to look at staff perceptions surrounding development of the practice of self‐administration of medication for patients.

•  The findings support the view that all disciplines need to be involved in health service change.

•  Health service employees should have a knowledge of the theory associated with the change process and be open about their views of proposed alterations in practice.

•  They also need to have a sense of dissatisfaction with the present, a clear outline of what the problem is and the direction which they intend to take.

•  Change involves many complex issues. It should be worked through from a bottom‐up approach and consist of repeated evaluation exercises which are akin to a cyclical strategy and include a reflective process.
Living the revolution: Cuban health workers
Authors: Warman Andrea
Published: March 2003

• The cuban government has placed a very high emphasis on health since 1959 and vaccination and health education campaigns, as well as access to a comprehensive free healthcare system, have contributed to dramatic improvements in the population’s health status.

• Much that has been written about the Cuban health service has relied on published sources, but this article is based on 18 months spent carrying out ethnographic fieldwork in the country, with particular emphasis on the daily lives of women employed in the health sector. Data were collected by participant observation, interviews and life‐story work. Family doctors are usually young women completing their specialist training. They work in health centres in apartment blocks in which they also live. They work closely with nurses and other health and social service workers.

• Health workers are expected to live and work in their own communities, to act as role models for their patients, and to be available at all times.

• Whilst this has led to an extremely well‐informed population and accessible healthcare, it has brought costs to healthcare workers in terms of very high expectations, a feeling that they do not have a private life, and stress caused by the inability to meet patient demands in the face of shortages of medicines and other supplies as a result of the continuing US trade blockade.

• These pressures and frustrations for healthcare workers may have parallels in Western healthcare services which are subject to resource constraints.
Evidence‐based practice: tap water cleansing of leg ulcers in the community
Authors: Selim Pam , Bashford Chris , Grossman Cheryl
Published: March 2003

• To establish and encourage wound management practices based on evidence, a Community Nursing Organization in metropolitan Adelaide began a series of research initiatives in 1997.

• Based on the results of a wound management survey, and through the processes of participatory action research with clinicians, many wound management practice changes were instigated throughout the Community Nursing Organization.

• One question remains unanswered: What is the evidence for the use of sterile saline or clean tap water for cleansing of leg ulcers in the community?

• In this paper we describe a project where we applied the three principles of planning, action and evaluation.

• Application of these principles enabled clinicians to collaborate in the search for evidence to support or refute tap water cleansing of leg ulcers.

• To conclude, we report on a pilot research project undertaken to obtain further evidence either to support or refute the use of tap water cleansing for leg ulcers in the community.
Adherence to self‐care and social support
Authors: Toljamo Maisa , Hentinen Maija
Published: March 2003

• The purpose of the study reported in this paper was to describe adherence to self‐care, perceived difficulties and social support in a group of adult patients (n=213) with insulin‐treated diabetes from two outpatient clinics in Northern Finland.

• Data were collected by questionnaire. The instruments were developed to measure adherence to self‐care, difficulties in self‐care and social support. The response rate was 76%.

• One‐way ANOVA, logistic regression analysis, contingency and Pearson’s correlation coefficients were used in the statistical analysis.

• A fifth of the respondents were neglecting their self‐care. The others undertook flexible, regimen‐adherent or self‐planned self‐care.

• The subjects had no difficulties with insulin treatment, but had more problems with other aspects of self‐care.

• Poor metabolic control, smoking and living alone predicted neglect of self‐care, but if patients had support from family and friends, living alone was not a predictor of neglect of self‐care.

• Those with poor metabolic control perceived themselves as getting peer support from other persons with diabetes.
Consumer issues in navigating health care services for type I diabetes
Authors: Rasmussen Bodil , Wellard Sally , Nankervis Alison
Published: March 2003

• Despite increasing interest in consumer awareness and participation in health care service delivery, there has been little exploration of consumer views in relation to services for people with type I diabetes.

• The purpose of this qualitative exploratory study was to identify strategies people with type I diabetes used to access health services and the barriers they perceived in accessing the services they needed.

• Data gathered in semi‐structured interviews revealed that consumers experience significant barriers when navigating the health care system.

• Three dominant themes were identified. They relate to access to specialist medical skill, to the transition from teenager to young adult and to pre‐pregnancy and obstetric care.

• Directions for change in service delivery and policy development are discussed.
Learning intravenous cannulation: a comparison of the conventional method and the CathSim Intravenous Training System
Authors: CHANG KATHERINE KA‐PIK , CHUNG JOANNE WAI‐YEE , WONG THOMAS KWOK‐SING
Published: March 2003

• Intravenous cannulation is a nursing procedure carried out in some clinical units that may induce trauma and discomfort. Nurses should be well prepared before practising the procedure with clients.

• Conventionally, a plastic arm was used for practice but, with innovative developments in technology, a computer program called the CathSim Intravenous Training System (CathSim ITS) is available for this purpose. This study was conducted to compare the effectiveness of learning using a plastic arm with the CathSim ITS.

• Twenty‐eight nurses were divided into two groups and randomly assigned to the two different methods: plastic arm (control group) or CathSim ITS (experimental group). Both groups were provided with 1 hour of theory input and 2 hours of nursing laboratory work.

• When the nurses felt ready to practise on clients, their performances were assessed by researchers with an intravenous cannulation qualification using a validated checklist. Prior to the assessment, trait and state anxiety levels were measured using the State‐Trait Anxiety Inventory (Hong Kong Chinese adaptation) to check whether anxiety would affect the performance. Following the assessment, a semi‐structured interview was conducted to reveal any knowledge acquired through using the selected method.

• Both the control and CathSim ITS groups demonstrated a high success rate, scoring 100% and 92.86%, respectively, with their first client.

• The semi‐structured interviews revealed that the CathSim ITS group appreciated several features of their assigned method. However, there is room for further development.
Working with women experiencing mid‐trimester termination of pregnancy: the integration of nursing and feminist knowledge in the gynaecological setting
Authors: HUNTINGTON ANNETTE D.
Published: March 2003

• Working with women experiencing a mid‐trimester termination of pregnancy is part of clinical practice in many gynaecological services. In this paper recent research with nurses working in the gynaecological area is drawn on to explore the issues for nurses working with women experiencing mid‐trimester termination. Mid‐trimester terminations are those carried out between approximately 12 and 20 weeks.

• Mid‐trimester termination results in the delivery of a fetus and this event requires sensitive management as it is has the potential to cause distress for the women due to the psychological and physical impact of the procedure. However, health professionals involved can also find this a distressing clinical event due to the complex nature of the management and care required.

• Consideration of this clinical event from a feminist perspective led to my exploring the way in which feminist theory could be applied in the situation of mid‐trimester termination. Using notions from feminist theory can assist in the management of this process, and feminist concepts related to the centrality of women's experience can be integrated into actual practice.

• A series of recommendations are provided in this paper to show the way in which feminist concepts can be integrated into clinical practice. Integrating feminist principles into practice can support both the woman experiencing the abortion and the nurse whose role in the event is sustained and intimate, and result in positive outcomes for both women. This can result in an environment that is safe and supportive for all women involved in mid‐trimester terminations.
Nurses' decision‐making in collecting information for the assessment of patients' nursing problems
Authors: JUNNOLA TARJA , ERIKSSON ELINA , SALANTERÄ SANNA , LAURI SIRKKA
Published: March 2003

• The paper addresses two questions: Firstly, what kind of information do nurses acquire from cancer patients for purposes of judging their patients' problems and preparing a care plan? Secondly, how systematically do nurses proceed in the decision‐making process from the formulation of initial assumptions about the patient's situation to the final definition of problems?

• The instrument used for data collection was a computer‐simulated case description compiled by a team of four nursing researchers and one medical researcher. The case description was based on a real patient history.

• The sample consisted of 107 Registered Nurses on four oncology, two internal medicine and five surgical wards of two central university hospitals in Finland. Data were collected in autumn 1998 and spring 1999 using a laptop computer and a tape recorder.

• The four most important problems identified by nurses at baseline were pain (85%), pain medication (59%), family situation (66%) and spread of cancer (49%). Presented with a list of 23 options, they obtained additional information on average on 13 areas. Almost one‐third collected information from 16 to 22 areas. On average nurses identified 12 of the 28 nursing problems specified. A statistically significant association was observed between information acquisition and problem definition in seven different variables. These had to do with pain, general condition and prognosis.

• Nurses adequately prioritized their patients' problems and systematically collected data on those problems. On the other hand they also identified a number of problems that were not relevant to the situation.
Nursing care and collaborative practice
Authors: KESBY SHEILA G.
Published: March 2003

• This article argues that the time is right for nurses in the UK to become the case managers in all healthcare settings. The re‐launch of family health nursing, as a model for the organization and delivery of nursing care in the community, and the advent of the GP practice‐based self‐managed integrated nursing teams, offer the means by which to take up the opportunities presented by recent legislation and the national strategies for promoting partnership working and collaborative practice.

• Nurses could approach this by combining their current involvement with developing the single assessment process for older people with the overall development of interprofessional collaborative practice across all boundaries in health and social services. Despite the new opportunities, this will not be straightforward because of the still existing problems associated with the health and social care divide.

• In order to generate high quality care, it is imperative for nurses and their patients that the profession gains control and ownership of its own policy, remit and practice.

• Nursing care should be defined according to the patient's condition, so that their dependency level, diagnostic picture and potential for rehabilitation govern the eligibility criteria for health or social care and not the level of technicality in the task itself.
Crossing boundaries, re‐defining care: the role of the critical care outreach team
Authors: COOMBS MAUREEN , DILLON ANN
Published: March 2003

• There is clear indication that both government and professional policy in the United Kingdom supports a radical change in the role of healthcare practitioners, with a move towards a patient‐focused service delivered by clinical teams working effectively together.

• Recent health service imperatives driving the agenda for flexible clinical teams have occurred simultaneously with an increased public and political awareness of deficits in availability of critical care services.

• Against this policy backdrop, working across professional and organizational boundaries is fundamental to supporting quality service improvements. In the acute care sector, the development of critical care outreach teams is an innovation that seeks to challenge the traditional support available for sick ward patients.

• Activity data and observations from the first 6‐month evaluation of two critical care outreach teams identify the need for clinical support and education offered by critical care practitioners to ward‐based teams.

• The experiences from such flexible clinical teams provides a foundation from which to explore key issues for intradisciplinary and interdisciplinary working across clinical areas and organizational boundaries.

• Adopting innovative approaches to care delivery, such as critical care outreach teams, can enable clinical teams and NHS trusts to work together to improve the quality of care for acutely ill patients, support clinical practitioners working with this client group, and develop proactive service planning.
‘The Hidden Client’– women caring for husbands with COPD: their experience of quality of life
Authors: Bergs Dóróthea
Published: March 2003

• The purpose of this phenomenological study was to describe the experience of quality of life of women, taking care of husbands with chronic obstructive pulmonary disease (COPD).

• Unstructured, in‐depth, tape‐recorded personal interviews were used to collect data from six women living with husbands with COPD.

• The women ranged from 47 to 69 years in age and their husbands had given up work because of the illness.

• The wives in the study were dissatisfied with their lack of recreation, as well as support from friends, families and health care providers.

• Factors that increased the wife's quality of life were children andgrandchildren and being able to please the husband and care for him until the very end.
Hierarchy of evidence: a framework for ranking evidence evaluating healthcare interventions
Authors: Evans David
Published: March 2003

• A number of hierarchies of evidence have been developed to enable different research methods to be ranked according to the validity of their findings. However, most have focused on evaluation of the effectiveness of interventions. When the evaluation of healthcare addresses its appropriateness or feasibility, then existing hierarchies are inadequate.

• This paper reports the development of a hierarchy for ranking of evidence evaluating healthcare interventions. The aims of this hierarchy are twofold. Firstly, it is to provide a means by which the evidence from a range of methodologically different types of research can be graded. Secondly, it is to provide a logical framework that can be used during the development of systematic review protocols to help determine the study designs which can contribute valid evidence when the evaluation extends beyond effectiveness.

• The proposed hierarchy was developed based on a review of literature, investigation of existing hierarchies and examination of the strengths and limitations of different research methods.

• The proposed hierarchy of evidence focuses on three dimensions of the evaluation: effectiveness, appropriateness and feasibility. Research that can contribute valid evidence to each is suggested. To address the varying strengths of different research designs, four levels of evidence are proposed: excellent, good, fair and poor.

• The strength of the proposed hierarchy is that it acknowledges the valid contribution of evidence generated by a range of different types of research. However, hierarchies only provide a guide to the strength of the available evidence and other issues such as the quality of research also have an important influence.
Software design to support discussion in the primary curriculum
Authors: Wegerif R. , Mercer N. , Dawes L.
Published: March 2003

This paper puts forward a framework for the integration of pedagogy and software design to support educationally valuable discussion within the primary curriculum. In order to illustrate and to evaluate this framework, two educational programs were designed to be used in conjunction with a series of lessons to coach the use of ‘exploratory talk’ in small group work. Evaluation of the first item of software, in the area of citizenship, focused upon the difference that off‐computer lessons in exploratory talk made to the way it was used. Evaluation of the second program, in the area of science, focused on the effect of the overall approach on learning outcomes. The results of these two illustrative studies support the value of the proposed framework. The first shows that combining software design with the off‐computer coaching of exploratory talk can enhance the quality of interactions at the computer. The second shows that, with this pedagogical framework, computers can be used to stimulate collaborative learning and to direct it towards curriculum goals.
Learning in cyberspace:shaping the future
Authors: Gilliver R. S. , Randall B. , Pok Y. M.
Published: March 2003

Proponents of multimedia and Internet based educational tools have long claimed their potential, but the absence of broad based quantitative research from controlled experimental use, continues to mitigate the transfer of that potential to reality. This paper reports on experimental work in Singapore, which was designed to establish a supportable theoretical foundation for the hypothesis that the use of information technology (IT) resources in education, does improve pedagogic outcomes. The authors reach a positive conclusion, and attribute those improved outcomes to the use of IT resources through the conduit of improved student motivation. The paper also draws the important distinction between using multimedia and the Internet as a facilitator of learning rather than teaching, and reports upon the research project in detail, particularly improvements in student understanding and results, quantified at 11% in one semester. There were also productivity gains of 16% for educators as a result of effective use of Internet resources and use of the Internet to deliver course material for learning. Based on the research work done, this paper draws the statistically valid conclusion that use of IT resources does improve student learning.
The impact of LOGO on gifted children's achievement and creativity
Authors: Subhi T.
Published: March 2003

It was hypothesised that problem solving via the Arabic logo programming environment would enhance gifted children's mathematics achievement and their creativity as measured by their performance on Torrance Tests of Creative Thinking (TTCT) and Mathematical Skills Assessment (MSA). The study findings extend previous research by indicating that problem solving via the LOGO programming environment can enhance mathematics achievement and creativity in figural, as well as verbal, domains. The evaluation of a large number of previous studies on the enhancement of creativity concluded that many of these studies have a positive effect. An implication is that computer environments may offer appropriate special provisions to meet the special needs of gifted children. In addition, this experiment provided some evidence that if gifted children work in pairs the need for teacher intervention to motivate the children is decreased. Also, if gifted children choose their own goals this increases their motivation and task commitment but might also restrict the range of mathematical ideas used.
A cross‐institutional approach to staff development in Internet communication
Authors: Creanor L. , Littlejohn A.
Published: March 2003

Abstract  Recent upsurge in emphasis on larger class sizes and work‐based learning requires lecturers to be equipped to switch from traditional face‐to‐face teaching techniques to communicating with students using new technologies. Dialogue is the vital ingredient which underpins the successful learning experience, and staff in HE are facing a challenge in developing the necessary skills to make effective use of the emerging communication tools. These skills can only be acquired through practice, understanding of the pedagogy and awareness of the various options available. The aim of this paper is to explore, through presenting a case study, the potential benefits of cross‐institutional collaboration in information and communication technology staff development. Since both the University of Strathclyde and Glasgow Caledonian University were investigating ways of promoting good practice in the development and use of new learning technologies, it seemed prudent to combine forces and share ideas. The paper will examine how attempts were made to bridge the skills gap by enabling academic staff to experience Internet communication from the perspective of both student and teacher.
Variation in the effects of vegetation and litter on recruitment across productivity gradients
Authors: Suding Katharine NasH. , Goldberg Deborah E.
Published: March 2003

1 We tested predictions about how the effect of vegetation and litter on seedling establishment varies among sites and herbaceous community types (sand barrens, prairies, fens). For both vegetation and litter, we also separated direct interactions from indirect interactions and interaction modifications along the gradient.

2 Although the intensity of the effects varied across sites, the direct effects of vegetation or litter alone were consistently facilitative along the productivity gradient. Predominance of facilitative effects may be due to the focus on the seedling establishment phase.

3 However, inclusion of indirect interactions and interaction modifications caused the net effects of both vegetation and litter to become largely negative. While one layer of biomass may be advantageous to ameliorate some moisture stress, the addition of another layer may be disadvantageous if this layer limits light proportionally more than it relieves moisture stress.

4 One exception to this pattern occurred at high productivity when the net effect of vegetation, even in the presence of litter, remained facilitative. The net effect of vegetation was competitive at low productivity and grew increasingly facilitative with productivity. Thus, indirect effects of litter may alter interaction patterns across this gradient.
Calcareous groundwater raises bogs; the concept of ombrotrophy revisited
Authors: Lamers Leon P. M. , Farhoush Cornelis , Van Groenendael Jan M. , Roelofs Jan G. M.
Published: March 2003

1 Raised bogs are traditionally regarded as being solely dependent upon atmospheric influences. However, these terrestrial carbon stores may also be affected by calcareous (bicarbonate‐rich) groundwater, which is often found in deeper peat layers.

2 Field data from a bog area in the Netherlands were used to select appropriate levels of bicarbonate supply for an aquarium mesocosm experiment. The effects of 0, 0.1, 0.5, 1 and 2 mmol HCO3–l–1, and 1 mmol HCO3–l–1 + 2 mmol SO42–l–1, on the biogeochemistry of peat monoliths, including theirSphagnumvegetation, were investigated.

3 Slightly increased alkalinity rapidly stimulated buoyancy of livingSphagnumdue to higher inorganic carbon concentrations in the water layer. Moderate HCO3–concentrations also stimulated buoyancy of the entire peat monoliths after 3 weeks, because of increased methane production rates. High alkalinity, however, led to rapid internal phosphate mobilization, peat disintegration andSphagnumdie‐off. This detrimental effect was stronger when sulphate was supplied simultaneously.

4 The results are discussed with respect to the carbon dynamics and overall functioning of peat bogs, in relation to hydrology and hydrochemistry (groundwater influence, sulphate pollution).
Positive and negative interactions at different life stages of a colonizing species (Quercus humilis)
Authors: Rousset Olivier , Lepart Jacques
Published: March 2003

1 The downy oak Quercus humilis has recently recolonized the Causse du Larzac plateau in southern France. We studied the influence of the shrubs Buxus sempervirens and Juniperus communis on Q. humilis establishment, and of Buxus on the growth of established Q. humilis individuals.

2 Percentage germination of experimentally planted Q. humilis was higher under shrubs than in nearby open areas and higher on the north than the south side of the canopy. Germination where part of the canopy has been removed was similar to that away from the shrubs, suggesting that the facilitation mechanism is related to changes in microclimate rather than to a soil effect.

3 When exposed to sheep for 1 month, 100% of 326 unprotected oak seedlings were grazed, causing 44% mortality. The presence of Buxus and Juniperus improved seedling survival by protecting them against sheep grazing and summer drought. Predation by rodents was however greater under shrub cover.

4 The highest leaf dry mass of oak seedlings was recorded under Juniperus where light conditions seem more favourable for growth than under Buxus (direct effect) or in grassland (indirect effect). The growth of naturally established individuals of Q. humilis (in terms of total leaf mass per annual branch and width of rings) was lower under Buxus than in grassland but the values became similar once the canopy was overtopped.

5 The balance between positive and negative interactions varied in relation to the life stage of Q. humilis and the two shrub species. Regeneration of Q. humilis in open grassland was prevented by grazing. The protection offered by shrubs continues to offset the negative interference on growth, particularly under Buxus, so that plants could survive to overtop the shrub canopy and reach maturity. The succession pathway therefore depends closely on the distribution of shrubs in the grassland.
Spatial genetic structure and clonal diversity of Anemone nemorosa in late successional deciduous woodlands of Central Europe
Authors: Stehlik Ivana , Holderegger Rolf
Published: March 2003

1 We tested whether established populations in similar environmental conditions exhibit similar or varying spatial genetic structures by comparing populations of the long‐lived species Anemone nemorosa from a number of late successional deciduous woodlands in Central Europe. We discuss the ways in which genetic structure may have been shaped by clonal growth and sexual reproduction.

2 A standardized sampling strategy was used to collect 30 ramets from each of 20 populations. Genotypes of the samples were determined by allozyme electrophoresis and analysed assuming that A. nemorosa shows tetraploid‐tetrasomic inheritance.

3 Genetic variation and clonal diversity were high compared with other clonal species. Most (95%) of the sampled ramets had unique multilocus genotypes with only 22 examples occurring more than once. Differences between observed and expected heterozygosities within populations were generally small to moderate. Fixation indices (mean of over 14 loci) in the populations ranged between 0.08 and 0.56 (grand mean = 0.21) confirming reports that the breeding system in A. nemorosa is predominantly outcrossing or mixed‐mating.

4 Limited historic gene flow among populations (Nm = 0.62) was reflected by high population differentiation (GST = 0.29), low genetic identities among populations and a non‐significant correlation between these identities and geographical distances.

5 Spatial autocorrelation (Moran’s I) showed no significant differences in genetic structures between populations under similar environmental conditions. Samples taken less than 0.5 m apart were genetically more closely related than to more distant samples, but similarity of genotypes decreased only slightly with further increase in distance.

6 The high levels of genetic variation found in populations of A. nemorosa are probably due to repeated seedling recruitment and the outcrossing or mixed‐mating breeding system, whereas vegetative propagation and short‐distance seed dispersal may contribute to the positive genetic autocorrelation observed at a small spatial scale.
Geographical variation in seed production, predation and abortion in Juniperus communis throughout its range in Europe
Authors: García Daniel , Zamora Regino , Gómez José M. , Jordano Pedro , Hódar José A.
Published: March 2003

1 The geographical variation of seed production, predation and abortion was analysed in Juniperus communis for 31 populations in seven distinct regions throughout the species’ distribution range in Europe, including both the northern and southern boundaries.

2 The number of seeds per cone and the number of filled seeds per cone varied significantly between geographical regions and among populations within regions. Populations from the Mediterranean mountains (south‐east Spain) showed the highest values in the number of seeds per cone but the lowest values in the number of filled seeds per cone.

3 Losses due to predispersal seed predation varied significantly among populations within a region but not between regions, suggesting that predation incidence depends on local‐scale factors. Seed abortion rates were higher in southern Iberian populations than in the other regions, and varied significantly among populations and regions. As a result of predation and abortion, seed production was lowest in the Iberian regions.

4 Seed abortion showed a significant quadratic relationship with latitude, with higher values of abortion at either end of the gradient, but particularly at the southern limit.

5 The production of filled seeds declined gradually towards both northern and southern distribution limits. In the Mediterranean mountains (southern limit), low seed production coincided with a marked limitation placed upon natural regeneration by summer drought, leading to a demographic bottleneck in populations. Although seed abortion levels were relatively high in the subarctic tundra (northern limit) populations, they were free from predispersal seed predators, suggesting that population viability here may be under less pressure.
Seven characteristics of medical evidence
Authors: Upshur Ross E. G.
Published: March 2003

This paper outlines seven essential characteristics of medical evidence and describes the implications of these for both the theory of evidence‐based medicine and clinical practice. The seven characteristics are: (1) Provisional; (2) Defeasible; (3) Emergent; (4) Incomplete; (5) Constrained; (6) Collective and (7) Asymmetric. It is argued that the epistemological theory that best fits medical evidence is that of fallibilism.
Shared decision making observed in clinical practice: visual displays of communication sequence and patterns
Authors: Elwyn Glyn , Edwards Adrian , Wensing Michel , Hibbs Richard , Wilkinson Clare , Grol Richard
Published: March 2003

The aim of the study was to examine the communication strategies of general practitioners attempting to involve patients in treatment or management decisions. This empirical data was then compared with theoretical ‘competences’ derived for ‘shared decision making’. The subjects were four general practitioners, who taped conducted consultations with the specific intent of involving patients in the decision‐making process. The consultations were transcribed, coded into skill categorizations and presented as visual display using a specifically devised sequential banding method. The empirical data from these purposively selected consultation from clinicians who are experienced in shared decision making did not match suggested theoretical frameworks. The views of patients about treatment possibilities and their preferred role in decision making were not explored. The interactions were initiated by a problem‐defining phase, statements of ‘equipoise’ consistently appeared and the portrayal of option information was often intermingled with opportunities to allow patients to question and reflect. A decision‐making stage occurred consistently after approximately 80% of the total consultation duration and arrangements were consistently made for follow‐up and review. Eight of the 10 consultations took more than 11 min – these specific consultations were characterized by significant proportions of time provided for information exchange and patient interaction. The results demonstrate that some theoretical competences are not distinguishable in practice and other stages, not previously described, such as the ‘portrayal of equipoise’, are observed. The suggested ideal of a shared decision‐making interaction will either require more time than currently allocated, or alternative strategies to enable information exchange outside the consultation.
An explanatory model of medical practice variation: a physician resource demand perspective
Authors: Long Michael J.
Published: March 2003

Practice style variation, or variation in the manner in which physicians treat patients with a similar disease condition, has been the focus of attention for many years. The research agenda is further intensified by the unrealistic assumption that by reducing variation, quality will be improved, costs will be reduced, or both. There is a wealth of literature that identifies differences in health care use of many kinds, in apparently similar communities. Attempts have been made by many scholars to identify the determinants of variation in terms of differences in the population characteristics (e.g. age, sex, insurance, etc.) and geographical characteristics (e.g. distance to provider, number of physicians, number of hospital beds, etc.). When significant differences in use rates prevail after controlling for differences in population characteristics, it is often attributed to ‘uncertainty’, or the fact that there is no consensus on what constitutes the optimum treatment process. It is suggested by this literature that the greatest variation can be found in the circumstances where there is the most ‘uncertainty’. In this work, a physician resource demand model is proposed in which it is suggested that, during the diagnosis and treatment process, physicians demand resources consistent with the clinical needs of the patients, modified by the intervening forces under which they practice. These intervening forces, or constraints, are categorized as patient agency constraints, organizational constraints and environmental constraints, which are characterized as ‘induced variation’. It is suggested that when all of the variables that constitute these constraints are identified, the remaining variance represents ‘innate variance’, or practice style differences. It is further suggested that the more completely this model is specified, the more likely area differences will be attenuated and the smaller will be the residual variance.
Clinical and economic outcomes of pneumonia in children: a longitudinal observational study in an Italian paediatric hospital
Authors: Ciommo V. Di , Russo P. , Attanasio E. , Liso G. Di , Graziani C. , Caprino L.
Published: March 2003

Rationale, aims and objectives Antibiotic prescription for acute lower respiratory infections (ALRI) in hospitalized children can have a major impact on cure and costs. We performed a longitudinal study to explore the appropriateness of prescriptions, the predictors of therapeutic patterns, and the main outcomes: readmission, length of stay (LOS) and costs. Methods Ninety‐nine children who were inpatients of a paediatric hospital receiving antibiotic treatment for community acquired ALRI were consecutively enrolled. To calculate the costs of pneumonia treatment, we collected data on clinical presentation and resources consumption. We used multiple regression analysis to identify predictors of LOS and choice of therapy, and one‐way ANOVA to evaluate cost differences among treatment groups. Results Parenteral antibiotics were administered in 64.6% of cases, whereas 35.4% received oral antibiotic therapy by itself (OAT). Switch therapy (SWT) was performed in 43.4% of cases. The most frequently prescribed antibiotic for parenteral therapy was ceftriaxone (58.3%), and for oral therapy cefprozil (58.1%). The median LOS was 3 days and the cure rate 99% (95%CI: 97–100%). SWT and OAT were significantly associated with a shorter LOS. The clinical variables were not significantly associated with SWT or OAT. The average costs per patient in the management of pneumonia were _1435. SWT or OAT were associated with significant lower costs: _1487 per patient (95%CI: 1395–1580) and _1335 per patient (95%CI: 1233–1437), respectively. Conclusions The hospital management of paediatric pneumonia was more influenced by the early discharge policy than by clinical variables without under‐cure.
Fishing gear‐induced skin ulcerations in Baltic cod, Gadus morhua L.
Authors: Mellergaard S , Bagge O
Published: March 2003

In 1982 a high prevalence of skin ulcerations was observed in Baltic cod in the vicinity of the Danish island of Bornholm. In March the prevalence varied from 6 to 13%, and in May it had increased to between 26 and 48%. The ulcerations had a sequential development. The initial stage appeared as severe skin abrasions in the area from the pectoral fin posterior to the level of the anus. The skin abrasions developed into large spots of necrotic dermal tissue with a diameter of 2–5 cm. The central part of the necrotic area sloughed off exposing a large haemorrhagic ulcer. Characteristically, most of the ulcerations on the trunk occurred bilaterally. A common histopathological finding was coagulation necrosis of the muscular tissue. The ulcerated fish were mainly 24–28 cm in length. A correlation between high concentrations of cod around Bornholm, high fishing activity in the area, length of fish escaping from the nets, combined with bilateral occurrence of the ulcers, strongly indicates that the skin ulcers were induced by the fishing gear. Features of the pathology could be linked to the temporary retention of cod in trawl meshes.
Establishment and characterization of a continuous cell line (GF‐1) derived from grouper, Epinephelus coioides (Hamilton): a cell line susceptible to grouper nervous necrosis virus (GNNV)
Authors: Chi S. C. , Hu W. W. , Lo B. J.
Published: March 2003

A new continuous cell line (GF‐1) was established and characterized. The GF‐1 cell line, derived from the fin tissue of a grouper, Epinephelus coioides (Hamilton), was maintained in L15 medium containing 5% foetal bovine serum (FBS) at 28 °C, and has been subcultured more than 160 times since 1995. The majority of GF‐1 cells are fibroblast‐like, together with some epithelioid cells. Spontaneous transformation of GF‐1 cells occurred during subculture 50 to subculture 80, and led to an increase of plating efficiency, less requirement of FBS and de novo susceptibility to grouper nervous necrosis virus (GNNV). Cytopathic effects (CPEs) could be observed in GF‐1 cells 3–5 days post‐infection with pancreatic necrosis virus (IPNV), hard clam reovirus (HCRV), eel herpes virus Formosa (EHVF) and GNNV. In addition, abundant GNNV particles were found in the cytoplasm of GNNV‐infected GF‐1 cells using electron microscopy and nucleic acids of GNNV virus were detected by polymerase chain reaction in the culture medium of GNNV‐infected cells after CPE appeared. The experimental results indicated that GF‐1 can effectively proliferate fish nodavirus and is a promising tool for studying fish nodavirus.
Ultrastructural analysis of Saprolegnia secondary zoospore cyst ornamentation from infected wild brown trout, Salmo trutta L., and river water indicates two distinct morphotypes amongst long‐spined isolates
Authors: Fregeneda Grandes J M , Fernández Dıez M , Aller Gancedo J M
Published: March 2003

Transmission electron microscopy was used to study the ornamentation of secondary cysts of 52 long‐spined Saprolegnia isolates, with and without oogonia, obtained from wild brown trout, Salmo trutta L., and water samples from various rivers in León (NW Spain). All the isolates had secondary cysts with long hooked hairs grouped in bundles, although significant individual differences were observed. There was a direct relationship between the number of bundles per cyst, the number of hairs per bundle and hair length. The isolates were classified into two morphological groups. The isolates with a higher number of bundles per cyst and bundles with a greater number and length of hairs, were included in cyst morphological Group I. The isolates with a smaller number and shorter length of these bundles and hairs were included in cyst morphological Group II. There was a relationship between the type of ornamentation of the secondary cysts and the origin of the isolates. The isolates from salmonids with saprolegniosis belonged to Group II, whereas most isolates from mucus and water belonged to Group I.
A rapid onset, post‐capture muscle necrosis in the Norway lobster, Nephrops norvegicus (L.) from the West coast of Scotland
Authors: Stentiford G D , Neil D M
Published: March 2003

A post‐capture, abdominal muscle necrosis of rapid onset has been identified in Norway lobsters, Nephrops norvegicus (L.), captured off the West coast of Scotland. Economic losses, as a result of the mortality of these animals in transport, were encountered by Scottish wholesalers during the summer and autumn of 1999. Affected animals show a characteristic whitening of individual muscle fibres and fibre bundles of the abdomen within hours of capture, with a progression towards complete opacity of the abdominal musculature within a number of days. The pathology causes a loss of the normal function of the abdomen; thus, preventing the normal ‘tail flip’ swimming. Electron microscopy failed to reveal any obvious causative agent but showed that affected tissue displayed a progressive disruption of sarcomere organization, loss of Z‐line material, condensation of myofibrils and infiltration of necrotic regions by granulocytes. SDS–PAGE of affected muscle tissue showed that there was a great reduction of most of the major contractile proteins. The condition most closely resembles idiopathic or spontaneous muscle necrosis, a pathology previously reported from both wild and cultured crustaceans. Damage to the integument in conjunction with exposure to various stressors during and immediately after capture is the most likely cause of the pathology. The rapid onset of the pathology has implications for the post‐capture handling procedure for N. norvegicus and their subsequent vivier transport to market. It may also be partially responsible for the high mortality rate of undersized N. norvegicus returned to the sea after capture and aerial emersion.
Immunostimulant effects of nucleotide isolated from yeast RNA on carp, Cyprinus carpio L.
Authors: Sakai M , Taniguchi K , Mamoto K , Ogawa H , Tabata M
Published: March 2003

Nucleotides from yeast RNA were evaluated for their ability to enhance the non‐specific immune responses in carp, Cyprinus carpio. Oral administration of nucleotides to fish daily for 3 days resulted in enhanced responses of phagocytic and nitroblue tetrazolium (NBT) activities in kidney phagocytic cells. This activation of kidney cells was observed for at least 10 days post‐treatment. The serum complement and lysozyme activities also increased in fish treated with nucleotides. Furthermore, the number of Aeromonas hydrophila in nucleotide‐treated fish significantly decreased in the blood, kidney and liver after intraperitoneal injection. Thus yeast nucleotides appear to enhance non‐specific immune responses in fish.
Acute LD50 and kidney histopathology following injection of erythromycin (Erythro‐200) and its carrier in spring chinook salmon, Oncorhynchus tshawytscha (Walbaum)
Authors: Kiryu Y , Moffitt C M
Published: March 2003

We evaluated the toxicity of commercial injectable erythromycin (Erythro‐200) and the injectable drug carrier alone (PEG‐400, ethyl alcohol and ethyl acetate) in sub‐adult spring chinook salmon, Oncorhynchus tshawytscha (Walbaum). Both compounds were toxic to salmon when administered in high dosages. The 50% lethal dose (LD50) of the erythromycin within its carrier (Erythro‐200) at 12 °C was estimated at 429 mg erythromycin kg–1 or 2.145 mL kg–1 when measured by volume. The LD50 of the drug carrier alone was 2.95 mL kg–1 by volume or equivalent to 3.21 g kg–1 of the carrier. We evaluated and scored the histopathology in kidney sections removed from fish 96 h after injection with Erythro‐200, the drug carrier alone, or sterile phosphate buffered saline (PBS) that served as a reference control. Kidneys from fish injected with saline had lowest average pathology scores; those injected with the carrier had moderate scores; and the pathology score was highest in tissues from erythromycin‐injected fish. In tests at 12 °C, vacuoles were more prominent in proximal and distal tubules of fish injected with higher dosages of 403 and 545 mg erythromycin kg–1 than in tissues from fish injected with 299 mg kg–1.